The whole is greater than the sum of its parts.
—ARISTOTLE
Integration is a process of establishing new autonomic rhythms. Living creatures are amazingly flexible in adapting to the environment and, in fact, change some of their physiological characteristics in order to survive. Fascinating research shows that the tiny water flea grows a helmet or spikes in response to cues of danger from predators in the environment (Reger, Lind, Robinson, & Beckerman, 2017). Although humans may not grow actual helmets or spikes, experiences leave an autonomic imprint and over time create autonomic habits. “Our nervous system grows to the modes in which it has been exercised” (Blanco, 2014, p. 1). If your clients’ autonomic patterns were created in an environment of unsafety, they often still move through life in ways that were once adaptive and are now limiting. When your clients predictably experience cues of safety and bring them into explicit awareness, they can shape their response patterns to match the new environment. With practice, an integration process unfolds and repeatedly activated states become new embodied traits (Siegel, 2007).
When autonomic patterns begin to change, your clients find themselves in the unfamiliar experience of being between—not held in old patterns and not yet predictably in new ones. They may feel untethered, ungrounded, unsure of how to engage with others or how to move through daily living experiences. Attending to the beginnings of change and wiring in new neural expectations is an essential part of the integration process.
The integration process takes the small shifts that are the essence of autonomic shaping, brings implicit experiences into explicit awareness, and utilizes the emergent properties of the new patterns to create a new story. There is a gap between intention and action and adding an implementation intention increases the likelihood that your clients will reach their goals (Achtziger, Gollwitzer & Sheeran, 2008; Gollwitzer & Sheeran, 2006; Milne, Orbell, & Sheeran, 2002). When your clients use an implementation intention, they keep moving toward their goals even when they are feeling the high levels of cortisol and increased heart rate that are signs of a sympathetically dysregulated state (Wieber, Thürmer, & Gollwitzer, 2015). The first section, A New Rhythm of Regulation, offers a series of five exercises that help your clients use autonomic awareness to identify and implement goals.
The second section focuses on resilience. Resilience emerges when, either in perception or in reality, there are more resources than stressors (Ruini, Offidani, & Vescovelli, 2015). Autonomic overload occurs when an environment is filled with frequent cues of danger, when the autonomic nervous system can’t adjust to the needs of the moment, or when a survival response keeps going long after it should turn off. Resilience emerges when your clients can accurately detect and effectively respond to cues of safety and danger. Resilience is teachable, learnable, recoverable, and takes practice and awareness (Graham, 2018). The second section, Resilience, offers two exercises to build resilience; Engaging the Vagal Brake and Building Resilience Routines. The capacity to manage distress and keep a healthy balance of resources to stressors relies on the actions of the vagal brake. The vagal brake exercise brings the biology of this ventral vagal circuit into useful form through metaphor. The second exercise gives your clients a way to create a personalized plan to build resilience by choosing actions that resource the capacities of their vagal brake and bring a flow of ventral vagal energy.
Let us not look back in anger, nor forward in fear, but around in awareness.
—JAMES THURBER
We are all creatures of habit. In fact, some studies have shown that 90% of daily actions are so routine they can be predicted by a few mathematical equations (Buchanan, 2007). “We establish physiological and behavioral set points or default patterns that, once established, the brain and nervous system strive to maintain” (McCraty & Zayas, 2014, p. 7). Your clients see the world through the lens of their autonomic expectations. Awareness of body state and awareness of emotional state are interconnected experiences that make it likely that more awareness of autonomic states will be of benefit in regulating emotions (Fustos et al., 2012).
Habitual autonomic patterns work in the background, bringing a familiar rhythm to your clients’ everyday experiences. When those patterns are anchored in a flexible autonomic nervous system, ventral vagal energy supports their ability to safely and successfully meet challenges and move through the day. This is a rhythm to deepen and celebrate. Ongoing activation of sympathetic or dorsal vagal energy creates rigid response patterns, and with rigidity comes suffering. Here you need to help your clients gently shake up the system, interrupt the engrained patterns of protection, and enliven their ventral vagal capacities. Using practices to recognize, reflect, regulate, and re-story, your clients can create a new rhythm of regulation.
This exercise is the foundation for building new autonomic patterns. The simple two-step process is an easy way for clients to build the habit of knowing moment to moment what autonomic state is active.
BACKGROUND
Autonomic awareness is a protective factor. Without the ability to recognize states and state changes, you are at risk for remaining stuck in dysregulation. The question, “Where am I on my autonomic map?” is a simple way to build autonomic awareness.
STEPS
1. Notice. Bring awareness to your autonomic state. Use what you learned about your autonomic states from the exercises in Chapters 4 and 5 to tune in.
2. Name. Stay out of your story and identify your state. Where are you on your autonomic map?
3. Repeat these two steps often. Create ease with this practice until you can quickly and accurately place yourself on your autonomic map.
TIPS
While a seemingly simple skill, it takes repeated practice for your clients to become expert state detectors. Stop in your sessions to notice and name and help your clients create confidence with this skill. Take time with this step to build the foundation for the next steps.
Building on clients’ ability to recognize their autonomic states, this exercise adds the next step of turning toward the state and spending a moment listening to the essential information held in the state.
BACKGROUND
Once the notice-and-name practice becomes easy and automatic, add the next step of turning toward your autonomic nervous system to listen for just a quick moment to what it is telling you. Don’t spend a long time hearing the full story. Just take long enough to get the general idea of what is happening.
STEPS
1. Be curious about what just prompted a mobilization of your sympathetic system, a descent into dorsal vagal conservation mode, or an experience of ventral vagal regulation.
2. Listen to what your state wants you to know.
•My sympathetic mobilization is telling me . . .
•My dorsal vagal state is letting me know . . .
•My ventral vagal system is inviting me to . . .
3. Listen for just a brief moment with curiosity and without judgment. Don’t spend more than a minute or so listening. This practice is a quick experience of listening to the outlines of your story and not diving deeply into the details.
TIPS
This exercise builds your clients’ ability to turn toward their autonomic experiences and reflect without getting pulled in. Your clients should spend just long enough to hear the essential information and not a full story. As clients listen, they begin to hear how their sympathetic and dorsal vagal states are a way their autonomic nervous system is activating an adaptive survival response and how their ventral vagal state is offering a moment of regulation and connection.
Building on the Recognize and Reflect exercises, this exercise uses clients’ awareness of their autonomic patterns to move into goal setting.
BACKGROUND
Everyday navigation of daily living involves setting goals and then acting to make your goals a reality. Goals are helpful in identifying what you want to achieve and are often stated in the form of an intention.
STEPS
1. Consider the autonomic goals you want to set. Ask yourself:
•Where do I want my autonomic patterns to take me?
•What do I want to change?
•What do I want to deepen?
2. Write goals that address what you discovered. Begin each statement with the words “I intend to.” For example: I intend to not get stuck in dorsal vagal collapse. I intend to more quickly manage my sympathetic response. I intend to find moments of ventral vagal happiness to savor. Find the words that express your autonomic goals and write your personal intentions.
TIPS
Autonomic goal setting helps your clients work with the autonomic states that underlie their personal narratives. Working with their biology first, your clients can shape new response patterns that create a foundation for new behaviors and beliefs.
This exercise shows clients how to add an implementation intention to autonomic goals. Using the proven if-then formula, clients write goals to shape their responses to dorsal vagal, sympathetic, and ventral vagal experiences.
BACKGROUND
Once you identify your autonomic goals, the next step is to translate your intention into action by adding what is called an implementation intention. An implementation intention is an if-then statement that identifies when, where, and how you plan to respond to a situation. Writing implementation intentions brings awareness to experiences by creating a link between cues and responses, making it easier for you to recognize situations and take action.
STEPS
1. Set goals for responding to cues of safety and danger in new ways. Set goals for all three states. Make sure your goals aren’t too big (unrealistic as a starting point), too broad (undefined and hard to put into action), or too bland (uninteresting and don’t keep your attention). Set goals that begin with small steps and lead to a larger change, are well defined with tangible ways to measure, and entice you to want to see what happens when you follow through.
2. Use the beginning statement, “If this happens then I will” to write if-then statements for each of your identified goals.
3. Write statements for external cues (response to certain people, places, or events).
4. Write statements for internal cues (response to autonomic state changes).
5. Read your if-then statements and check your autonomic response. Make sure each statement brings a neuroception of safety. Rewrite any statements that trigger a move into a sympathetic or dorsal vagal response.
6. Use your statements and track what happens. As your responses shift you may want to add new goals and write new if-then statements.
TIPS
The neuroception of safety is an essential element in the change process. To be successful, your clients’ autonomic goals and if-then statements have to bring the right degree of challenge. Too much and the system moves into a survival response. Not enough and the system won’t recognize the invitation to repattern. Help your clients track their movement toward a goal, celebrate reaching their goal, and then create new goals and if-then statements when they successfully realize their original ones.
The following examples are offered as a guide. If the goal is to return to regulation more easily, if-then statements might be written like this:
For external cues:
•If I’m going to be around my family, then I will make sure my talisman stone is in my pocket so I can reach it easily.
•If my work to-do list seems overwhelming, then I’ll take a quick break to get up and move every hour.
•If I go to the coffee shop with friends, then I will tell them how much I like being there with them.
For internal cues:
•If I feel the beginning of disconnection, then I will send a text to my friend.
•If I notice my sympathetic system beginning to rev up, then I will use my sighing practice.
•If I get back to my state of ventral vagal ease, then I will put my hand on my heart and celebrate.
Resisting the pull of old stories and giving new stories time to take shape is an integral part of the change process. This exercise helps clients follow the subtle shifts that bring a new rhythm of regulation and bring attention to concrete markers of change.
BACKGROUND
Humans are meaning-making beings, automatically pulled toward story. Working with the skills of recognizing, reflecting, and regulating brings you to the important step of re-storying. As you integrate new patterns, you move out of your old stories and head toward new ones. This transition often brings with it discomfort and you can easily be pulled back into old familiar stories about yourself and the world. The re-storying process disrupts the habit of listening to an old story and encourages the development of a new one. Re-storying invites you to become an active author of your own autonomic adventure.
STEPS
1. What are the ways your autonomic nervous system is responding differently? Fill in the following sentences to bring awareness to the shifts that are happening.
•Instead of my expected sympathetic mobilization I . . .
•Instead of my familiar dorsal vagal disconnection I . . .
•I notice I am more . . .
•I notice I am less . . .
2. Write a story that speaks to your new pattern. Choose words that come from your ventral vagal state and keep that state online and active. For example, “I’m strong when I interact with other people” might bring sympathetic mobilization while “I have inner strength that serves me when I’m interacting with others” could keep you anchored in ventral.
3. Write about qualities and not behaviors. Use sentences that begin with “I am” (a quality) rather than “I do” (a behavior). I am kind is a different story than I do kind things.
4. Create a story that illustrates your new autonomic responses.
•Use I am beginning to or It is possible that as the opening line to the new story.
•Write in small increments. In the re-storying process, a short story is more effective than a long essay.
TIPS
Through their stories your clients define who they are and how they find their way in the world. Embedded in their old stories are acts of protection that come from sympathetic or dorsal vagal states. Help your clients create new stories that are anchored in their ventral vagal energy and nourish their nervous systems.
Resilience—the capacity to bend with the wind, go with the flow, bounce back from adversity, is essential to the survival and thriving of human beings and human societies.
—LINDA GRAHAM
Through the lens of the autonomic nervous system, resilience is the ability to return to a ventral vagal state following a move into sympathetic or dorsal vagal responses. Autonomic state shifts in response to the challenges of everyday life are a normal and expected experience. The goal is not to always be in a state of ventral vagal regulation but rather to be able to flexibly navigate the small, ordinary shifts that a part of everyday life and build enough resilience to weather the ones that are traumatic. Your clients build resilience by moving through cycles of regulation, dysregulation, and the restoration of regulation.
Before birth, the capacity for resilience is shaped as a mother’s levels of stress impacts the prenatal programming of her baby’s autonomic nervous system (Bush et al., 2017). As we mature, ventral vagal activity measured through heart rate variability (HRV) is associated with resilience. People who have high HRV score higher on resilience questionnaires, recover more efficiently from acute psychological stress, and are less vulnerable to the development of PTSD-and depression-related symptomatology (Carnevali, Koenig, Sgoifo, & Ottaviani, 2018).
Resilience helps your clients stay hopeful when things feel hopeless, engage an effective survival response in the face of danger, manage levels of stress in an ongoing stressful environment, and keep moving forward when the world around them is filled with suffering.
This exercise brings attention to the role of the ventral vagal pathway to the heart’s pacemaker (the sinoatrial node) in regulating autonomic responses. Through the use of image and movement, clients are able to access and exercise the important regulating capacities of the vagal brake.
BACKGROUND
The vagal brake is responsible for speeding up and slowing down your heart rate. The vagal brake allows you to feel more sympathetic nervous system energy while keeping your ventral vagal system online and in charge. As the vagal brake begins to release, the mobilizing energy of the sympathetic nervous system that is in the background begins to move into the foreground. Then as the vagal brake reengages, the process is reversed, sympathetic energy moving to the background and ventral vagal back to the foreground. Think about the vagal brake working similarly to the brakes on a bicycle. Imagine you are riding a bike down a hill and you want to go a little faster. Release the brakes a bit and feel the wheels spin faster. Gently squeeze the brakes to slow down.
When your vagal brake relaxes but doesn’t fully release, you have access to a range of responses, including feeling calm, engaged, joyful, excited, passionate, playful, attentive, alert, or watchful, while still safely anchored in the ventral vagal system. You can bring the energy necessary to respond to what is needed in the moment. When working well, the vagal brake supports flexibility in your responses and creates a sense of ease to transitions.
Using metaphor and imagery you can experiment with engaging, relaxing, and reengaging the vagal brake and experience the ways this part of the ventral vagal system helps you safely navigate everyday challenges. With ongoing practice, you create more flexibility in your responses and feel the benefits of a resilient autonomic nervous system.
STEPS
1. Find an image of your vagal brake that brings to life your sense of regulating the increase and decrease of energy in your ventral vagal pathways. Look for an image that gives you the feeling of controlling the dimensions of something. Some commonly used images include bicycle brakes, a door, a bridge, a gate, a water faucet, a volume control knob, and a dimmer switch. Let your imagination guide you as you find an image that you can manipulate and measure the changes.
2. Write a simple story about your vagal brake using the image. Describe your image and how you use it to increase energy and return to calm.
3. Use a movement. Not everyone creates imagery to come into connection with inner experience. For some people movement is the preferred method. Find a movement that changes shape to illustrate the increase and decrease of energy.
4. Connect your vagal brake image and/or movement to your breath cycle. A subtle pattern of relaxation and reengagement happens with every breath cycle. With each inhalation, the brake relaxes just a bit, allowing a slight speeding up of the heart, and then reengages on the exhalation to bring a return of the slower beat. Take a moment and play with these two pathways. Feel your vagal brake relax, then reengage with each breath in an ongoing cycle. Move through several breath cycles until it begins to feel natural.
5. Use the image and/or movement to intentionally engage, relax, and reengage the brake.
•See yourself as an active operator of your vagal brake, shaping the rise and fall of energy. Bring the image to life—see it, hear it, feel yourself adjusting it, and feel your energy moving in synchrony with the changing image.
•Bring the movement connected to your vagal brake into awareness either in outward action or inward experience. Change the movement and feel the increase and decrease of sympathetic energy in your system.
6. Play with the experience of intentionally exercising your vagal brake.
•Start with a small challenge, perhaps something that is commonly experienced in your day-to-day life. On a scale of intensity from 1–10, choose something in the 1–3 range.
•Use your image and/or movement to relax the brake to meet your chosen challenge and reengage the brake when the challenge is over. Feel the influence you have over the ways your vagal brake works in service of managing the challenge.
7. Experiment with a variety of challenges. Build confidence in using your vagal brake to meet everyday challenges.
•Once you feel confident in successfully meeting small challenges, choose a slightly stronger challenge. Notice how your vagal brake relaxes, allowing your energy to rise in the face of more intense challenges while maintaining the ventral vagal state of safety. Then reengage the brake and return to your ventral vagal starting point.
•Practice using your vagal brake with environmental experiences.
•Practice using your vagal brake with relationship stressors.
TIPS
The vagal brake is an embodied system of regulation that you can help your clients intentionally access and exercise. Without the vagal brake, your clients lose their anchor in the ventral vagal state of safety and connection and move into the sympathetic nervous system’s protective states of fight and flight. Without the vagal brake they may stay stuck in sympathetic mobilization or continue the descent into dorsal vagal collapse. With ongoing practice, clients create more flexibility in their responses, learn to safely access the mobilizing energy of the sympathetic system, and feel the benefits of a resilient autonomic nervous system.
Here are some examples of vagal brake imagery:
•Open a bridge to allow big ships to pass through safely and then close it for the usual boat traffic.
•Open and close a door, letting in the amount of light and air wanted. Make the opening the right size just to look through or to walk through.
•Use a dimmer switch for a light fixture. There are many adjustments between on and off. Decide how much light I need moment to moment and move the dimmer switch up or down.
This exercise helps clients take what they have learned about their autonomic patterns and choose practices that fit their personal needs around feeling nourished and increase their capacity to respond with resilience. Since resilience is a quality that can be enhanced over time, this exercise combines ongoing core practices with regularly changing practices.
BACKGROUND
Resilience is an emergent property of a ventral vagal state. As you build resilience, instead of responding to a challenge with an automatic move into a survival response, you are able to respond with more flexibility. And in the times when you are pulled into a survival response, rather than getting stuck there, you’re able to return to the state of ventral vagal regulation. As resilience builds, your capacity for flexibility of response deepens.
STEPS
1. Create resilience routines that draw from practices that engage your body and brain in a variety of ways. Revisit Chapter 6 and see if there are shaping exercises from the different categories that fit into your resilience routine.
2. Experiment with actions that bring moments of ventral vagal experience.
•Look inward to breath and reflection practices.
•Look outward into the environment of your home and nature.
•Look at the way you move in the world and the people who accompany you.
3. Choose experiences that feel nourishing and ones that feel a bit challenging. You want a mix of practices that feel comfortable and are easy to engage with and ones that take concerted effort. Building resilience is about both deepening into ongoing practices that feel sustaining and inviting in new practices that bring the right degree of neural challenge for your system.
4. Find a few core practices that will remain constant in your resilience routine.
5. Create a second category of practices that routinely change.
•Decide on the length of time you want to use. The time period can be anywhere from 1 week to 6 months.
•Choose a few new practices to experiment with over your chosen time period. At the end of that time some practices may become core practices while you let others go. As you try out new practices, your resilience routines continue to develop.
6. Regularly review and revise your resilience routines. Some practices will become lifelong, while others will serve you for a time and then be replaced with new ones.
FIGURE 7.1. Sample Resilience Routines
TIPS
Resilience routines (Figure 7.1) help your clients build the capacity to meet challenges without being pulled into and held captive by a survival response. Encourage your clients to take time finding two or three core daily resilience practices. These should be simple practices that they find easy to use and lead to an increased sense of actively regulating and resourcing. Have your clients share their resilience routines with you. During sessions you can use their core practices to support working at the edges of regulation.
CHAPTER 7 SUMMARY
If light is in your heart you will find your way home.
—RUMI
The word integrate comes from the Latin to make whole. When your clients integrate new autonomic rhythms, they make their systems whole in new ways. They move from a pattern of rigid responses to an autonomic platform that supports flexibility. Integration of new autonomic patterns happens over time and can be explicitly encouraged.
The exercises in Chapter 7 help your clients incorporate the skills they explored in Befriending, Attending, and Shaping. You can think about the process of integration through the four “D’s”: discover, disrupt, develop, deepen.
Discover. Your clients begin their journey to integration by discovering their patterns of protection and connection.
Disrupt. The next step toward integration is to disrupt familiar autonomic survival responses and the stories of mobilization and disconnection that accompany them.
Develop. Having interrupted old patterns, opportunities open for clients to develop new ways of responding that are grounded in ventral vagal safety.
Deepen. The final step is to bring together new responses and new stories.
Integration takes time, happens incrementally, and is a lifelong endeavor.