overview: the polyvagal theory alternative organizing …the polyvagal theory: the autonomic nervous...

The following document is a reproduction of slides presented at a workshop in Zurich conducted on May 18-19, 2003. The material contained in this document are only for the educational use of the workshop participants.

© 2003 Stephen W. Porges. All rights reserved

The Polyvagal Theory: The Autonomic Nervous System RevisitedImplications for Somatic Psychotherapists

Stephen W. Porges, Ph.D. Brain-Body Center

Department of PsychiatryUniversity of Illinois at Chicago

[email protected]© 2003 Stephen W. Porges. All rights reserved

Overview: The Polyvagal Theory1. Evolution provides an organizing principle to understand

neural regulation of the human autonomic nervous system.

2. Three neural circuits form a phylogenetically-ordered response hierarchy that regulate behavioral and physiological adaptation to safe, dangerous, and life threatening environments.

3. “Neuroception” of danger or safety or life threat trigger these adaptive neural circuits.

4. New models relating neural regulation to health, learning, and social behavior may be reversed- engineered into treatments.


Alternative Organizing Principles


The metaphor of safety: A basic principle of our nervous system

Environmentoutside the bodyinside the body

Nervous System

Safety Danger

Neuroception

Spontaneously engages otherseye contact, facial expression, prosody supports visceral homeostasis

Defensive strategiesfight/flight behaviors (mobilization)

Life threat

Defensive strategiesdeath feigning/shutdown (immobilization)


Evolution

X-X+X+X-X+Mammals

X+X+X-X+Reptiles

X+X-X+Amphibians

X+X-X+Teleosts

X-X+Elasmobranchs

X+Cyclostomes

NAAD/mSNSDMXCHMNeural Regulation of the Heart in Vertebrates

CHM = chromaffin tissue DMX = dorsal motor nucleus of the vagus SNS = sympathetic nervous system AD/m = adrenal medulla NA = nucleus ambiguus


Polyvagal Theory: Emergent “Emotion” Subsystems

VVC SNS DVCheart ratebronchigastrointestinalvasoconstrictionsweatadrenal medullatearsvocalizationfacial muscles

+ / -+ / -

+ / -+ / -+ / -

++

+++

-

--

+

eyelidsmiddle ear muscles

+ / -+ / -


Polyvagal Theory: Phylogenetic Stages of Neural Control

Dorsal motor nucleus of the vagus

Immobilization (death feigning, passive avoidance)

Unmeyelinated vagus(DVC – dorsal vagal complex)

I

Spinal cordMobilization (active avoidance)

Sympathetic-adrenal system(SNS – sympathetic nervous system)

II

Nucleus ambiguusSocial communication, self-soothing and calming, inhibit sympathetic-adrenal influences

Myelinated vagus(VVC – ventral vagal complex)

III

Lower motor neurons

Behavioral FunctionANS ComponentStage


VVC SNS DMX

Communication

Mobilization

Immobilization

+

+

+

FunctionStructure

Head

Limbs

Viscera

Polyvagal Theory: A Phylogenetic Hierarchy of Response Strategies


Phylogenetic Organization of the ANS: The Polyvagal Theory

head

visceralimbs

trunk

“old” vagus



head

visceralimbs

trunk

Sympathetic NervousSystem

Corticospinal Pathways


Mobilization: Flight


Mobilization: Fight



head

visceralimbs

trunk

“new” vagusCorticobulbar pathways


The “Smart” Vagus and Social Engagement System

Cranial Nerves V,VII,IX,X,XI

Muscles of Mastication

Middle Ear Muscles

Facial Muscles

Larynx Heart

Head Turning

Bronchi

Pharynx

cortex

brainstem

environment© 2003 Stephen W. Porges. All rights reserved

Social Engagement System:Emergent Behaviors at Birth


Looking and Listening: Common Neurophysiological Mechanisms


The Listening Project:Before Intervention

Borg & Counter, 1989Scientific Americant


VVC SNS DMX

Communication

Mobilization

Immobilization

+

+

+

FunctionStructure

Head

Limbs

Viscera

Polyvagal Theory: A Phylogenetic Hierarchy of Response Strategies


The Face: A Critical Component of a Social Engagement System

•Unlike reptiles, the mammalian nervous system needs a “caregiver” to survive and signals the caregiver via the muscles of the face and head.

•The face is “hardwired” to the neural regulation of visceral state via a mammalian “neural circuit.”

•Physical and mental illness retract the “mammalian” neural circuit with the resultant symptoms of a face that does not work.


Unveiling Darwin


Social Engagement System: Observable Deficits in Several Psychiatric and

Behavioral Disorders

• Prosody

• Gaze

• Facial expressivity

• Mood and affect

• Posture during social engagement



head

visceralimbs

trunk

“new” vagusCorticobulbar pathways

My Child’s Face Does Not Work!

Gabriel Metzu, The Sick Child


When Other Faces Do Not Work!


Beauty is a journey that starts with a

choice… Learn about your

Choices

Beauty is a journey that starts with a

choice… Learn about your

Choices

When the nervous system fails use Botox!


Autism


The “Social Nervous System”

Frontal cortex

Precentral gyrus

Medullary source nuclei of SVE

Laryngeal Pharyngeal

Head turning

Facial Middle ear HeartBronchi Thymus

Muscles of the Head

Neuropeptides

AVP OT

HPA axis

Visceromotor Components

Somatomotor Components© 2003 Stephen W. Porges. All rights reserved

Voodoo Death: Insights into PTSD

His cheeks blanch, and his eyes become glassy, and the expression of his face becomes horribly distorted. He attempts to shriek but usually the sound chokes in his throat, and all that one might see is froth at his mouth. His body begins to tremble and his muscles twitch involuntarily. He sways backward and falls to the ground, and after a short time he appears to be in a swoon. He finally composes himself, goes to his hut and there frets to death.

R. Herbert Basedow (1925), The Australian Aboriginal


Voodoo Death: Insights into PTSD

• Voodoo Death was defined as death due not disease or injury, but do to emotional stress.

• Cannon assumed that even this "immobilized" response would be associated with increased sympathetic nervous system excitation.

• "If in the future, however, any observer has opportunity to see an instance of voodoo death, it is to be hoped that he will conduct the simpler tests before the victim's last gasp.”

Cannon, W.B. (1942) "Voodoo" death. Amer. Anthropol., 44: 169.


Hopelessness: Vagal or Sympathetic Mechanisms?

“...we believe that human victims, like our rats, may well die a parasympathetic rather than a sympathico-adrenal death, as Cannon postulated”

C.P. Richter (1957)


A New Paradigm?

• If social behaviors are not learned, are they emergent properties of specific neurophysological states?

• If dysfunctional social behavior is a spontaneously occurring emergent property of the nervous system (i.e., part of a feedback loop), could intervention strategies be focused on manipulating or supporting the neurophysiological states (e.g., engaging and exercising feedback loops) from which social behavior would spontaneously occur?


New Model

Mobilization

“Insult”

Behavioral/PsychologicalOutcomes

Immobilization

Social Nervous System

Social CommunicationState regulation

HyperarousalHypervigilance

AvoidantSocial Withdrawal

Affect limitationsSelf-medication

Dissociative statesRisk of Suicide

HypertensionGut problems

Anxiety disorders

HypotensionVasovagal syncope

Fibromyalgia


Reverse Engineering: A Treatment Model

Mobilization

Intervention

Behavioral/PsychologicalOutcomes

Immobilization

Social Nervous System

Social Communication

Enhanced social behavior, affect regulation, state regulation


Principle 1. Less is more (fragile system)Principle 2. The intervention must occur in a “safe” environment (“neuroception”)Principle 3. The auditory system has an efferent component that actively select human voice from background sounds (corticobulbar)Principle 4. Due to common embryological development in the nervous system, the cortical regulation required to select human voice will improve state regulation and social behavior (special visceral efferent pathways - SVE)

The Listening Project:Principles of Intervention


Principle 1. Less is more (fragile system)Principle 2. The intervention must occur in a “safe” environment (“neuroception”)Principle 3. The auditory system has an efferent component that actively select human voice from background sounds (corticobulbar)Principle 4. Due to common embryological development in the nervous system, the cortical regulation required to select human voice will improve state regulation and social behavior (SVE)

The Listening Project:Principles of Intervention


The Listening Project:During Intervention


Improved Social Engagement


Percentage of Children

0 20 40 60 80 100

hearing sensitivityspontaneity

communicationspeech

listeningcontingencyrelatedness

eye contactbehavioral organization

em otional control

affect expressionhyperactivity

Improvem ent post Intervention-1Improvem ent post Placebo-1

Behavioral Improvements


Follow-up Assessments

Percentage of C h ildren

0 20 40 60 80 100

Im m ediate Im provem entIm provem ent fo llow ing 1 m onthIm provem ent fo llow ing 3 m onths

hearing sensitiv ity

spon tane itycom m unica tion

speechlisten ing

con tingencyre latedness

eye contact

behaviora l organizationem otional contro l

affect express ionhyperactiv ity


John’s Story: Before


Six Months Later


Measuring Eye Gaze

© 2003 Stephen W. Porges. All rights reservedOff = 79% Eye = 10% Mouth = 11%


Off = 21% Eye = 33% Mouth = 46%© 2003 Stephen W. Porges. All rights reserved

The Listening Project:Effects of the Intervention?

Triggers the “Social Engagement System”

Stimulates processes associated with attention, intention, and contingency

Increases looking, listening, vocalizing and responding

Increases the “integration” of social engagement behaviors


What we know?

• Noticeable effects on the Social Engagement System in 3-5 year old ASD

• Effects observed in about 80% of approximately 100 subjects

• Parental reports

• Behavioral coding of video tapes


What Needs to be Done?• Apply The Listing Project to other psychiatric diagnostic categories that have affect regulation problems.

•Validate the neural mechanisms mediating the behavioral changes (fMRI, NIRS, ANS, facial EMG & IR thermography) to demonstrate the involvement of frontal areas of cortex (i.e. corticobulbar pathways).

•Expand intervention strategies to efficiently trigger neural circuits to support social behavior


Summary• “Neuroception” of safety or danger mediates the

beneficial consequences of social behavior.• Autonomic reactions to challenges are organized

in a phylogenetically-determined hierarchy.• Various atypical behaviors are adaptive for short

periods.• Several psychopathologies are expressed as

deficits in the Social Engagement System.• Biologically-based behavioral interventions can

trigger neural circuits that mediate positive social behavior.


The Future of Biobehavioral Research:New Organizational Principles

Several physical and psychiatric diseases are emergent properties of the neural regulation of the autonomic nervous system (feedback, evolution, development)

New diagnoses and new treatments will emphasize measurement and manipulation of the neural regulation of the autonomic nervous system

Environments will be designed that support the functions of the nervous system

– Computers that modulate neural regulation of the ANS

– Quiet environments

– Nervous system “friendly” classrooms

– Improved social behavior: People need people – a biological basis


Blissful, but not social!


overview: the polyvagal theory alternative organizing …the polyvagal theory: the autonomic nervous...

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