The first step toward change is awareness. The second step is acceptance.
—NATHANIEL BRANDEN
How do you help your clients learn to tune in and turn toward their bodies and, in particular, the autonomic nervous system? Befriending establishes the ability to safely feel autonomic states, identify individual aspects of each state, and activate and maintain curiosity and compassion during the process. Many of your clients live in their stories, disconnected from the body states from which those stories emerge. And as van der Kolk (2014) reminds us, “You can be fully in charge of your life only if you can acknowledge the reality of your body, in all its visceral dimensions” (p. 27).
By putting things in categories, your clients’ perception of them changes and they gain expertise in recognizing and differentiating between them (Petersen, Schroijen, Mölders, Zenker, & den Bergh, 2014). “Sensing, naming, and identifying what is going on inside is the first step to recovery” (van der Kolk, 2014, p. 68). Recognizing sympathetic mobilization and dorsal vagal immobilization as adaptive survival responses triggered by too many cues of danger and not enough cues of safety helps your clients reappraise their responses as actions in service of survival. Research shows that rethinking states of arousal as functional responses reduces the intensity of activation and supports a connection to regulating resources; thinking about physiological activation as a resource to meet a challenge brings positive outcomes (Jamieson, Nock, & Mendes, 2011). The simple act of labeling responses impacts autonomic activity and likely supports vagal function (Kanbara & Fukunaga, 2016).
When your clients learn to mindfully meet their autonomic nervous systems, bring compassion to their embodied experiences, and honor each autonomic response, they have begun to befriend the nervous system. The befriending exercises are presented in three categories: Accurate Autonomic Awareness, the Art of Befriending, and the Practice of Reconnecting. Accurate Autonomic Awareness presents one exercise to help your clients create personal archetypes of each state and a second exercise that brings ventral vagal experiences into concrete usability. The Art of Befriending offers your clients exercises to deepen the connection to their autonomic hierarchy through the use of art, writing, and movement. The final section, the Practice of Reconnecting, offers four exercises to explore the range of responses possible within each autonomic state.
Before your clients can explore new ways to regulate, they first need to recognize their autonomic state. The ability to regulate is dependent on how accurately incoming information is interpreted. Being able to correctly identify autonomic states is the necessary first step in the process of shaping the system in a new way.
Autonomic Landmarks—Stories of Landmark Moments
This exercise is a good way to introduce clients to recognizing autonomic responses by focusing on key experiences. Clients can write their experiences in their journal and share them with you during a future session.
BACKGROUND
Landmarks give structure to our environments, forming cognitive anchors, marking points of orientation, and becoming references for communication. Autonomic landmarks are the internal reference points that mark the experience of states. We have personal landmarks that represent the embodied experience of a state and are stored in our memory. This is a moment that stands out from all the others, a moment you can look back on as a defining experience of an autonomic response. Identifying the landmark moment for each state is a way to quickly bring the properties that personify the state to mind.
STEPS
1. What are the stories of your dorsal vagal (collapse or shutdown), sympathetic (fight or flight), and ventral vagal (safe and connected) landmark moments? To make it easier to think about your states, you can give them descriptive names in addition to the physiological ones. Take time to look back and locate the moments in your memory. Find the times that stand out and become the archetype for each state.
2. Landmarks are recognizable by their names and characteristics. Write a story describing the landmark moment. Make sure to identify the concrete details of what happened, how you responded, what your body felt like, and what you thought.
3. When you are done, read through the story and identify the crucial moment. Use this to give the story a name.
TIPS
Identifying clients’ key autonomic moments and giving them a name can create useful anchors to use during therapy sessions as you explore your clients’ experiences. Your clients may benefit from examples of stories to get a feel for the experiences to explore (the autonomic hierarchy from dorsal vagal to sympathetic to ventral vagal) and the level of detail for their descriptions. You can provide your own examples or use the following ones.
Dorsal Vagal Bowl-Shattering Moment: In my commitment to eating in a healthier way, I took time to make a salad for lunch. I used the special bowl that I brought back from France and enjoyed cutting up and layering vegetables making a lunch that was nutritious and looked inviting. As I walked out of the kitchen, my arm caught on the counter and I dropped the bowl. It shattered, spreading vegetables and pieces of pottery across the floor. I stood there unable to move, just staring at the mess, and then walked to the living room and sat down on the couch. It felt like an overwhelming disaster, not a dropped bowl of salad, and I went into a full collapse. I sat and stared and felt numb. The only thing I could say was “I’m done”—without even knowing what that meant. It took 15 minutes to begin to feel the stirring of enough energy to clean the kitchen floor. Lunch was a thing of the past and my attention was now focused on simply putting one foot in front of the other. While the intensity of collapse I experienced in response to the accident made no sense in isolation, in a larger context it was the last straw for my nervous system that couldn’t keep up with the overwhelming demands of daily living. This “bowl-shattering moment” is for me the epitome of a dorsal vagal experience.
Sympathetic Jack-in-the-Box: I learned growing up that it was safer to be seen and not heard—ever. I’ve worked hard to find my voice as a grown-up, and now, instead of the shutdown experience of my childhood, when I feel someone is minimizing my experience, I’m immediately mobilized to fight. I’m like a Jack-in-the-Box—coiled tight and ready to spring. I feel the lever turning and then I pop. The moment that sticks in my mind is a phone call with my brother during the holidays. I had been estranged from my sister for some time and my brother made an innocent comment about holidays and families being together and POP! I stopped hearing what he said, hung up on him, and threw the phone. When I regained enough regulation to look back on that moment, I knew it wasn’t what my brother said, it was that my rupture with my sister was unacknowledged and my experience dismissed.
Ventral Vagal Wise Woman: I was on a 2-week meditation retreat struggling with doubt, fear, self-criticism, and boredom—all the kinds of feelings that find their way into awareness when you sit silently for hours a day. One day, when I was sitting with tremendous sadness, I saw the image of an old woman silently sitting in a warm, dark room, next to an enormous, glowing, pulsing shape that I knew was my own heart. In that moment I knew there was nothing in the world that would stop her from sitting next to that heart. Her presence was unconditional. Her warmth and regard unchangeable. She was sitting with my heart. The tremendous sadness I was feeling didn’t go away, but it was somehow eased and seen in such a way that I wasn’t burdened by it anymore. For me, in that moment, being with became the essence of the ventral vagal state.
Encourage your clients to explore the details of their experiences. If they have trouble getting in touch with a state, talk with them about some of their memories. Have them write a few words, short phrases, or sentences to begin their landmark story. They can then take their beginning story home and continue the work on their own. You can return to this exercise the following week(s) and revisit it later in the therapy process to expand your clients’ stories and understanding.
Ventral Vagal Anchors—Anchoring in Safety
This exercise helps your clients identify the experiences that anchor them in a ventral vagal state, using the categories of who, what, where, and when. Invite your clients to work on this at home and share their anchors with you during a session. This is an exercise to return to as your clients add ventral vagal anchors and update their lists.
BACKGROUND
The Merriam-Webster dictionary defines an anchor as “something that serves to hold an object firmly; a reliable support.” A ventral vagal anchor holds the connection to the energy of your ventral vagal system when experiences threaten to pull you into a sympathetic or dorsal vagal state. Your ventral vagal anchors help you find the way back to regulation and stay there. These are autonomic cues of safety that can be found in the categories of who, what, where, and when. You can use your anchors by reconnecting to the anchor or by activating the memory of the anchor. With regular practice, ventral vagal anchors strengthen your capacity to return to regulation.
STEPS
1. Who. Reflect on the people in your life and make a list of the ones who bring you a feeling of being safe and welcome. You might also have a pet who fills that role. First identify a person or pet who is present in your life. Then, if you wish, you can expand your search to also include people who are no longer living, people you haven’t met but who bring your ventral vagal state alive, and spiritual figures.
2. What. Think about what you do that brings your ventral vagal state alive. Look for small actions that feel nourishing and inviting of connection. Keep track of the things that bring moments, or micro-moments, of ventral vagal regulation.
3. Where. Take a tour of your world and find the physical places that bring you cues of safety. Look around your home, your neighborhood, your community, your workplace, a place you feel a spiritual connection. Bring to mind the everyday places you move through. Take note of the environments and name the ones that activate your ventral vagal state.
4. When. Identify the moments in time when you feel anchored in your ventral vagal energy. Take a moment to go back and revisit those experiences. Bring them into conscious awareness and write them down.
5. Create a portfolio of your ventral vagal anchors. Decide how you want to gather your anchors together in one place: write them in a notebook, illustrate them in a journal, make a list and hang it in a prominent place, write on sticky notes and put them around your home and at work in places that are easy to see. Experiment and find the way that works for you, making sure you have easy access to your anchors.
TIPS
You might share your own anchors to prompt your clients, or they may readily identify anchors on their own. The following are some examples of anchors in each category that can be used to start the exploration.
Who: Sometimes one person is identified as an overarching anchor.
•My old friend from childhood is my anchor. I have been sharing stories with her for almost 60 years and know I can count on her to be there no matter what I need.
•At other times different people are identified as anchors for specific kinds of moments.
–I have someone who is my “happy moments” anchor, someone who is my “angry moments” anchor, and someone who is my “lonely moments” anchor.
–I have a person who is an anchor in my professional world and another person who is a personal anchor.
What:
•My walk to work, checking my horoscope, looking out the window, holding my lucky stone, watering my plants
Where:
•By the ocean, at my local coffee shop, under my favorite tree, in my car, at my friend’s house, in the kitchen, in the garden
When
•The very early hours of the morning, climbing into bed at the end of the day, Sunday afternoon, in the evening when the kids are asleep, leaving work and heading home
Just as the ancient Greek philosopher Epictetus wisely recommended that we not moor a ship with one anchor, having a variety of ventral vagal anchors to choose from makes it easier to find an anchor to hold onto when needed. During the course of therapy, you’ve probably heard your clients identify anchors (although not named in that way), and they can bring their awareness to those. Many clients begin by finding one anchor in each category and add more as time goes on. Because trauma often happens in relationships, the who category can be the most challenging for your clients. In the beginning, they may not have safe, regulated people in their lives and may identify you as the person who is their ventral vagal anchor.
THE ART OF BEFRIENDING—AN ILLUSTRATED HIERARCHY
The autonomic hierarchy can be visualized in many ways. The autonomic ladder presented in The Polyvagal Theory in Therapy (Dana, 2018) is one way that has proven to be easy to understand and use.
Art, writing, and movement are other options for your clients to get to know the autonomic hierarchy. Art is a means of self-expression and communication that supports experiencing emotions in a safe way (McPherson, Barrett, Lopez-Gonzalez, Jiradejvong, & Limb, 2016). Making visual art has been shown to have an impact on resilience (Bolwerk, Mack-Andrick, Lang, Dörfler, & Maihöfner, 2014) and is a way to explore, understand, and express experiences that may be difficult to put into words (Stuckey & Nobel, 2010). Writing brings together cognition, emotions, and biology and offers a new way of understanding experiences of self (Pennebaker, 2018) while movement has been shown to support self-awareness (Stuckey & Nobel, 2010). Once your clients have a feel for the states of the autonomic nervous system, the ways to illustrate the hierarchy are unlimited.
This exercise uses a simple vertical line to represent the hierarchy. Clients explore a variety of design options and a range of ways to illustrate their personal experiences of moving between states. Invite your clients to work on these at home and bring their completed designs to sessions.
BACKGROUND
With the ability to name your states and recognize the shifts that happen between states, you can represent your experience of moving along the hierarchy. Portraying these movements in different ways expands that connection. As you engage in the process of designing hierarchies, you are engaging in an act of befriending.
STEPS
1. Draw a vertical line, divide it in thirds, and mark the three states (ventral, sympathetic, dorsal, or the words you choose to name your states).
2. Imagine moving along that line and feel the autonomic state shifts.
3. Illustrate the small increments of change that happen as you travel down and up the hierarchy using:
•color to represent your states and transitions from state to state, blending shades to illustrate the full range of the autonomic hierarchy
•words to label the continuum of your experience from dorsal through sympathetic to ventral
•photos of faces to show the many ways your states are expressed
•images of animals to represent states
•pictures of places that bring the points along the continuum to life
•nature scenes that portray the many stops you make along the hierarchy
•names of songs that carry the energy of states
4. Create a few illustrated hierarchies to get a sense of how different designs work for you. See if you resonate with one particular way of representing the hierarchy or if you connect with several different styles.
5. Choose one or more hierarchies and create an ongoing practice of using it (or them) to find your place and name your state.
TIPS
Encourage your clients to create their first hierarchy using the style they feel most comfortable with and then experiment with other designs. Have them share their completed hierarchies in session. Discuss how they connect with each and compare their autonomic experiences.
This exercise is a multifaceted way to help clients safely create connection to their autonomic states. Three modalities—art, writing, movement—are used to help clients come into connection with their regulated and reactive responses in new ways. Clients can create variations at home and share their different autonomic expressions in sessions.
BACKGROUND
A tree is a commonly used metaphor. The tree of life is often used to illustrate both evolutionionary processes and patterns of relationships. Using a tree metaphor, you can investigate your autonomic experiences: with trees representing regulated responses and ones representing reactive systems. There are many ways to dive into discovering the qualities of autonomic trees, and each brings its own pathways to befriending the embodied experience of your autonomic nervous system.
Art: Making art is a safe way to explore autonomic states. Creating images of regulated and reactive trees invites you to bring your autonomic states to life and befriend them through color and design.
Writing: Sitting down to write the stories of regulated and reactive autonomic trees requires a stance of curiosity that lends itself to befriending.
Movement: Imagined or enacted movement is a way to feel the rhythms of your regulated and reactive trees. Autonomic trees can feel as if they are stomping and swaying, their trunks bending or twisting, their branches reaching up and out, and their spring buds emerging or autumn leaves falling.
STEPS FOR AUTONOMIC TREE ART:
1. Set up your creative space. Gather various-sized papers and other art materials.
2. There are thousands of species of trees, many living only in one specific place in the world. Your regulated and reactive trees live in your personal world and have their own unique characteristics. Visualize their roots, branches, and leaves. See their forms, shapes, and colors.
3. Create your trees. You might design one tree that illustrates all three states, one regulated and one reactive tree, or a family of regulated and reactive trees (Figure 4.1).
FIGURE 4.1. Autonomic Tree by David Keevil; Autonomic Tree by Rebecca Gerbig
4. Reflect on your designs. What autonomic experiences do they represent?
5. Periodically return to your trees and connect to your personal tree kingdom.
TIPS
Clients’ art trees are useful tools to explore ventral, sympathetic, and dorsal states. Because the images can be brought to life quickly, they become easy reference points to use in sessions.
STEPS FOR WRITING TREE STORIES
1. If you have created your tree maps, you can use those as an entry point for listening. Otherwise, bring your regulated and reactive trees to life by focusing on an internal image.
2. Use the following prompts to begin to write a story for each of your trees:
•The (roots, trunk, branches) of my tree bring . . .
•When I sit under my tree, I . . .
•When I put my arms around my tree, I . . .
•When I listen to my tree, I hear . . .
3. Read your story and add any other information you want to complete it.
4. Give your story a title.
TIPS
Similar to art trees, clients can create tree stories for more than one regulated and reactive state. Have your clients share their tree stories with you. Get to know the particular words that are meaningful for each client as they describe their experiences of being with each tree. The act of reading a story and having a story read to you evokes different experiences. Invite your clients to read their tree stories to you and also read their tree stories to them. Explore what happens when they speak and hear their stories.
STEPS FOR MOVING TREES
1. Visualize your tree and feel its movement inside your body.
2. Either see the movement in your mind’s eye or let the movement come into physical expression. Choose the way that brings a neuroception of safety.
3. Explore the ways your tree moves. Ventral vagal regulation is experienced in many different ways along the continuum of stillness to joy-filled passion. Reactivity includes both the intensity of sympathetic mobilization with fight and flight and the absence of energy in dorsal vagal disappearance, disconnection, and collapse.
4. Repeat the process with all of your trees.
5. Build an ongoing practice of moving with your trees.
TIPS
Regulated and reactive trees have a multitude of movements. Just as living trees are impacted by daily weather and changing seasons, the shifts in your client’s autonomic weather affect their embodied trees and can be seen in the changing movements.
A common posttraumatic response is a sense of disconnection from the body. Since 80% of the information from the vagus is sent through afferent pathways from the body to the brain, learning to turn toward and listen in to what the autonomic nervous system is communicating is an important part of befriending.
Safe embodiment is a challenge for many clients, so introduce this exercise and experiment with it during a session where you are there to be a co-regulating presence. Once safety with this way of listening has been established, your clients can continue the practice at home.
BACKGROUND
With an ability to safely connect to your autonomic states and bring that embodied experience into explicit awareness, you have access to the important autonomic information that is guiding your daily experience.
STEPS
1. Find the place in your body where you feel most connected to your ventral vagal state. Bring the qualities of that experience into explicit awareness and add language to describe it.
2. Find the place in your body where you feel most connected to your sympathetic state. Bring the qualities of that experience into explicit awareness and add language to describe it.
3. Find the place in your body where you feel most connected to your dorsal vagal state. Bring the qualities of that experience into explicit awareness and add language to describe it.
4. Connect to the three places in your body where you identified feeling each state most fully. Move from one place to another. Feel the ways your experience changes as you shift your focus.
5. Connect to your ventral vagal state of safety and connection. Tune in to how this is expressed in your body. Identify the qualities of your breath, muscle tone, and posture. Track the flow of energy throughout your body and notice any movements connected with this state.
6. Move to your sympathetic nervous system and consider the activation of the mobilizing energy of fight and flight. Tune in to how this is expressed in your body. Identify the qualities of your breath, muscle tone, and posture. Track the flow of energy throughout your body and notice any movements associated with this state.
7. Move to your dorsal vagal state and consider the ways collapse and shutdown are experienced. Tune in to how this state is expressed in your body. Identify the qualities of your breath, muscle tone, and posture. Track the flow of energy throughout your body and notice any movements associated with this state.
8. Move from state to state and notice the changes that happen. Become familiar with the ways your body moves through states.
TIPS
Bringing safe awareness to the embodied experiences of states is more challenging than working with cognitive awareness. This is an exercise where small and often is an important guideline. Support your clients in listening for small moments to make connecting to this autonomic information a natural, uncomplicated, and ordinary practice.
The Continuum Between Survival and Social Engagement
This exercise brings explicit awareness to the experience of being safe and engaged or disconnected and in danger. Since this is often experienced as an either/or event, the use of a continuum helps identify the subtle autonomic shifts that happen between the two opposite ends of experience.
BACKGROUND
Between the two ends of autonomic responses, there are many points along the way. Some bring a nuanced experience of an autonomic shift while other points are where you make a bigger step from one state to another. Using a continuum is a way for you to map the progression of small steps that connect two opposite end points. To create this continuum, bring focused attention to the particular ways you move between protection and connection.
STEPS
1. Draw a horizontal line and name the two ends of your continuum. What is your label for engagement? What is your label for disconnection?
2. Start at either end. Identify the first small step out of that state toward the other end. Repeat this, marking small steps along the way until you reach the other end.
3. Mark the midpoint where you feel the larger shift from connection to protection. The midpoint is a good way to identify this moment of change.
4. Remember you are always moving along this continuum, sometimes firmly planted in one place and other times pulled from one end to the other. Stop and see where you are. Use the midpoint to first see if you are on the side of protection or closer to the state of connection. Then identify more precisely where you are on your range of responses.
5. Return to your continuum and practice placing yourself on it until it becomes second nature for you to know where you are and in which direction your autonomic nervous system is taking you.
FIGURE 4.2. Between Protection and Connection Continuum and Example
TIPS
By using the continuum illustrated in Figure 4.2, your clients learn to see the flow of experience and move away from thinking in all-or-nothing terms. They create skill in feeling the nuanced shifts that lead to large scale changes. Once your clients have worked with this continuum, this becomes a useful template to create other continuums. Just identify a particular experience, name the two ends, find the midpoint, and then fill in the steps that lead from one end to the other.
This exercise is a way for clients to identify their personal experiences of the ebb and flow of social engagement that happens within the ventral vagal state. With the social engagement scale, clients are able to track the level of participation that is resourcing in the moment.
BACKGROUND
Rather than a straightforward on or off mode, the social engagement system can be online and bring a range of responses. Sometimes you may feel a pull to enter into conversations and at other times feel a deep contentment in sitting back and listening. One moment you may be moving in synchrony with another person, while the next brings the joy of being an observer. Between the two ends of engagement there are a variety of experiences. In addition to the expected everyday fluctuations, the capacity for social engagement is impacted by illness and wellness. In a state of illness, the social engagement system retracts, responding to the physiological demand to attend to internal conditions. In a state of wellness, the social engagement system is at work in the external environment, seeking and signaling readiness for connection.
STEPS
1. Use the scale to fill in your personal experience of the points between “open and engaged” and “internal and engaged.” Start by naming each end and then label the points between.
2. Consider where you are right now. Stop and find your place on your scale.
3. Reflect on recent experiences and see where you were on your scale.
4. Look at when your place on the scale fits with the environmental and relational demands of the moment and when there is a mismatch.
5. Recognize any patterns to your placement on the scale. Look for people, places, and experiences that predictably take you to a certain point along the scale. Become curious about the characteristics of those interactions that activate that response. Get to know your personal social engagement profile.
FIGURE 4.3. Social Engagement Scale and Example
TIPS
Clients often assume they are in a protective response and move into self-criticism when they are in fact nearer the “internal and engaged” end of the Social Engagement Scale. Help your clients understand the range of responses that are still within the state of ventral vagal safety. Using the scale shown in Figure 4.3, your clients can begin to bring curiosity and self-compassion to their personal patterns of engagement.
This exercise brings the implicit experience of neuroception into explicit awareness where it can be used to understand activation of autonomic states. Neuroception is working in the background below the level of awareness. Bringing perception to this flow of information is a foundational skill. This is a good exercise to introduce to clients early in the therapy process.
BACKGROUND
Neuroception, the messages the autonomic nervous system receives and records from inside your body, in the environment around you, and between you and other people, provides a valuable stream of information when brought to conscious awareness. When you bring perception to neuroception, you can find reminders of ventral vagal possibilities and identify moments of messiness and distress. Keeping a neuroception notebook is one way to bring explicit awareness to the ways the autonomic nervous system is working in the background shaping your life.
STEPS
1. Divide a notebook in sections for the three categories of neuroception: ventral vagal safety, sympathetic danger, and dorsal vagal life-threat. Use your own words to name the sections.
2. Carry the notebook with you and write in it as you feel your state shifting. Or create time at the end of the day to look back and reflect on your experiences.
3. Look for the specific cues that activated your state changes. Write down the cues of safety, danger, or life-threat you have identified.
4. Find any predictable patterns in the cues that move you toward connection or into protection.
TIPS
Tracking neuroception is an important skill. Introduce the neuroception notebook exercise in a session and then use it during the session. Stop several times to ask your clients to identify their neuroceptive experiences. With this practice, clients begin to bring explicit awareness to their implicit experiences. Have your clients continue to use their notebooks to track experiences and routinely bring their notebooks to therapy to share with you what they are learning. Things that bring a neuroception of safety become resources while things that bring a neuroception of unsafety (sympathetic or dorsal vagal) often become a focus of therapy.
CHAPTER 4 SUMMARY
Know thyself.
—INSCRIPTION AT THE TEMPLE OF APOLLO AT DELPHI
The practice of recognizing autonomic states is a neural exercise and a step in the process of creating a more resilient system (Sullivan et al., 2018). As a physiological system, the autonomic nervous system doesn’t attach moral meaning to states and state changes; it simply acts in service of survival. Through the skills of befriending, your clients learn to nonjudgmentally recognize the connecting and protecting actions of their autonomic nervous systems and bring curiosity to the patterns that have been created. The exercises presented in this chapter offer a guide to recognizing the full range of autonomic states. With ongoing practice, your clients build a habit of connecting with compassion. When you help your clients create a pattern of tuning in and turning toward without self-criticism, they build the important habit of befriending.