Introduction into Polyvagal Theory

Have you ever been stuck in traffic? Has your child ever had a tantrum in public?

We have all been in these situations many times. When these circumstances occur, are there days when you respond in a calm and constructive fashion while at other times become frustrated, aggravated, or felt like giving up? Of course, we have all experienced these feelings and reactions to these situations at one time or another.

Why does this occur?

The situations are the same, or at least very similar, so why might we have such a different responses? The answer to this important question lies in the function of our nervous system. Specifically, the explanation relates to how our nervous system is continuously scanning our internal & external environment for cues of safety and cues or risk or uncertainty. While this may seem complex, an understanding of Polyvagal Theory makes this more accessible than it may appear at first.

The concepts of Polyvagal Theory are becoming more commonly discussed and encountered within all areas of life. While the more frequent discussion of this theory may be relatively recent, it was first described by Stephen Porges, PhD in the mid 1990’s. This theory is evidence-driven and describes how our nervous system, specifically the autonomic component, functions in response to the cues and stimuli we continuously encounter in our internal and external environments. The theory further explains how our nervous system uses this information to direct responses across our entire body, including our thoughts, muscle tension, posture, hearing, voice, breathing, and digestive functioning.

The basis for these widespread effects is our vagus nerve and its connections to many aspects of our physiology. The true power of this theory lies not only in its explanation of how we experience the events in our life, but through the provision of skills and strategies that we can implement to direct our physiology in ways that are most supportive of what we are trying to accomplish in a particular situation.

Polyvagal Theory is based on details of our neurophysiology which are common to all social mammals.

There are specific core principles which are important to understand in order to apply the details of the theory in our lives. These include the physiological states determined by our nervous system, the process of neuroception, the social engagement system, and the concept of our physiological state as an intervening variable. With an understanding of these concepts, it is possible to embody the principles of the theory and improve our lives as well as the lives of those around us.

The physiological states determined through Polyvagal Theory are ventral vagal, sympathetic, and dorsal vagal.

These states are evolutionarily determined with the ventral vagal state being most recent. It is important to understand the characteristics of each state in order to be able to identify our state at any given time and learn to shift our state towards that which we choose.

The ventral vagal state is one in which we are grounded and connected to ourselves and others. Our thinking tends to be more oriented towards curiosity, being open to possibilities, and optimistic. Our muscle tone is relaxed, our jaw and facial features are softened, there is range & prosody in our voice, and our posture is open. Our breathing is deeper and slower, typically in conjunction with a diaphragmatic pattern. There is increased variability in the time between our heartbeats, referred to as heart rate variability. Our heart rate is increased during inhalation and decreases during exhalation, referred to as respiratory sinus arrhythmia. This state is considered as a state of safety and connection, both to ourselves and others. It is within this state that our body is in homeostasis and is able to recover and restore itself.

The sympathetic state is the widely known as the fight or flight response. This occurs in response to a perceived risk or threat. This state is characterized by anxious, angry, or aggressive thoughts. Our muscle tension and jaw tighten. The prosody and pitch of our voice loses its fluctuation. Our posture becomes more closed. Our breathing pattern typically becomes faster, more shallow, and centered in the chest. Heart rate variability is decreased.

The dorsal vagal shutdown state is best described by the response of the body to an overwhelming threat in which we try to conserve as much resource as possible by hiding and, at the extreme, feigning death. Our muscle tone is decreased. Our facial features become flat. Our breathing slows and becomes shallow. Our thoughts are consistent with giving up and hiding.

While each of these physiological states are appropriate and adaptive in certain circumstances, we are best able to express our truest and fullest potential as well as problem solve and perform to our highest capacity in either a ventral vagal state or a blended ventral vagal-sympathetic state. Due to this, the states can be organized in a hierarchy with the ventral vagal state at the top, followed by the sympathetic state, and the dorsal vagal state. It is important to note that we both descend and ascend this hierarchy through each state. In practice, this means that in order to ascend from a dorsal vagal state, we must first reach a sympathetic state, if even only briefly, before reaching a ventral vagal state.

The next foundational principle of Polyvagal Theory is neuroception.

This is the process by which are nervous system essentially scans our internal and external environments to detect cues of either safety and connection or cues of uncertainty, risk, and threat. This process occurs continuously and beneath conscious awareness. On the basis of whether there is a preponderance of cues of safety and connection or uncertainty, risk, and threat our physiology will shift on the hierarchy. If the balance of cues is in favor of safety and connection our body moves towards a ventral vagal state. On the other hand, if the balance is towards uncertainty, risk or threat our physiology moves first towards a sympathetic state and, if there are further cues of risk and threat or the initial threat is not resolved, then into a dorsal vagal state. It is important to emphasize that neuroception occurs whether or not we choose to acknowledge the process and develop skills to shift our states towards our chosen physiology. This process occurs beneath conscious awareness and, as such, it is not our choice to shift towards sympathetic and/or dorsal vagal states and to take on the characteristics of those

states.

The next foundational principle of the theory which will be discussed is the social engagement system.

This describes the connection from our brainstem to the muscles and organs in our face and chest through various cranial nerves. Many of the characteristics of the physiological states described above specifically reference the head and neck region. The resulting changes in facial features, voice, muscle tone, posture, and breathing not only reflect and impact our own physiological state, but also provide cues to those individuals around us. Through the process of neuroception, those individuals will then determine whether or not we are providing cues of safety and connection or cues of uncertainty, risk, and threat. It is through this social engagement system that we are able to influence the physiological state of ourselves and those around us. If we truly feel safe and connected in our body, we are able to project these cues externally through the social engagement system and this will allow those around us to shift their physiology towards a ventral vagal state. This process is termed co-regulation. The ability to shift our own physiology towards a ventral vagal state is termed self-regulation. Typically, it is not possible initially for younger children to self-regulate. Rather their future ability to self-regulate is dependent upon co-regulation from their caregivers when they are young.

The final foundational aspect for consideration is the principle of physiological state as an intervening variable.

Functionally, this corresponds to the understanding that our current physiological state will influence the process of neuroception such that a particular cue may be neurocepted as a cue of safety and connection if we are in a ventral vagal state but may be neurocepted as a cue of uncertainty, risk, or even threat if we are in a sympathetic or dorsal vagal state. This principles informs our everyday experience of noticing different reactions to very similar events, such as the traffic and public tantrum examples, described above.

In response to cues of uncertainty, risk, and threat both internally and externally, we have seen how our physiology can shift towards sympathetic and dorsal vagal states. This process is not in and of itself maladaptive. Rather it is the normal, predictable, and expected response of our nervous system in response to these cues. By extension, the hallmark of a healthy, resilient, and adaptive nervous system is not the lack of dysregulation towards these states. Rather, the defining feature of resilience within our nervous system is our ability to restore stability following periods of dysregulation. In particular, it is our capacity to efficiently and effectively self-regulate.

Follow along to read more about Polyvagal Theory and Parenting in this next blog!

Blog contribution from Darin Davidson MD, MHSC, FRCSC Polyvagal Informed Coaching & Concierge Care

Follow on social media: @ParentSuitcase on Instagram and Pinterest

REFERENCES:

Dana, D. Polyvagal Exercises for Safety and Connection: 50 Client-centered Practices. New York: W.W. Norton & Company; 2020.

Dana, D. Anchored: How to Befriend Your Nervous System Using Polyvagal Theory. Boulder, Colorado: Sounds True, 2021.

Delahooke, M. Brain-Body Parenting: How to Stop Managing Behavior and Start Raising Joyful, Resilient Kids. New York: HarperCollins, 2022.

Porges, SW. Polyvagal Safety: Attachment, Communication, Self-Regulation. New York: W.W. Norton & Company; 2021.

Porges, SW. The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, Self-Regulation. New York: W.W. Norton & Company; 2011.

Porges, SW. Presidential Address, 1994. Orienting in a Defensive World: Mammalian Modifications of our Evolutionary Heritage. A Polyvagal Thoery. Psychophysiol 1995; 32: 301-318.

Parental Health, Partner Support, and PMADs: Part I

I’m going to open this blog up with a question to all of the parents reading this blog:

How do you differentiate between struggling and suffering?

If you’ve been on social media lately, I’m sure you’ve heard (or seen) the phrase “the struggle is real”. According to Merriam-Webster: to struggle (v): to proceed with difficulty or with great effort.

Now to suffer , here are some definitions (v.):

• to submit to or be forced to endure.

• to feel keenly: labor under

• to put up with especially as inevitable or unavoidable.

• to allow especially by reason of indifference

• to endure death, pain, or distress

• to sustain loss or damage

• to be subject to disability or handicap

According to various studies, parental stress has increased significantly during COVID-19 and has not returned to pre-CV19 levels*. We are collectively short on mental health resources & other ante/postnatal parenting support to meet these enormous demands. From a public health perspective, this is highly problematic as it can have a direct impact on child / family wellbeing. Parents are both struggling and suffering to varying degrees. Is there anything we could have done about this before it became such a colossally pervasive issue?

From a parental perspective, we need to overhaul the amount of support we, as a society, are extending to parents.

• Effective stress management strategies- affordable, attainable, easy to access. Could this be a component of family planning? Certainly.

• Support system scaffolding to aid parents throughout all stages of parenthood. If we have preventive measures in place as early as possible, it would help to mitigate more serious effects in the future (i.e. parental burnout, neglect, maltreatment, etc). Some examples of this type of “scaffolding” include affordable childcare, mental health services for both birthing partner and non-birthing partner, sleep optimization resources, and so forth.

• Collaborative partner support- this is more of an individual discussion, although all parents can have discussions on household equity, their own definition of “household task completion”, and how family-specific tasks are divided amongst all contributing parties.

• More time with your care team!!!!! There are so many bureaucratic reasons why one may have quick ante/postnatal visits (lots of patients, not a lot of time, administrative demands and so on). If you have questions for your care team, you should never feel rushed or dismissed.

• Education on recognizing signs & symptoms of perinatal or postpartum mood and anxiety disorders (PMAD) and differentiating between “baby blues” and PMAD. Roughly 50-80% percent of new moms experience changes in mood and sadness during the first 2-3 weeks following birth which typically resolve without intervention- this is referred to as postpartum “baby blues”.** Baby blues and PMAD are not the same as symptom length and severity are different.**

If you follow @RunTellMom on Instagram, you know that parental health is one of my favorite topics to cover. One of the reasons why I started my @RunTellMom social media account was to provide a space for parents to share stories, to communicate and collaborate with other parents / specialists, and to bring you fresh insight and parental wellbeing resources to further support parents throughout various stages of their parenting journey. One of my favorite collaborators is Scott Mair. He is a Mental Health Campaigner, Author, Army Veteran, Trainer, Speaker and Consultant. Scott has been featured on multiple podcasts including @Therapy4Dads, Bystanders, Knock on Parenthood, to name a few.

Next week’s collaborative blog will feature Scott and some of his favorite tips and tools for parental support and parental wellbeing. Don’t forget to follow along on Instagram and Pinterest!

Stay tuned…

Sources:

1. https://www.frontiersin.org/articles/10.3389/fpsyt.2021.626456/full

2. https://www.chop.edu/conditions-diseases/perinatal-or-postpartum-mood-and-anxiety-disorders

The Importance of Community: Part II

Would you consider a disrupted support system to be a risk factor for postpartum depression?

One of the (many) reasons why community support for parents is so vital…MENTAL WELL-BEING!

In an ideal (frankly realistic!) world, postpartum parents would receive additional external support & extended time off granted for postpartum recovery following the birth of their child(ren). Over the past 2.5 years, support systems have drastically shape-shifted to navigate unpredictable circumstances due to CV-19, leaving many without reliable backup newborn support / childcare, household support, local support, etc.

We have all read & seen statistics on both postpartum depression and postpartum anxiety covered on social media. According to various bodies of research, anywhere from 1 in 7-10 women will experience postpartum depression following birth.(1) It’s also been estimated that approximately 50% of mothers with postpartum depression are not diagnosed by a healthcare professional. (1)

Whether your friend, neighbor, or a beloved family member has postpartum depression OR is exhibiting a change in mood or behavior, one of the most important things to do during that period of time is to demonstrate support, encouragement, and to be nonjudgmental. It can be very difficult for people to reach out if they feel like they are being judged either silently or outright.

What are some of my favorite resources for parents who are struggling to find community and / or may be looking fo additional therapeutic support?

Here are 5 resources to utilize if you or someone you know needs additional support as a postpartum parent:

1. Postpartum Support International: https://www.postpartum.net

   PSI HelpLine: 1-800-944-4773 #1 En Español or #2 English

   Text “Help” to 800-944-4773 (EN), text en Español: 971-203-7773

2. 988 Suicide & Crisis Lifeline: if you or someone you know is struggling or in crisis, help is available. Call or text 988 or chat 988lifeline.org

3. National Alliance on Mental Illness: https://www.nami.org/help

   NAMI HelpLine can be reached Monday through Friday, 10 a.m. – 10 p.m., ET.
   Call 1-800-950-NAMI (6264), text "HelpLine" to 62640 or email us at helpline@nami.org

4. Perinatal Support Washington: https://perinatalsupport.org

   Need help? Call or text our toll free peer support line (se habla español).

   1-888-404-7763

5. The Family Help Line: http://www.parenttrust.org/for-families/call-fhl/ Call: 1-800-932-HOPE (4673) in Washington State
   

It’s not just therapy that is the answer here. It’s adequate resourcing, accessibility, equity, and feeling like you are DESERVING of support.
If you or someone you care about is experiencing concerning symptoms, please connect with a licensed mental health professional or healthcare professional to discuss in more detail.

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Disclaimer: The information on this platform is not intended or implied to be a substitute for personal professional medical advice, diagnosis, or treatment. All Parent Suitcase website & Parent Suitcase social media platform content including text, graphics, images, and information is for general information purposes only & does not replace clinical consultation with your own doctor/mental health professional.

Sources:

1. https://www.postpartumdepression.org/resources/statistics/