Updated: Jun 15, 2022
The Polyvagal Theory (PVT) is a concept that was introduced by Dr. Stephen Porges to explain the autonomic nervous system. In particular, the PVT describes the relationship between social connection, fear/self-protection, and emotion regulation.
The ‘vagal’ part of the term polyvagal references the vagus nerve, the longest cranial nerve in the human body and a major component of the parasympathetic nervous system, our body’s down-regulating response.
The ‘poly’ part of the term references the two branches of the vagus nerve. The dorsal vagal branch of the vagus nerve is the older and more primitive of the two. It connects to organs below the diaphragm (the stomach, liver, speen, kidney, colon, and intestines). When operating well, the dorsal vagus helps us “rest and digest.” The ventral vagal branch is the newer branch and connects to organs above the diaphragm (the heart, lungs, pharynx, and larynx). When operating well, the ventral vagus maintains a positive homeostasis in the body.
In PVT, Porges proposes that the PVT follows a hierarchy, in which the ventral vagal component of the parasympathetic nervous system is at the top. Remember, the ventral vagus nerve is one branch of the vagus nerve. When the ventral vagus is online, we feel safe (at least safe enough) and we are able to socialize and connect.
In general, this social engagement piece is a huge component of the PVT. It highlights how important connection and community are in wellbeing - emotional, physical, or otherwise. Our ability to co-regulate with other humans is a huge reason we’ve survived as a species, and reminds us that we can’t heal in isolation. For those who read my previous piece: while the WoT doesn’t intentionally leave out this role of connection and co-regulation, some criticize that it doesn’t highlight it either and instead focuses on self-regulation as a personal responsibility.
Underneath the ventral vagal response is the sympathetic nervous system. The sympathetic nervous system contributes to the energy we need to make it through each day. In the face of stress, the sympathetic nervous system activates our fight-or-flight response by pumping cortisol and adrenaline throughout our bodies.
At the bottom of the PVT hierarchy is the dorsal vagal response. Remember, the dorsal vagal system is the other part of the vagus nerve and we need it to rest and digest. In the face of stress or danger, the dorsal vagus immobilizes the body to conserve energy or even intentionally numb out/dissociate.
For those who read my previous piece: to make an extremely simple comparison, in the PVT we are essentially just switching the top and middle of the WoT.
Polyvagal Theory in Therapy
At least two therapists have helped to make the PVT more applicable in psychotherapy. Deb Dana developed a metaphor of a ladder. Justin Sunseri has broken the complexity of the model down throughout his excellent podcast series, Stuck Not Broken. These metaphors can be useful for helping clients learn not only about the PVT, but how to incorporate it into their lives.
In order to find our ventral vagal state our body has to metaphorically “climb” the polyvagal ladder. Think of it this way: when our body is used to living in shutdown it is doing so because this is what feels safest. Any sympathetic activation, therefore, can be read by our bodies not just as uncomfortable, but unsafe. That said, our bodies have to be able to tolerate some level of activation in order to get to the top of the ladder/ventral vagus state.
When we struggle with finding emotional safety in physiological activation we might stay in a sympathetic state as a means to keep trying, or we might collapse and give up because we feel helpless.
Trauma, as you might recall from my previous post, is not what happens to us, but what happens in our bodies as a result of an overwhelmingly distressing experience. When we are suffering with the lasting impacts of trauma, we often feel “stuck” in a physiological experience. We might feel more activation as a result of our sympathetic nervous system firing, or we might feel shutdown and spaced out as a result of the dorsal vagal response from the parasympathetic nervous system. Or, we might feel a bit of both.
One of the things a lot of practitioners like about the PVT is that it creates more space to talk about mixed states. Confidently setting a boundary or playing a game of pick-up basketball is made possible with input from both the sympathetic nervous system and ventral vagus. The combination of a dorsal vagus with a ventral vagus response allows for us to rest with ourselves or in our relationships. Finally, the freeze state (like deer in headlights) occurs when the body activates both the sympathetic/fight-or-flight response and the dorsal vagal/shutdown response; it’s like one foot on the gas and one foot on the breaks.
I often defer to Justin Sunseri’s graphic of the Polyvagal Ladder, which illustrates the mixed states really effectively.
In my next post, I’ll expand on critiques of psychological models such as the WoT and PVTfrom a historical and politicized context and consider where we go from here.
Dana, D. and Porges, S., 2018. The polyvagal theory in therapy. 1st ed. Norton Professional Books
Ogden, P., Minton, K., & Pain, C. (2006). Trauma and the body: A sensorimotor approach to psychotherapy. W. W. Norton & Company.
Sunseri, Justin. Primary and Mixed States of the Autonomic Nervous System. www.JustinLMFT.com