The Polyvagal Theory of Trauma

The Polyvagal Theory of Trauma

Trauma is an experience that a person’s perception takes in as deeply disturbing or distressing emotional shock. This psychological trauma to the mind can lead to acute or chronic symptoms of post-traumatic stress disorder (PTSD). According to the National Institutes of Health, at least 70 percent of the U.S. population experience a traumatic situation at least once in their lives, and up to 20 percent of them develop PTSD. Individuals diagnosed with PTSD are among those using the highest rates of health care services [6]. Stephen Porges, M.D., created a valuable framework that changed how trauma is understood with research focused on the neurological response to trauma that led to the polyvagal theory.

Trauma Response Basics

The body has two nervous systems that play a role in the response to events in the environment: the central nervous system (CNS), which includes the brain and spinal cord, and the peripheral nervous system (PNS), which includes all the other nerves and ganglia throughout the body. The CNS runs thoughts and sensations and the PNS helps to regulate muscles, limbs and organs. The PNS consists of two parts: the somatic nervous system, which controls voluntary movements, and the autonomic nervous system (ANS), which controls involuntary body systems. The ANS has two parts: the somatic controls the fight-or-flight response and the parasympathetic controls resting and digesting [4].

Polyvagal Theory Basics

Dr. Stephen Porges’ research focused on an advanced understanding of the ANS as it related to trauma and the subsequent resulting PTSD. The ANS is regulated by the tenth cranial nerve, the vagus, which is the largest parasympathetic nerve and inhibits activity in the sympathetic system. It connects the brain to the major body systems, such as the heart, lungs, stomach, digestion and facial muscles. The vagus nerve contains two parts: the ventral vagal and the dorsal vagal pathways that work in a top-down way.

Dr. Porges’ theory focused on these two parts of the vagus nerves system. The ventral vagal system supports the individual’s sociability and safety. Feeling safe, comfortable and connected to others means the ventral vagal pathway is in charge. The dorsal vagal pathways take over in the face of danger, which removes the person from awareness to a protective state of feeling numb or frozen. When the individual is mobilized (normal life activities), the sympathetic system is in charge [1].

The Body’s Response to Trauma

The ANS is a top-down system. At the top is the social engagement system that regulates breath, heartbeat, voice and facial expression. From here, individuals take information from the environment to determine if they feel safe to function normally or if the situation feels unsafe. If a threat is detected, the social engagement system’s first response is to communicate. If communication does not dispel the threat, the sympathetic system triggers the flight response to leave the situation. If leaving is not an option, the fight response takes over. If fighting is impossible, the situation is now perceived as life-threatening, and the parasympathetic system will take over to immobilize the individual, who will freeze, dissociate or faint [3]. For a visual explanation, watch this short video.

How the Effects of Trauma Can Affect a Person

A person will develop one of three modes of coping with stress. First, is the resilient coping in which the individual has high vagal tone and can experience activation and relaxation with internal composure versus using the fight or flight response. Resilient coping leads to a high level of social engagement and social supports as the person is able to navigate through their environment without a high level of over-responsiveness to stress.

The second type of coping with stress is the fight-flight response. The individual will often misinterpret a situation to be a dangerous one and will quickly respond with the fight or flight response. These reactions can become the person’s behavioral habits, such as generally fighting or fleeing any perceived stressful (interpreted as dangerous) situation. Sociability is inhibited during the fight-flight response, so this person is less sociable, resulting in fewer social supports.

The third type of coping is to freeze. This individual will interpret stressful situations as overwhelmingly dangerous, perceive themselves as helpless, and freeze or dissociate from the situation. Sociability is the lowest for this individual, who will be unable to engage with others for social support [1].

Using the Polyvagal Theory for Treatment

According to the polyvagal theory, traumatic events are sensory and based in the body instead of in cognition. Keeping this in mind while treating an individual with PTSD, it changes the approach from initial talking therapy to a focus on creating basic safety first. The individual is unlikely to access the trauma without being in a relaxed state. Safety will allow for and strengthen a therapeutic alliance in which stress management coping skills can be taught before approaching the trauma.

Yoga, meditation and mindfulness have been found to be effective in helping to create a sense of control and safety. Using mindfulness practices, such as a three-minute meditation focused on the breath, improves the individual’s focused move to their body. In using a mindfulness approach to talking about the event as a story, the focus is more on the sensations it created. For example, if the individual was traumatized by witnessing a shooting, the mindfulness approach would focus on the person’s senses and bodily response to the event.

Conclusion

The polyvagal theory helps to provide a better understanding of trauma and the resulting PTSD. It can be helpful for understanding why a person exposed to trauma may avoid, fight or freeze during social interactions. It can provide some guidance on how to approach treating an individual with trauma in a way that does not re-traumatize or create a barrier to treatment.

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