Dana - The polyvagal theory in therapy : engaging the rhythm of regulation

THE
POLYVAGAL
THEORY
IN
THERAPY

To Steve with gratitude for inviting me to join him on this great adventure, to my Polyvagal family who reminds me Im not alone, and to Bob who fills my heart with joy every day.

Since Polyvagal Theory emerged in 1994, I have been on a personal journey expanding the clinical applications of the theory. The journey has moved Polyvagal concepts and constructs from the constraints of the laboratory to the clinic where therapists apply innovative interventions to enhance and optimize human experiences. Initially, the explanatory power of the theory provided therapists with a language to help their clients reframe reactions to traumatic events. With the theory, clients were able to understand the adaptive functions of their reactions. As insightful and compassionate therapists conveyed the elements of the theory to their clients, survivors of trauma began to reframe their experiences and their personal narratives shifted to feeling heroic and not victimized. The theory had its foundation in laboratory science, moved into applied research to decipher the neurobiological mechanisms of psychiatric disorders, and now through the insights of Deb Dana and other therapists is informing clinical treatment.

The journey from laboratory to clinic started on October 8, 1994 in Atlanta, when Polyvagal Theory was unveiled to the scientific community in my presidential address to the Society for Psychophysiological Research. A few months later the theory was disseminated as a publication in the societys journal, Psychophysiology (Porges, 1995). The article was titled Orienting in a Defensive World: Mammalian Modifications of Our Evolutionary Heritage. A Polyvagal Theory. The title, crafted to cryptically encode several features of the theory, was intended to emphasize that mammals had evolved in a hostile 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.

In 1994 I was totally unaware that clinicians would embrace the theory. I did not anticipate its importance in understanding trauma-related experiences. Being a scientist, and not a clinician, my interests were focused on understanding how the autonomic nervous system influenced mental, behavioral, and physiological processes. My clinical interests were limited to obstetrics and neonatology with a focus on monitoring health risk during delivery and the first days of life. Consistent with the demands and rewards of being an academic researcher, my interests were directed at mechanisms. In my most optimistic dreams of application, I thought my work might evolve into novel assessments of autonomic function. In the early 1990s I was not interested in emotion, social behavior, and the importance of social interactions on health and the regulation of the autonomic nervous system; I seldom thought of my research leading to strategies of intervention.

After the publication of the Polyvagal Theory, I became curious about the features of individuals with several psychiatric diagnoses. I noticed that research was reliably demonstrating depressed cardiac vagal tone (i.e., respiratory sinus arrhythmia and other measures of heart rate variability) and atypical vagal regulation of the heart in response to challenges. I also noticed that many psychiatric disorders seem to share symptoms that could be explained as a depressed or dysfunctional Social Engagement System with features expressed in auditory hypersensitivities, auditory processing difficulties, flat facial affect, poor gaze, and a lack of prosody. This curiosity led to an expanded research program in which I conducted studies evaluating clinical groups (e.g., autism, selective mutism, HIV, PTSD, Fragile X syndrome, borderline personality disorder, women with abuse histories, children who stutter, preterm infants). In these studies Polyvagal Theory was used to explain the findings and confirm that many psychiatric disorders were manifest in a dysfunction of the ventral vagal complex, which included lower cardiac vagal tone and the associated depressed function of the striated muscles of the face and head resulting in flat facial affect and lack of prosody.

In 2011 the studies investigating clinical populations were summarized in a book published by Norton, The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation. The publication enabled Polyvagal Theory to become accessible to clinicians; the theory was no longer limited to the digital libraries linked to universities and research institutes. The publication of the book stimulated great interest within the clinical community and especially with traumatologists. I had not anticipated that the main impact of the theory would be to provide plausible neurophysiological explanations for experiences described by individuals who had experienced trauma. For these individuals, the theory provided an understanding of how, after experiencing life threat, their neural reactions were retuned towards a defensive bias and they lost the resilience to return to a state of safety.

This prompted invitations to talk at clinically oriented meetings and to conduct workshops on Polyvagal Theory for clinicians. During the past few years, there has been an expanding awareness of Polyvagal Theory across several clinical areas. This welcoming by the clinical community identified limitations in my knowledge. Although I could talk to clinicians and deconstruct their presentations of clinical cases into constructs described by the theory, I was not a clinician. I was limited in how I related the theory to clinical diagnosis, treatment, and outcome.

During this period, I met Deb Dana. Deb is a talented therapist with astute insights into trauma and a desire to integrate Polyvagal Theory into clinical treatment. For Deb, Polyvagal Theory provided a language of the body that paralleled her feelings and intuitive connectedness with her clients. The theory provided a syntax to label her and her clients experiences, which were substantiated by documented neural mechanisms. Functionally, the theory became a lens or a perspective in how she supported her clients and how she reacted to her clients. The theory transformed the clients narrative from a documentary to a pragmatic quest for safety with an implicit bodily drive to survive. As the theory infused her clinical model, she began to develop a methodology to train other therapists. The product of this transition is the current book. In The Polyvagal Theory in Therapy, Deb Dana brilliantly transforms a neurobiologically based theory into clinical practice and Polyvagal Theory comes alive.

References

Porges, S. W. (1995). Orienting in a defensive world: Mammalian modifications of our evolutionary heritage. A Polyvagal Theory. Psychophysiology, 32(4), 301318.

Porges, S. W. (2011). Norton Series on Interpersonal Neurobiology. The Polyvagal Theory: Neurophysiological foundations of emotions, attachment, communication, and self-regulation. New York, NY: Norton.

Embarking on this journey, I discovered that in order to write I needed to step out of the flow of my ordinary life. And so, my husband and I moved to an ancient stone cottage in Sainte-Marie-du-Mont, France for a month. It was there I found my writing rhythm, moving in harmony with the ringing of the bells from the cathedral across the street that have marked the passage of time since the 11th century. The bells became a mantra for me as the words came, pages filled, and the first part of the book took shape. The rest of the book was written in Kennebunkport, Maine in my house near the sea at the edge of the woods. The trees and the ocean offered their steady presence, guiding me back into regulation when the challenge of finding the right words felt overwhelming.