The Polyvagal Theory in Therapy

1. The Autonomic Nervous System is Our Innate Survival Guide

Polyvagal Theory provides a physiological and psychological understanding of how and why clients move through a continual cycle of mobilization, disconnection, and engagement.

Understanding the ANS. The Polyvagal Theory (PVT) reveals how our autonomic nervous system (ANS) acts as a sophisticated surveillance system, constantly asking, "Is this safe?" This system, operating largely below conscious awareness, dictates our capacity for connection, our reactions to danger, and our ability to return to a regulated state. It's the fundamental biological platform underlying every human experience, from joy to trauma.

Three pathways of response. Our ANS operates through an evolutionary hierarchy of three pathways, each with distinct adaptive responses:

• Ventral Vagus (Newest): Supports social engagement, safety, and connection. Think calm, social, and engaged.
• Sympathetic Nervous System (Middle): Triggers mobilization for fight or flight in response to danger. Think anxious, angry, or "on the move."
• Dorsal Vagus (Oldest): Leads to immobilization, shutdown, or dissociation in extreme life-threat. Think hopeless, numb, or "not here."

The vagal brake. A crucial concept is the "vagal brake," controlled by the ventral vagus. It allows us to quickly slow our heart rate and maintain a regulated state, offering flexibility to energize and then return to calm. Trauma can impair this brake, leading to chronic dysregulation and difficulty transitioning between states.

2. Our Nervous System Constantly Scans for Safety or Threat: Neuroception

Different from perception, this is “detection without awareness” (Porges, n.d.), a subcortical experience happening far below the realm of conscious thought.

Beyond conscious perception. Neuroception is the ANS's automatic, unconscious assessment of cues of safety, danger, or life-threat from within our bodies, the environment, and our relationships. This "detection without awareness" happens before our thinking brain processes information, profoundly influencing our physiological state and subsequent behavior.

Cues shape our state. Neuroception is influenced by various cues:

• Internal: Sensations from our heart, lungs, and gut.
• External: Sounds (frequencies, prosody), sights (facial expressions, eye gaze), and proximity.
• Relational: The subtle signals exchanged between nervous systems.
  For example, low-frequency sounds might trigger a neuroception of predator threat, while a warm, prosodic voice signals safety.

Biological rudeness. PVT introduces "biological rudeness" to describe moments when neural expectations for reciprocal connection are violated, even subtly (e.g., someone checking their phone during a conversation). These micro-moments, though often unintentional, register autonomically as a neuroception of unsafety, leading to shifts away from connection.

3. Every Autonomic Response is an Adaptive Action for Survival

A working principle of the autonomic nervous system is “every response is an action in service of survival.”

Survival is paramount. No matter how incongruous or self-defeating a behavior may appear from the outside, from an autonomic perspective, it is always an adaptive survival response. The ANS doesn't judge actions as "good" or "bad"; it simply acts to manage risk and seek safety. This reframing is crucial for reducing shame and self-blame in trauma survivors.

State drives story. Our physiological state, determined by neuroception, dictates our psychological narrative. A neuroception of danger or life-threat limits our abilities to mobilizing (fight/flight) or immobilizing (shutdown) strategies, creating stories of anxiety, anger, or hopelessness. Conversely, a neuroception of safety allows for ventral vagal engagement, fostering stories of connection, curiosity, and possibility.

Trauma's impact. Trauma compromises our ability to engage with others by replacing patterns of connection with habitual patterns of protection. These early adaptive survival responses become ingrained autonomic patterns. Therapy, through a polyvagal lens, helps clients repattern these responses, moving from automatic survival to intentional engagement.

4. Co-regulation is a Biological Imperative for Connection and Healing

Polyvagal Theory describes autonomic safety as a “preamble to attachment” (Porges, 2012).

Wired for connection. Humans are inherently social beings, wired from birth to seek attuned relationships. Co-regulation, the reciprocal regulation of autonomic states between individuals, is a biological imperative. It creates a physiological platform of safety that supports psychological security, leading to healthy attachment and social engagement.

The cost of loneliness. When opportunities for co-regulation are missing, especially in childhood, the nervous system carries this distress. Loneliness triggers a neuroception of unsafety, activating defense systems and leading to chronic health and mental health problems like compromised immune function, heart disease, and depression. A lonely person feels not only unhappy but also unsafe.

Reciprocity in relationships. Reciprocity, the mutual ebb and flow of giving and receiving, is a vital regulator of the ANS. It's the heartfelt listening and responding that defines nourishing relationships. A lack of reciprocity signals distressed relationships and triggers a neuroception of danger, moving us from a sense of "friend" to "stranger."

5. Mapping Your Autonomic States is the First Step to Self-Awareness

The goal of autonomic mapping is for clients to illustrate their experience of the world from the three states of activation—safety, danger, and life-threat—by detailing body responses, beliefs, emotions, and behaviors.

Visualizing your inner world. Autonomic mapping provides a concrete way for clients to understand their unique "autonomic profile" and recognize their individual patterns of engagement and activation. Using metaphors like the "autonomic ladder," clients identify their somatic, cognitive, emotional, and behavioral landmarks for each state.

The three core maps:

• Personal Profile Map: "Where am I?" Clients describe what each state (ventral vagal, sympathetic, dorsal vagal) feels, looks, and sounds like, including thoughts, feelings, body responses, and behaviors.
• Triggers and Glimmers Map: "What brought me here?" Clients identify specific cues of danger (triggers) that activate sympathetic or dorsal vagal defense, and cues of safety (glimmers) that activate the ventral vagal system.
• Regulating Resources Map: "How do I find my way to ventral vagal regulation?" Clients list individual and interactive actions that help them shift out of dysregulated states and maintain safety.

A shared language for healing. Mapping creates a shared autonomic language between therapist and client, fostering mutual understanding and compassion. It helps clients move from self-criticism ("It's my fault") to curiosity ("How do I respond?"), recognizing their dysregulation as adaptive attempts at protection.

6. Befriending and Attending to Your Nervous System Separates State from Story

With autonomic awareness, clients learn to listen to their embodied stories.

Beyond judgment. Befriending the nervous system involves approaching one's autonomic experiences with curiosity and without judgment. This process, often facilitated through creative arts like Art Maps, music, movement, and writing, helps clients connect with their states and understand them as separate from their familiar psychological narratives.

Becoming an expert state detector. Attending practices, such as "Notice and Name," teach clients to:

• Tune into thoughts, feelings, and body sensations.
• Identify their current autonomic state on their map.
• Name the state (e.g., "I'm in sympathetic mobilization").
• Bring curiosity to what their ANS is communicating.
  This skill reduces confusion, builds predictability, and interrupts automatic response patterns, allowing clients to separate their physiological state from their personal story.

The Goldilocks principle. Clients learn to identify their "just right" autonomic zone, avoiding "too much" (sympathetic distress) or "not enough" (dorsal vagal collapse). Tools like the Goldilocks Graph and Time and Tone Graph help track these shifts, fostering flexibility and resilience in navigating daily challenges.

7. Your Environment and Relationships Powerfully Shape Your Autonomic State

The neuroception of safety or unsafety has a powerful effect on the ways we survive and thrive.

Passive pathways of influence. Our ANS is exquisitely attuned to both our physical and social environments, constantly receiving information through passive pathways of neuroception. These cues, often outside conscious awareness, profoundly influence our physiological state and gene expression, impacting our well-being for weeks and months.

Creating safe surroundings. Therapists can intentionally design their office environment to send cues of safety, fostering ventral vagal regulation. This includes:

• Sound: Avoiding low-frequency (predator threat) or high-frequency (danger) sounds; using prosodic voice.
• Temperature: Ensuring thermal comfort, as physical warmth is linked to social warmth.
• Nature: Incorporating natural elements or views, which reduce stress and promote parasympathetic response.
  The "Path to Therapy" exercise helps clients track their neuroceptive experience from arrival to the office, identifying and mitigating environmental triggers.

Relational context. The therapeutic relationship itself is a primary source of safety cues. A therapist's consistent ventral vagal presence, empathic attunement, and use of the Social Engagement System (eye contact, warm voice, gestures) actively invite the client's ANS into co-regulation, establishing a foundation for healing.

8. Repairing Relational Ruptures Builds Resilience and Trust

Reconnection after a rupture is sometimes awkward, often painful, and a practice we need to become skillful with because the end result is a return to the sweetness of connection.

Rupture and repair are natural. Even in healthy relationships, moments of "biological rudeness" or emotional misattunement (ruptures) are common. These can range from micro-moments of disconnection to more significant missteps. The goal is not to avoid ruptures, but to develop the skill of recognizing and repairing them.

The repair process:

• Track reciprocity: Notice when the autonomic flow of connection is disrupted.
• Notice and name the rupture: Acknowledge the shift in autonomic state and protective responses, rather than assigning blame or creating a narrative of fault.
• Find the right repair: Explore what the client's ANS needs to feel fully repaired and reconnected, often involving specific words or actions that mend the tear.
• Come back into connection: Intentionally return to relational connection, savoring the experience of resolution and reinforcing the expectation of future safe navigation.

Therapy as a lab for repair. The therapist-client relationship provides a safe space to practice rupture and repair. For trauma survivors, who often have a history of unrepaired ruptures, these experiences offer crucial "disconfirming experiences" that build new neural expectations of safety and trust in relationships.

9. Breath and Sound are Direct Pathways to Autonomic Regulation

“Breathing is an efficient and easily accessible voluntary behavior to systematically reduce and increase the influence of the vagus on the heart” (Porges, 2017b, p. 13).

Breath as a regulator. Our breath is a powerful, direct, and rapid pathway to influence the ANS. Consciously manipulating breath—through type, rate, and ratio—engages vagal pathways, affecting heart rate and brain messages. Slow, deep breathing, prolonged exhalation, and resistance breathing (like Ujjayi breath) increase parasympathetic activity, promoting calm and inhibiting distress.

The power of a sigh. Sighs, which naturally occur several times an hour, act as "resetters of regulation." A sigh of relief, for instance, can return the ANS from a sympathetic state to parasympathetic balance. Intentionally sighing can be a low-threat way for clients to begin experimenting with breath as a regulating resource.

Sound shapes our state. The ANS is wired to respond to different sound frequencies. Low frequencies can signal danger, high frequencies distress, while the frequencies of the human voice (prosody) signal safety. Toning the nervous system through sound involves:

• Playing with Prosody: Experimenting with vocal tone to convey different emotional states and track autonomic responses.
• Vocal Bursts: Using non-verbal sounds (groans, "ahhh," "mmm") to communicate emotion and foster connection.
• Humming, Singing, Chanting: These practices increase vagal tone, improve breath control, and can reduce anxiety and stress.

10. The Body and Movement Offer Profound Avenues for Shaping Your System

The full range of experience, from trauma to joy, shows up in the body, and the autonomic nervous system tells this story.

Embodied regulation. Effective therapy is body-oriented, recognizing that our relationship with self and others is inherently a mind-body experience. The ANS reacts to body movement and posture shifts, making intentional movement a powerful way to influence autonomic state.

The healing power of touch. Touch, the first sense to emerge, is integral to development and can be a profound healing modality. Moderate pressure touch stimulates the vagus, reducing depression, pain, and stress. Therapists can:

• Discuss touch openly: Create "touch agreements" to explore safe, non-sexual touch.
• Use self-touch: Guide clients to place hands on their heart, face, or base of the skull to activate ventral vagal energy.
• Remembered touch: Help clients recall positive touch memories as a resource.

Movement for flexibility. Movement is a fundamental resource for regulation. Intentional posture shifts (e.g., from slumped to upright) can change autonomic tone. Exercises like "Three Movements" (inward, outward, center) help clients explore boundaries between states and exercise the vagal brake, fostering flexibility and resilience.

11. Cultivating Intertwined States Enriches Life and Fosters Well-being

For many clients, the experiences that require cooperation between states bring an intensity that is too great a challenge for their nervous system to meet.

Beyond single states. While PVT often focuses on the three distinct states, many rich human experiences involve complex interactions of multiple autonomic states working together. For trauma survivors, these "intertwined states" can be challenging but are vital for a full life.

The magic of play. Play is a blend of ventral vagal social engagement and sympathetic mobilization, regulated by the vagal brake. It strengthens the ability to flexibly transition between activity and calm. For clients with a history of trauma, safe, interactive play opportunities can reshape the nervous system, increasing resilience and capacity for joy.

The tenderness of stillness. Stillness without fear is a blend of the ancient dorsal vagal and new ventral vagal circuits. It allows for intimate connection and self-reflection without triggering shutdown or dissociation. This is crucial for experiences like sitting in silence with a loved one or engaging in physical intimacy.

Awe and elevation. These emotions enrich life by connecting us to something larger than ourselves:

• Awe: A sense of wonder, often solitary, found in nature, art, or music. It slows time and promotes curiosity and prosocial behavior.
• Elevation: A warm, uplifting feeling from witnessing acts of human goodness, kindness, or courage, inspiring us to help others.
  Cultivating these experiences helps clients build ventral vagal capacities and find vibrancy in daily living.

Last updated: December 27, 2025