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Polyvagal

TheoryThe Neuroscience Behind the Unification of Heart,

Presence, and Voice

AHNA Conference,2019

Thursday, June 6th 9:30am-11:00am

Jaime Vinson, BSN, RN, HN-BC, RYT

What is Polyvagal Theory?

Dr. Stephen Porges and His Discoveries

� Discovered Heart Rate Variability

(HRV) in the 1960’s

� The subtle differences in length

between heart beats

� Good indicator of Vagal tone

� Differences in baseline indicator

resilience and reaction

� Indicator of mental effort

� The difference in how the

heartbeat reacts in different

people

� Neuro influences – biomarkers

� Polyvagal theory in 1994

� New and old branch of the vagus

� Vagal paradox - Sudden infant

death and bradycardia

� Vagal brake – vagal inhibition

� Social engagement system

� Vagal regulation/ dysregulation

� Disassociation

� Uses newer circuits first

� Regulation

Phylogenetic

Evolution

Photo from: Why Evolution is True https://whyevolutionistrue.wordpress.com/2013/04/19/coelacanth-genome-sequenced/coelacanth-genome-tree/

From reptile to mammal

From isolated to community

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The Three

Responses

Fight/Flight

Freeze/Death Feigning

Social Engagement

“The three circuits are organized and respond to challenges in a

phylogenetically determined hierarchy consistent with

the Jacksonian principle of dissolution. Jackson proposed that in the brain,

higher (i.e., phylogenetically newer) neural circuits inhibit lower (i.e.,

phylogenetically older) neural circuits and ‘when the higher are suddenly

rendered functionless, the lower rise in activity.’ Although Jackson proposed

dissolution to explain changes in brain function due to damage and illness,

the polyvagal theory proposes a similar phylogenetically ordered hierarchical

model to describe the sequence of autonomic response strategies to

challenge.” (Porges, The Polyvagal Theory: New Insights into active reactions

of the autonomic nervous system, Cleveland Clinic Journal of Medicine, Vol

75, p. S3 2008)

“Incompatible with the neuro-physiological states and behaviors promoted by the

two neural circuits that support the dangerous fight and flight strategies and the

life-threatening freeze strategies. Thus, via evolution, the human nervous system

retained three neural circuits, which are in a phylogenetically organized

hierarchy. In this hierarchy of adaptive responses, if the newest circuit fail to

provide safety, the older circuits are recruited sequentially”. (Porges, The

Polyvagal Theory, Cleveland Clinic Journal of Medicine, Vol 75, 2008, pp. S3-S4)

Flight

� Increased sympathetic response

� Increased adrenaline

� Breath quickens

� Pupils dilate

� Reduced blood flow to viscera

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Flight

� Increased sympathetic response

� Increased adrenaline

� Breath quickens

� Pupils dilate

� Reduced blood flow to viscera

Photo from: https://computing.ece.vt.edu/~santol/projects/zsl_via_visual_abstraction/interact/interact_stand-alone_dataset/html/interact_dataset_gallery_is_running_away_from.html

Freeze and Death Feigning

� Dorsal or ventral

� Loss of control of bowel and bladder

� Unable to run

� Protective mechanism

� Disassociation

� Pain tolerance is increased

� Not able to respond in a “normal” manner

� Vasovagal syncope

� Reduced cardiac output

Photo from: https://www.businessinsider.com/facebook-versus-ad-blockers-is-a-neverending-ping-pong-game-2016-8?r=UK&IR=T

Co-regulation/the Social Engagement

System

� Play

� Body language

� Voice

� Hearing

� Eating/nursing

Photo retrieved from: https://attachmentdisorderhealing.com/porges-polyvagal/

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Neuroception Kolacz Jacek, Porges Stephen W. (2018) Chronic Diffuse Pain and Functional Gastrointestinal Disorders After Traumatic Stress: Pathophysiology Through a Polyvagal Perspective. Frontiers in Medicine. Volume

5, page, 145. DOI=10.3389/fmed.2018.00145

Neuroception-

It is Written

on Our Faces

Neuroception-

It is Written on Our Faces

Photo from: https://www.medicaldaily.com/breastfeeding-infant-more-6-

months-linked-lower-risk-childhood-leukemia-335896

Neuroception-It is Written on

Our Faces

Photo from: https://www.pinterest.ca/pin/10062799152015002/

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Neuroception-

It is Written

on Our Faces

Neuroception-

It is Written

on Our Faces

Neuroception-

It is Written

on Our Faces

You Hear it in the Voice!

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The Vagal Nerve

The Wanderer � From the brainstem

� The nucleus ambiguous- to the face, soft palate, pharynx, and larynx

� Innervates the heart

� Into the thorax on the between the common carotid artery and left subclavian artery.

� Hooks around the aortic arch

� Splits into the recurrent laryngeal nerve

� Up to the trachea and esophagus

� Thoracic cardiac branches,

� Breaks up into the pulmonary plexus

� esophageal plexus, and

� Enters the abdomen as the anterior vagal trunk at the esophageal hiatus of the diaphragm.

� Innervates visceral organs

The Vagal Nerve- Cranial Nerve X

� Myelinated/Ventral

� Share with most mammals

� “Vagal Brake”

� Social engagement

� Neuroception

� Self-soothing- calming

Uses this system first

� Non-myelinated/Dorsal

� Share with most vertebrates

� Old Vagus

� Recruited during life threat

� Vagal syncope

� Mobilize or immobilize

When social engagement fails us

The Vagal Nerve- Feedback System

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The Vagal Nerve-

Link to the Heart

� The nucleus ambiguus – which

gives rise to the branchial

efferent motor fibers of the vagus

nerve and preganglionic

parasympathetic neurons that

innervate the heart

� Broken Heats?

� Baroreceptor axons connect to

the Vagus- blood pressure

Facial Expression

� Neuroception

� Facial feedback

� Mirror neurons

� What are we saying with our face?

� Allow yourself to hear and feel

someone's story

� Flat faces when we speak with

dissociation

� Can you hold back happiness?

The trigeminal nerve (V), the facial (VII), glossopharyngeal (IX),

and vagus nerves (X) also convey information to the spinal

trigeminal nucleus.

Eating/nursing

� Uses many nerves in the face

� Uses nerves to coordinate

swallowing and breathing

� Social engagement or source

of survival?

� Breastfeeding – facial

feedback

https://www.fitpregnancy.com/baby/breastfeeding/nutrition-tips-breastfeeding-moms

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The Vagal Nerve-

Link to the

Subdiaphragmatic

Organs

•Nervous stomach

•Feeling content

•Bloated

•Gut feelings

•Loss of bowel or bladder

The Vagal Nerve- Link to the Middle Ear

� Innervate the inner (canal) portion of the outer ear

� Auricular branch - Alderman's nerve

� Laryngeal cancer can present with

pain behind the ear.

� Transcutaneous Vagus Nerve

Stimulation to prevent seizure

(being researched in the US

available in Europe)

� Bones are unattached to the

mandible

� What do you hear?

Photo retrieved from: http://www.dallasear.com/cochlear-implant-ear-education.html

The Vagal Nerve-

Link to the

Larynx

Voices crack

Can you hear a lie?

How does it make you feel to

talk?

Photo retrieved from: http://laryngealtransplant.blogspot.com/2013/11/human-larynx-innervation.html

Techniques

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Cues of Safety throughout History- Yoga

Cues of Safety throughout History-Pranayama

� Kapalabhati – skull shining

� Ujjayi – ocean breath

� Nadi Shodhana – alternate

nostril breathing

� Dirga – three part breath

� Bhramari - bumble bee breath

� Lions breath

Cues of Safety Throughout History-Singing/Chanting Cues of Safety Throughout History- Music

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Cues of Safety Throughout History- Music

HAKA

� https://www.youtube.com/watch

?v=rX4Q4AaVELw

Cues of Safety Throughout History-

Eating/Nursing

Cues of Safety throughout History-Posture/Prayer

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Putting the Theory to Work

Neuroception- The Breathing Exercise Find a friend!

The Power of

Voice- Singing

Exercise

Singing

Exercise

Sing Out

LOUD!!!

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The Power of Sound- Tibetan

Singing Bowl Sound Bath Application Into Practice

How does it

relate?

TRAUMA RESPONSE?

WEIGHT GAIN/LOSS?

CONVERSION DISORDER?

ANXIETY

SOCIAL ISOLATION

AGORAPHOBIA? LOUD VOICE/NOISES

Cues of Safety in the Hospital Environment

� Removal of low frequency sound

� What is on the TV?

� What are they hearing in the next

room/nurses station?

� Awareness of facial expression

� What else????

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Conscious Manipulation of the Vagal

System

� Breath- Teach Breathing Techniques

� Sound- Play Happy Music

� Voice- Hum and Sing

� Other- (Smiles, etc.)/ Discussion Questions?

References

Dana, D. A. (2018). The Polyvagal Theory in Therapy: Engaging the Rhythm of Regulation (Norton Series on Interpersonal Neurobiology). New York, NY: W. W. Norton & Company.

Porges, S. W. (2008). The Polyvagal Theory, Cleveland Clinic Journal of Medicine, Vol 75.

Porges, S. W. (2011). The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-regulation (Norton Series on Interpersonal Neurobiology). New York, NY: W. W. Norton & Company.

Porges, S. W. (2014). Clinical Insights from the Polyvagal Theory: The Transformative Power of Feeling Safe (Norton Series on Interpersonal Neurobiology). New York, NY: W. W. Norton.

Porges, S. W. (2017). The Pocket Guide to the Polyvagal Theory: The Transformative Power of Feeling Safe (Norton Series on Interpersonal Neurobiology). New York, NY: W. W. Norton & Company.

Porges, S. W., & Dana, D. A. (2018). Clinical Applications of the Polyvagal Theory: The Emergence of Polyvagal-Informed Therapies (Norton Series on Interpersonal Neurobiology). New York, NY: W. W. Norton & Company.