Polyvagal Theory has become pretty en vogue—a popular toolkit for therapists wanting to conceptualize therapy through a trauma-informed lens that considers the nervous system’s response to safety and threat. At its core, the theory helps us understand that our clients’ behaviors aren’t random or irrational—they’re adaptive responses shaped by the autonomic nervous system in service of survival.
Below are my notes from Deb Dana’s application of Polyvagal Theory in therapy. Dana describes the three branches of the ANS, neuroception, co-regulation, and how safety gets communicated (or not) through the body. She alsoi includes practical, embodied interventions you can bring directly into your work to support regulation, connection, and healing.
Autonomic Nervous System (ANC)
Every response is an action in service of survival. The system does not make a judgment about good or bad, it simply acts to manage risk and seek safety.
We can experience an autonomic reaction when an anticipated response doesn’t happen.
The ANS supports health, growth, and restoration ONLY when not recruited for defense.
Three Phylogenetic Stages of the ANS
Stage 1: Primitive unmyelinated ‘dorsal’ vagus (DVC)
Immobilization behaviors (i.e., fainting, shutdown, dissociation)
Stage 2: Sympathetic Nervous System (SNS)
“Fight-flight” behaviors
• Stage 3: Myelinated mammalian ‘ventral’ vagus (VVC)
Social communication (supports homeostasis)
Enables social interactions to regulate physiology and promote health, growth and restoration (balance between unmyelinated vagus and SNS)
Autonomic nervous system pathways (hierarchy)
Dorsal Vagus: immobilization.
The freeze response.
It is a feeling of “numb, frozen, or not here.”
When we are trapped and cannot escape danger, the dorsal pathway immobilizes, and we shut down to survive.
The dorsal vagus promotes healthy digestion.
Sympathetic nervous system: mobilization.
Triggers fight-or-flight response.
Sympathetic adrenal medullary (SAM): brings a burst of adrenaline for a fast response to a stressor.
Hypothalamic pituitary adrenal axis (HPA): releases cortisol.
In the sympathetically charged states of fight or flight, danger lurks everywhere, and coming into connection is too big a risk.
The sympathetic nervous system supports healthy breathing cycles and heart rhythms and plays a role in regulating body temperature.
Ventral Vagus: Social Engagement and Connection.
Supports feelings of safety.
The social engagement system is unique to mammals.
From the ventral vagal state, we can acknowledge distress and explore options, reach out for support, and develop organized responses
The social engagement system looks for safety cues in faces, vocal tone, and gestures.
The ventral vagus controls the face-heart connection.
The Face to Heart Connection
At birth, mammals have bidirectional neural communication between the face and the heart (suck-swallow-breathe-vocalize), which forms the core of a Social Engagement System.
Metabolic demands, perceived danger, life threat, and illness reactivate the Social Engagement System, resulting in a face that is not “social” and a physiological state (removal of the vagal brake on the heart) that promotes defensive behaviors.
The face and voice reflect autonomic state.
Lack of prosody (intonation in voice).
Eye contact and difficulties in social communication.
Blunted facial expressivity.
Difficulties in behavioral state regulation (hypervigilant, anxious, distractible, impulsive, tantrums, hypoarousal)
Compromised vagal regulation (e.g., state regulation, digestion)
Difficulties in listening, following verbal commands, and speech-language delays
Sound sensitivities
Oral motor defensiveness (e.g., ingestive behaviors)
Neuroception
The way the autonomic nervous system responds to cues of safety, danger, and life-threat from within our bodies, in the world around us, and in our connections to others.
It is “detection without awareness” below the realm of conscious thought.
Biological rudeness: when neuroception changes from safety to danger
Unintentional disconnection occurs when neural expectations are disrupted. Whether it's a fleeting moment barely noticeable or a prolonged period of detachment, these instances of "biological rudeness" trigger an autonomic sense of unease.
Neuroception precedes perception.
Neuroception is the somatic signals that influence decision making and behavioral responses without explicit awareness of the provoking cues
Before the brain understands and makes meaning of an experience, the autonomic nervous system has assessed the situation and initiated a response.
Misattunement and trauma
We cannot reliably inhibit defense systems in safe environments or activate defense systems when needed in risky environments
If we are not safe, we are in a chronic state of evaluation and defensiveness.
Trauma is an overwhelming demand placed upon the physiological human system
Without the ability to inhibit defense responses, the nervous system is in a continual state of activated mobilization or immobilization
Polyvagal System
The vagus nerve is the longest of the 12 cranial nerves of the parasympathetic nervous system. It connects your heart to your face and abdomen. It is “polyvagal” because of the dorsal and ventral vagus.
We are “flooded” by the sympathetic nervous system and “drained” by the dorsal vagus.
Vagal tone, an indicator of parasympathetic nervous system activity, is commonly measured through respiratory sinus arrhythmia (RSA), which reflects heart rate variability linked to breathing.
The “vagal brakes” slows our heartbeat.
Connectedness
The body’s need to co-regulate biobehavioral state through engagement with others.
Connectedness is the ability to mutually (synchronously and reciprocally) regulate physiological and behavioral states.
Connectedness serves as the neurobiological bridge between social behavior and overall mental and physical health.
The autonomic nervous system of two individuals finds sanctuary in a co-created experience of connection.
Connectedness enables co-regulation.
When opportunities for connection are missing, we carry the distress in our nervous system.
Social disconnection and social exclusion activate the same pain pathways as experiences of injury.
Coregulation
Physical Contact While Immobilizing Without Fear.
Maintains a physiological state that supports health, growth, and restoration.
Optimizes the ability to rest, relax, sleep, digest, and perform bodily processes.
Enables moments of intimacy with feelings of trust, safety, and love.
Does not require face-to-face interactions.
We need ongoing opportunities for co-regulation, reliable relationships based on reciprocity, and time spent with safe people engaging in shared activities to enliven neuroception of safety.
Co-regulation creates a psychological platform of safety that supports a psychological story of security that leads to social engagement.
If a client feels you meet them in their distress with your ventral vagal state sending cues of safety, their autonomic nervous system can sense the offer of coregulation, helping their vagal brake to re-engage, and can come back into regulation.
Research with dogs and their owners has shown that an elevated human heart rate is regulated when an owner is reunited with their dog.
Detached Middle Ear Bones
Detached middle ear bones are a defining feature of mammals.
Without the “detached” middle ear bones, mammals wouldn’t be able to detect soft, high-frequency sounds, allowing them to communicate in a range that reptiles typically can’t hear.
Low frequency sounds and vibrations send a neuroception of life threat and initiate a vigilance for predators and a sensitivity to dorsal vagal immobilization, while high frequency sounds and vibrations launch a neuroception of danger and a sympathetic nervous system mobilization response
When the sympathetic nervous system takes over, the middle ear regulation shifts away from listening for human voice toward listening for low-frequency sounds of predators or high-frequency sounds of distress
Without functioning middle ear muscles, we are hypersensitive to the low-frequency sounds that trigger anticipation or the presence of a predator.
Without functioning middle ear muscles, we are hyposensitive to human voices that are masked by the low-frequency sounds signaling threat.
Exercises to improve vagal tone
Movement can be implemented to move out of the dorsal vagal state - even imagined movement can activate the motor cortex.
Create music playlists
Sharing playlists together is a meaningful experience of reciprocity.
People may sink into, and at times even savor, the emotional weight of sympathetic or dorsal vagal states—experiences that might otherwise feel too intense or disorganizing. By doing so, they create a sense of containment around their suffering, making it feel more tolerable, familiar, or even meaningful. This process can offer a safer way to come into contact with pain that might otherwise be avoided or dissociated.
Talking exercises elements of our social engagement system:
Ventral vagus: Regulates breath and vocalization via parasympathetic control of thoracic organs and vocal tract.
Larynx: Produces sound; innervated by superior and recurrent laryngeal branches of the vagus nerve (cranial nerve X).
Auditory pathways: Involve the cochlear nerve (part of cranial nerve VIII), not mentioned here but implied.
Cranial nerve V (trigeminal): Controls muscles of mastication, involved in articulatory stability via jaw control.
Cranial nerve VII (facial): Responsible for expressive facial muscle movements—key in nonverbal emotional communication.
We exercise our vagal brake with patterns of listening and responding
Face to face conversation is the most human and humanizing thing we do
Explore prosody of speech with common words or statements.
Humming increases ventral vagal tone.
Singing is a form of guided breathing that engages the larynx, lungs, heart, and facial muscles, requiring breath control and postural adjustments—all of which contribute to toning the ventral vagal system.
Chanting (such as an ohm meditation) combines sound, breath, and rhythm and has been shown to reduce anxiety and depression, block the release of stress hormones, and increase immune function.
Shifting posture brings a sense of activation as the vagal brake reengages. Changes postures by lying down, sitting, standing, turning, rocking, leaning, and changes autonomic tone.
Using a therapy ball uses micro-movements to shape the autonomic nervous system.
Using a rocking chair can improve anxiety and depression. Rocking gives an efficient and direct influence of the vagus.
Touch
Touch is the first sense to emerge in utero and the most developed at birth. Skin is the largest human organ, and touch is integral to our growth and development. Early touch experiences shape our adult experiences.
A handshake to begin a social interaction has been shown to increase people’s perception of trust, activate positive evaluation of competence and trustworthiness, and reduce avoidance behavior.
Play only occurs when one is safe, secure, and feeling good.
Play is a face-to-face, present-moment experience during which the autonomic nervous system moves between increased sympathetic nervous system influence and active inhibition via the vagal brakes.
Safe, interactive play opportunities tone the nervous system.
Stillness is possible when the dorsal vagal and ventral vagal circuits work together, allowing immobilization without fear.
Name it: experiment with different words that describe the experience of being safely immobile.
Observe it: describe a picture of stillness.
Imagine it: create imagery
Experience it: practice being with silence
Awe
Awe allows us to step outside ourselves and is a solitary moment that makes time appear to slow down. It can lead to curiosity, connection, attunement, and lower inflammatory responses.
Daily moments of awe predict well-being in the future.
Encourage clients to enter into past awe-inspiring experiences. We often experience it through art, music, and nature.
Elevation
Elevation is a warm, uplifting experience when people see an unexpected act of human goodness, kindness, courage, or compassion, and it makes the person want to help others and be a better person. It activates the ventral vagal and sympathetic circuits. It may be felt as goosebumps, tears in the eyes, and warmth in the chest.
We can experience elevation by listening to acts of kindness and watching videos of altruistic acts.
Breathing
Sighing can be thought of as a “resetter of regulation” in response to both physiological and psychological demands. A “sigh of relief” truly releases tension.
Resistance in the out-breath activates the parasympathetic nervous system (contract the back of the throat or purse lips).
Explore breath of fear (quick inhalation) vs. a "sigh of relief.”