Book Review: Clinical Applications of the Polyvagal Theory
Clinical Applications of the Polyvagal Theory is another work in the Norton series on interpersonal neurobiology.
I have come to believe that at least three theories are indispensable in learning and understanding how and why we behave the way we do — attribution theory, attachment theory, and our underlying physiology of safety, called the polyvagal theory.
The polyvagal theory was developed by Stephen Porges and presented to the Society for Psychophysiological Research in 1994. The theory takes into account how our autonomic nervous system is constantly working to keep us safe. Very simply, the components are our parasympathetic system (“rest and digest”), the mammalian ventral vagal system (positive social engagement), sympathetic system (“fight or flight”), and the reptilian dorsal vagal (freeze, faint, shut down, dissociate). These all work together to give us an ongoing sense of our surroundings and how to react, what Porges calls our neuroception.
The polyvagal theory is essential knowledge for everyone who works as a therapist, but familiarity with the theory can benefit us no matter what our profession because it deepens our understanding of what is going on with us in the moment. As the theory points out, our neuroception leads to how we perceive, and our perception gives rise to how we live our story.
In his presentation in 1994, Porges emphasized how “mammals had evolved in a harsh environment in which survival was dependent on their ability to down regulate states of defense with states of safety and trust, states that supported cooperative behavior and health.” This means our natural state is to be on red alert, but our “vagal brake” helps slow our heart rate and move to cooperation, safety and rest and digest — when we sense the conditions are okay for that. Porges gives an excellent overview of the theory at the beginning of the book.
While the theory was not initially developed for use in behavioral health, it has become a centerpiece, particularly in trauma treatment and mindfulness. As Pat Ogden writes in the book, “At its core, polyvagal theory is about love, and identifies the physiology behind it.” Connectedness and safety are the heart of the therapeutic process. Our core, as we learn in practices such as yoga, taijiquan and qigong, is our heart, our breath, and the vascular feedback loop.
The contributors to this book offer a wide range of the applications for polyvagal theory. Bessel van der Kolk discusses his submission to APA’s DSM committee for a developmental trauma diagnosis based on research from various sites that included over 20,000 children. The proposal was rejected. As van der Kolk points out, in the DSM we are left with a variety of “so-called diagnoses” that “capture some aspects of developmental trauma, while none of them provide a clue about what has really gone wrong, nor do they offer any suggestions about what can be done to help patients who have them.” Here, the polyvagal theory has been invaluable for treating developmental trauma.
Applications of the theory include working with traumatized children, people with a fear of flying, pediatric medical trauma presenting as Asperger’s, grief, dance and movement therapy, energy psychology, poetry and PTSD, doctor-patient relationships (you can read this chapter here), nursing, and more.
I was particularly interested in applications for the ICU and for veterinary practices. My father once spent the better part of almost two years in an ICU, and it is a very difficult place to feel safe. And for animals, something as simple as changing the surface of the examining table can have a big impact on how a companion animal reacts at the vet’s office. There are also especially moving and thoughtful chapters by co-editor Deb Dana on the stroke recovery of her husband and by Liza Morton on her congenital heart condition and the impact on her life, with each story telling how polyvagal theory helped with coping.
I highly recommend this book for professionals and the general public alike. I think those who consider themselves political leaders could especially benefit. I also think about the impact the theory would have when applied to things like economic game theory. It is for anyone who is interested in the underlying physiology on how we come to view the world and how we come to act as we do. We are all on some level seeking connection and safety. We mammals have evolved as social beings, and we truly are all in this together.
Clinical Applications of the Polyvagal Theory: The Emergence of Polyvagal-Informed Therapies
W.W. Norton & Company, June 2018
Hardcover, 464 pages