The body will reorganize when it feels safe.
—STEPHEN PORGES
Everyday living is a complex experience of autonomic navigation. Trauma, which might be thought of as “what happens to a person where there is either too much too soon, too much for too long, or not enough for too long” (Duros & Crowley, 2014, p. 238), creates an autonomic demand that shapes the system away from connection toward protection. The autonomic nervous system responds moment to moment to what are often competing needs to survive and to be social. In a state of protection, survival is the only goal. The system is closed to connection and change. In a state of connection, health, growth, and restoration are possible.
IN SERVICE OF SURVIVAL
Clients are faced with the dilemma of balancing the drive to survive with the longing to connect. The responses that were necessary and adaptive for survival in the past bring suffering in the present. Trauma stories are held in autonomic pathways that are tuned to a low threshold–high intensity pattern of responding. A question to ask when your client feels the rise of an adaptive survival response is, “Does this autonomic shift feel familiar?” The activation in the present moment often leads them back to the autonomic origin in their past.
The autonomic nervous system learns through experience. Even before birth, this system is taking in and responding to the environment. Prenatal exposure to a variety of adverse experiences including socioeconomic hardship, inadequate social support, and the use of substances influences the baby’s autonomic function (Alkon et al., 2014; Fifer, Fingers, Youngman, Gomez-Gribben, & Myers, 2009; Hambleton et al., 2013). Maternal mood is transmitted, with anxiety and depression impacting the developing baby’s level of activity and heart rate (Kinsella & Monk, 2009). First in the womb and then in the family, early experiences influence the autonomic nervous system, creating habitual response patterns. Through repeated experiences of co-created regulation, the intimate interactions between mother and baby shape the baby’s system (Ostlund, Measelle, Laurent, Conradt, & Ablow, 2017). Mother and child “sharing at the autonomic level” create the experience of attunement (Manini et al., 2013, p. 2). Held in a relationship with a responsive caregiver, the dyadic dance of connection, falling out of connection, and a return to connection, creates the foundation for a regulated nervous system. With a reliably regulated and regulating person, rhythms of reciprocity build experiences of safety in connection. When family dynamics are based in experiences of autonomic misattunement, there is little chance for experiences of repair. When the adults in a family carry their own patterns of dysregulation, habitually triggered into states of protection and unable to return to regulation and offer the safety of connection, the child’s autonomic nervous system responds by creating its own patterns of protection. “Without the experience of an organizing other, the nervous system is stunned” (Fisher, 2014). Without intervention, a legacy of dysregulated autonomic organization is passed from one generation to the next.
Trauma survivors often suffer from unpredictable, rapid, intense, and prolonged states of dysregulation. This autonomic imbalance and lack of flexibility leads to health problems. Physical problems include impaired immune function, digestive problems, respiratory problems, diabetes, increased risk of heart disease, stroke, and chronic fatigue (Andersson & Tracey, 2012; Dorrance & Fink, 2015; Mazur, Furgała, Jabłoński, Mach, & Thor, 2012; Merz, Elboudwarej, & Mehta, 2015; Thayer & Sternberg, 2006; Vaillancourt et al., 2017; Van Cauwenbergh et al., 2014). In addition to physiology, psychology is impacted. Social isolation and loneliness, a vigilance for angry faces, distraction from tasks, inability to discern meaningful cues from trivial ones, and increased depression and anxiety are some of the consequences of an out-of-balance autonomic nervous system (Grippo, Lamb, Carter, & Porges, 2007; Hawkley & Cacioppo, 2010).
The hopeful news for you and your clients is that since the autonomic nervous system learns from experience, ongoing experiences can reshape the system. Habitual response patterns can be interrupted and new patterns can be created. Autonomic flexibility is a hard-won outcome of therapy as you help your clients discover their autonomic vulnerabilities and together look toward resourcing autonomic resilience.
THE EVOLUTIONARY HIERARCHY
As illustrated in Figure 1.1, the autonomic nervous system is made up of two branches (parasympathetic and sympathetic) and, with the division of the parasympathetic system, three distinct pathways, each working in service of survival. As each new pathway emerged, the older one was retained, continuing to bring its unique survival response (Porges, 2006). When you follow the evolution of the three pathways of the autonomic nervous system, you see the autonomic hierarchy, the first organizing principle of Polyvagal Theory, and find the emergent properties and adaptive strategies for each of the three autonomic states.
FIGURE 1.1. The Shape of the Autonomic Nervous System: Two branches–Three pathways
Imagine the autonomic nervous system as a nested system. Over the course of evolution, what began as a single dorsal vagal system of immobilization that our reptilian ancestors used for survival was added onto first with the sympathetic system of mobilization and options for fight and flight and then with the ventral vagal system of social communication and connection. As each new system was built and the older system retained, the autonomic hierarchy emerged (Figure 1.2).
The earliest dorsal vagal system runs in the background, regulating organs below the diaphragm, including the digestive system. The sympathetic nervous system, next to arrive, works to circulate blood, shape normal heart rhythms, regulate body temperature, respond to changes in posture, and provide energy to the system to support passion and play. The most recent system, the ventral vagal system, brings the ability for connection and social engagement. The ventral vagus is tasked with overseeing the autonomic nervous system, metaphorically holding the sympathetic and dorsal vagal systems in a warm embrace. When the newest autonomic pathway is directing the system, healthy homeostasis is the result.
FIGURE 1.2. Nested Evolutionary Relation of Three Pathways
The vagus nerve is the major component of the parasympathetic branch of the autonomic nervous system. Not a single nerve, the vagus is actually a “family of neural pathways” that wander (vagus means wanderer in Latin) throughout the body (Porges, 2011, p. 27). Beginning in the brainstem, the dorsal vagus primarily influences organs below the diaphragm and the ventral vagus mainly affects organs above the diaphragm. Through the dorsal and ventral vagal pathways, messages are sent in two directions. Sensory information travels from the body to the brain and motor information returns from the brain to the body, making this a rich, bidirectional information highway. The two vagal pathways represent either end of the evolutionary history of the autonomic nervous system. The oldest dorsal vagal (our reptilian ancestors) and the newest ventral vagal (uniquely mammalian) are at opposite ends of the continuum of response from dorsal vagal immobilization and disconnection to ventral vagal social engagement. This is reflected in the maturation of these pathways in a developing baby. Autonomic function develops over the course of pregnancy, dorsal vagal and sympathetic systems emerging first and the ventral vagus myelinating during the last trimester of pregnancy and over the first year of life (Fukushima, Nakai, Kanasugi, Terata, & Sugiyama, 2011; Porges & Furman, 2011).
Activity of the ventral vagus, often referred to as vagal tone, can be measured through heart rate variability. While heart rate measures the number of beats per minute, heart rate variability measures the variation in time between heartbeats. A high level of variability indicates the ventral vagus is active and results in a flexible autonomic nervous system and the ability to adjust to the demands of daily living (Laborde, Mosely, & Thayer, 2017). In recent years heart rate variability measurement has moved beyond laboratories and expensive ECGs to the general public with widely available, low-cost, user-friendly devices that can be worn during daily activities (Georgiou et al., 2018). There is increasing understanding about the impact of the autonomic nervous system on well-being and the need to attend to ventral vagal pathways.
Where sympathetic and dorsal vagal states activate an either/or experience constricting the ability to see beyond limited options, the ventral vagal state at the top of the hierarchy brings alive the expansive world of both/and that is filled with possibilities and choices. The ventral vagal experience is one of being a part of the world, connected to self, able to reach out to others, open to change and willing to look at possibilities. Here, solitude and social connection, excitement and rest, joy and sadness, and frustration and flow are found. The glue for the diverse ventral vagal experiences is a sense of safety.
MINI EXERCISE
– Is there an experience of ventral vagal energy that comes to mind?
– By yourself? With others?
Philosophers and poets have long memorialized the face as the mirror to the soul. What is felt in the heart can be seen in the face. As the autonomic nervous system evolved and the ventral vagus emerged at the top of the hierarchy, the roots of five cranial nerves (trigeminal, facial, glossopharyngeal, accessory, and vagal) came together in the brainstem to create an integrated social engagement system. The ventral vagal pathway from the heart connected with pathways that control muscles of the face and head, regulating how you see, hear, speak, express emotions with your face, and turn and tilt your head, forming a “face-heart” connection (Porges, 2003). This social engagement system is both a sending system and a receiving system, constantly uploading and downloading information about connection. You are continuously posting information about yourself and gathering information about others. Each individual element of the social engagement system sends signals either inviting or discouraging connection and at the same time tunes into other social engagement systems looking for signs of warning or welcome.
Imagine the social engagement system as your autonomic safety circuit. Your eyes send signals of safety and look into other eyes for signs of welcome. Your ears tune in to conversations, listening for the sounds of friendship while your voice broadcasts the meaning underneath your words. Your shoulders move, your head turns and tilts, sending signals that you are safe to approach. When you encounter looks, sounds, and gestures that invite connection, you move closer. Meeting looks, sounds, and gestures that send signals of unsafety, you move into watchfulness. The social engagement system, with its exquisite ability to sense moment-to-moment actions in other systems, filters the stream of cues inherent in social interactions and responds by welcoming or discouraging physical proximity and social engagement (Porges & Furman, 2011).
MOVING DOWN THE HIERARCHY
Events are sometimes beyond the capacity of the ventral vagus to regulate the system. Illness and traumatic events predictably tax the system, but everyday experiences can also trigger dysregulation. Feeling alone, having too many responsibilities in a day, working in a challenging environment, and being in a distressed relationship are just some of the experiences that can overwhelm the ventral vagal system.
MINI EXERCISE
– What are some of the ordinary difficulties that predictably overwhelm your system?
– Is there an extraordinary distress that is too great a challenge for your system?
Following the predictable path of the autonomic hierarchy, when your ventral vagal capacity is depleted, you move one step down the hierarchy and enter the energy of the sympathetic nervous system and the experiences of fight and flight. This survival response is fueled by adrenaline and cortisol. Here you are a system in motion, or more accurately a system in commotion. Flooded with mobilizing energy, you no longer look for connection; you are now focused simply on survival. The body moves into action while the ability for complex, flexible reasoning is impacted (Maran et al., 2017).
MINI EXERCISE
– What does mobilization look like for you?
– Where does mobilization take you?
– Into fight? Into flight?
It is when mobilization doesn’t bring a resolution to the distress that the autonomic nervous system takes the final step down the hierarchy collapsing into dorsal vagal lifelessness. Sometimes called the primitive vagus, the dorsal vagal response takes the entire system offline and into conservation mode. The dorsal vagal experience is a response to what seems inescapable. The autonomic nervous system creatively finds a way out through numbing, disconnection, and dissociation. From a dorsal vagal state, it is difficult to find the way back to ventral vagal connection. In the beginning move out of dorsal vagal collapse, there is a moment of mobilization from the sympathetic nervous system. If not regulated, this necessary infusion of energy elicits the more typical sympathetic actions of fight and flight. Without a regulating influence (internal resourcing, connection with another person, an organized way to use the energy) the onset of mobilization is too much. Rather than moving through action into ventral vagal connection, there is a return to dorsal vagal shutdown.
MINI EXERCISE
– Is the experience of dorsal vagal shutdown familiar to you?
– How does the sense of disconnection happen for you?
MEETING THE DEMANDS OF THE DAY
The ability to return to regulation is the essence of resilience. When you establish and resource pathways to ventral vagal regulation, you recover your innate abilities for resilience. The ventral vagus connects with the heart’s pacemaker—the sinoatrial node—that regulates the rhythms of the heart. This pathway has been named the vagal brake because it describes the actions of the ventral vagus to slow down or speed up the heart, supporting a flexible response to the challenges of everyday living (Porges, 2017a). A well-functioning vagal brake brings the ability to rapidly engage and disengage, energize and calm, and experience ease in making these transitions. With a flexible vagal brake, you can reflect and respond rather than react. (See Chapter 7 for a full description and a vagal brake exercise.)
In describing five stages of neuroplastic healing, Norman Doidge (2015) identifies the influence of the autonomic nervous system on neuromodulation and restoring the balance in a busy brain. With the ventral vagal system overseeing sympathetic and dorsal vagal responses, the brain quiets and there is a powerful healing effect. Doidge says the state of parasympathetic rest and repair “ . . . also recharges the mitochondria, the power sources inside the cells . . . reenergizing them” (p. 111). The ventral vagal system truly powers the journey to well-being.
The natural healing force within each one of us is the greatest force in getting well.
—HIPPOCRATES
MINI EXERCISE
Use the following prompts to consider your autonomic nervous system. Spend a few moments exploring this important and often unacknowledged relationship.
– My autonomic nervous system is . . .
– When I think about my autonomic nervous system I . . .
– I’m grateful to my autonomic nervous system for . . .
– I wish my autonomic nervous system would . . .