18 Polyvagal Theory & How to Use the Exercises in Therapy

Ongoing research suggests that a better understanding of the vagus nerve could revolutionize how we treat various physical and mental health conditions, including epilepsy, obesity, inflammatory disorders, depression, and anxiety (Wade, 2023; Neuhuber & Berthoud, 2022).

According to the polyvagal theory, lowering “autonomic states that support threat reactions” (Porges, 2022, p. 2) and boosting ones that encourage feelings of safety can benefit our psychological wellbeing, potentially helping individuals who have experienced trauma.

This article introduces the polyvagal theory and some of its challenges and offers exercises and resources to support its use by mental health practitioners with their clients.

Before you continue, we thought you might like to download our five positive psychology tools for free. These science-based exercises will equip you and your clients with tools to better manage stress and find a healthier balance in your life.

The Polyvagal Theory Explained Simply

It is widely accepted that there are two distinct and continuously active divisions in our autonomic nervous system (Bridges & Porges, 2015; Tindle & Tadi, 2022).

• The parasympathetic system is associated with us being calm. When active, our heart rate is down, our breathing is regular, and our digestive system feels comfortable.
• On the other hand, when our sympathetic–adrenal system is on high alert, our heart rate is elevated, adrenaline is secreted, and ingestion and digestion are difficult. During this time, our focus moves to the safety of our bodies (Bridges & Porges, 2015).

According to polyvagal theory, the two systems are in constant dialogue. When everything runs normally, there is a bidirectional flow of energy and information, and the two work in harmony (Bridges & Porges, 2015).

However, when there is a problem and we feel threatened, that flow changes, and we engage our primary survival mechanism — fight or flight  — and are primed for action (Bridges & Porges, 2015).

It’s not always a bad thing. Whether our ancestors were escaping a lion, or we are jumping out of the way of a taxi, we need heightened awareness, focus, and instantaneous action to maintain our safety.

The theory holds that even when a threat has passed, our bodies can remain in a state of perceived danger, our defenses engaged, and we experience prolonged stress and anxiety. We can be left with trauma present in the body in the same way it inhabits our memories (National Institute for the Clinical Application of Behavioral Medicine, 2022).

As a result, treating trauma may be less about managing the upsetting experience and more about treating the resulting physiological response (National Institute for the Clinical Application of Behavioral Medicine, 2022).

Bridge and Porges (2015) have also suggested that several of the markers associated with autism, such as reduced social engagement, poor facial affect, and auditory hypersensitivities, may also result from disruption to the autonomic state.

Stephen Porges and the Origin of the Theory

“The vagus nerve is a bundle of neurons connecting the brain to many of the major organs, with nerves running both from the organ to the brain and vice versa” (Wilson, 2011, para. 2). Among other things, it helps regulate our heart rate, breathing, and appetite.

The polyvagal theory was developed by Stephen Porges, founding director of the Traumatic Stress Research Consortium at Indiana University, in the early 1990s. His research into the vagus nerve suggested a link between our evolved autonomic nervous system and our social behavior, behavioral problems, and psychiatric disorders (Kseib, 2022; Polyvagal Institute, n.d.).

The theory’s proponents believe it offers a “mind–brain lens” to examine, explore, and resolve psychological problems (Simpkins & Simpkins, 2013, p. 236).

According to Porges (1995), the autonomic nervous system has three primary states:

• Ventral vagal state
  A calm and connected state that supports social engagement, emotional regulation, and effective problem-solving
• Sympathetic state
  Includes the “fight or flight” response associated with fear and anxiety that helps individuals respond (though not always appropriately) to perceived threats
• Dorsal vagal state
  Connected with immobilization and shutdown responses, potentially leading to feelings of dissociation, numbness, and disconnection

Porges (1995) suggests that trauma leads to shifts in our autonomic state.

When in a state of threat, our nervous system fails to regulate bodily organs or manage social relationships successfully, and our priorities change. We move away from growth, restoration, health, and forming connections with others to survival and the here and now (Kseib, 2022; Porges, 2022).

The polyvagal perspective argues that we should think of trauma in terms of retuning the nervous system. To heal ourselves or our client, we should give the “nervous system the cues of safety so that it re-tunes itself to being more homeostatic,” says Porges (as cited in Kseib, 2022, para. 7).

As a result, when we start to listen to our nervous system, we lose the feelings of shame and hopelessness associated with believing we are at fault, freeing us to navigate through complex or challenging environments (Kseib, 2022).

Clinicians often measure vagal (relating to the vagus nerve) tone as an indication of levels of vagal activity. While impossible to observe directly, it can be estimated through heart rate variability — the time fluctuations between heartbeats (Marmerstein et al., 2021).

The window of tolerance

The window of tolerance is not a term central to the polyvagal theory and was not developed by Porges, yet it broadens our perspective on the activation and regulation of the nervous system (Siegel, 1999).

According to Siegel (1999), it is a physiological and emotional regulation state where individuals can effectively cope with stressors and engage in social interactions.

As a result, understanding, promoting, and expanding this window may be considered central to supporting wellbeing and resilience (Siegel, 1999).

Criticisms Against the Theory

Despite gaining widespread recognition and acceptance in the field of psychology and therapy, the polyvagal theory has been met with criticism.

Lack of empirical evidence

Critics argue that while the theory is compelling, it lacks robust empirical evidence to support its claims. Therefore, more rigorous research has been called for to validate its predictions further (Cacioppo et al., 2016).

Simplistic view of the nervous system

The polyvagal theory may oversimplify the complexities of the autonomic nervous system. As a result, some experts suggest a more nuanced and multifaceted view to fully understand the nervous system’s functioning (Porges, 2018).

Overemphasis on vagal tone

The theory heavily emphasizes vagal tone as a central indicator of the autonomic nervous system’s interplay with other physiological systems, such as the endocrine system (Beauchaine, 2015).

While these and other criticisms exist, the polyvagal theory has also received considerable support and is integrated into various therapeutic approaches (Dana & Porges, 2018).

A Scientific Look at Healing Trauma

Prescription drugs are a common treatment for trauma, with individuals often experiencing improvements in their overall coping and wellbeing. Yet research shows that pharmaceuticals can have their pitfalls, including side effects and subsequent resurfacing of symptoms when treatment ends (Althaver, 2020).

Psychotherapy has also been effective for treating clients who have experienced trauma, with therapists adopting various approaches, including the following (Althaver, 2020):

• Cognitive-Behavioral Therapy (CBT)
  Changing thoughts and beliefs about the trauma to transform emotions and behaviors
• Eye-movement desensitization and reprocessing (EMDR)
  Stabilizing thought processes by using dual attention to strengthen connections between brain hemispheres and disrupting the traumatic memory network (American Psychological Association, n.d.)

Studies have shown both CBT and EMDR to be effective at healing trauma in clients (Van der Kolk, 2015; Wheeler, 2007). Other treatments include virtual reality, yoga therapy, and mindfulness training (Althaver, 2020).

Training in Polyvagal Theory – 5 Courses

The following trainings provide an opportunity to form a deeper understanding of polyvagal theory and how to use it with clients.

The Polyvagal Institute

Experts in the field, including Stephen Porges and Deb Dana, teach the following courses:

• Overview of Polyvagal Theory for the Newly Acquainted
  Two hours of recorded lectures providing a foundation in polyvagal theory and its potential for application
• Polyvagal Theory: Principles & Practice for Individuals
  The practices and principles of polyvagal theory and how to bring them into clinical practice
• The Art & Science of Polyvagal Theory
  A deep exploration of the polyvagal theory and its scientific foundations that culminates in a clinical case study

Find out more from the Polyvagal Institute.

National Institute for the Clinical Application of Behavioral Medicine

The National Institute for the Clinical Application of Behavioral Medicine offers various courses that explore the theory and treatment of trauma.

• The Advanced Master Program on the Treatment of Trauma
  This five-module training program developed by several leading experts, including Stephen Porges and Deb Dana, explores how to treat trauma and work with emerging defense responses to trauma.
• Rethinking Trauma
  Understand the role of the brain and the nervous system in responding to and treating trauma. The course recognizes the importance of the polyvagal perspective in providing more targeted treatments.

Find out more from the National Institute for the Clinical Application of Behavioral Medicine.

10 Polyvagal Exercises to Use in Therapy

The goal of therapeutic interventions informed by polyvagal theory is to help individuals expand their window of tolerance. They promote self-awareness and self-regulation techniques that can return the autonomic nervous system to a regulated state (Porges, 2018).

To do so, therapists often use techniques such as mindfulness, deep breathing, and various forms of somatic (or bodily) therapy with clients (Fallis, 2017).

Deep and slow breathing

Deep, slow breathing has been shown to stimulate the vagus nerve, reduce anxiety, and boost the parasympathetic system (Fallis, 2017).

Try several of our free breathing and grounding exercises.

• Anchor Breathing Exercise
  The exercises include seven steps based on breathing deeply and calmly, while visualizing an anchor to represent staying where you want to be.
• Alternate Nostril Breathing
  Inhaling through one nostril at a time will help you breathe better and more consciously.
• Square Breathing
  Imagine breathing in and out while following the sides of a square to regain a calm sense of control.
• Three Steps to Deep Breathing
  Work through thoracic, clavicular, and abdominal breathing with these three steps.

Meditation and mindfulness

Mindfulness and meditation can stimulate the vagus nerve and improve vagal tone (Fallis, 2017).

Try these two exercises to improve your meditation practice.

• The Raisin Meditation
  Use the touch, taste, smell, and sight of a raisin to encourage mindfulness and provide a meditative focus.
• The Five Senses Worksheet
  This worksheet uses the five senses to reach a mindful state.

Somatic experiences

Somatic experiences, such as singing, humming, dancing, and touch, have also been linked to polyvagal techniques (Fallis, 2017).

Here are three worksheets that make use of somatic experiences.

• The Voo Sound
  This exercise is used to regulate the body’s responses and avoid or reduce overriding the nervous system.
• Shake It Off
  Shaking it off can help individuals soothe and calm themselves by releasing excess energy resulting from the stress response.
• Self-Soothing Touch
  This is a purposeful concentration on self-calming behaviors like touch that can benefit the nervous system.

Cold water exposure

Immersion in cold water, whether turning the temperature down for the final 30 seconds of a shower or purposeful dips in a frigid body of water, can calm the sympathetic fight-or-flight response, reduce inflammation in the body, and help with mental health conditions such as anxiety and depression (Barnes, 2011; Harper, 2022).

3 Books About the Polyvagal Theory

Polyvagal theory continues to fascinate researchers, academics, and mental health practitioners. It offers an alternative or addition to many more-established ways of thinking about trauma and mental wellness.

The following books are three of our favorites on the theory.

1. The Polyvagal Theory in Therapy: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-regulation – Stephen W. Porges

Stephen Porges combines decades of research into one vital text and explores the role of the autonomic nervous system in mediating social engagement, intimacy, and trust.

It is an essential book both for those new to the theory and existing researchers wishing to dig deep into the findings underpinning the approach.

Find the book on Amazon.

2. Our Polyvagal World: How Safety and Trauma Change Us – Stephen W. Porges and Seth Porges

This engaging and practical book takes the reader deep into the practical application of Porges’s work and theory.

The content challenges accepted thinking on managing stress and retaining calm in the modern world and offers practical approaches to real-world problems regarding trauma.

Find the book on Amazon.

3. The Polyvagal Theory in Therapy: Engaging the Rhythm of Regulation – Deb Dana

Deb Dana has written a fascinating book that explores how we can apply polyvagal theory in therapeutic settings with clients.

It offers an essential approach for those wishing to help re-pattern their clients’ nervous systems and new solutions for those offering support for trauma victims.

Find the book on Amazon.

Related Resources From PositivePsychology.com

If you’ve found this look at polyvagal theory interesting, you may also enjoy our article on the biopsychosocial model of health.

This article explores how biological, psychological, and social factors interact to shape health and nervous system functioning, offering a whole-person framework for situating polyvagal theory within broader wellbeing.

We also have various resources available for therapists working with clients who have been through difficult and traumatic events and situations.

Our free resources include:

• Growing Stronger From Trauma
  Optimism can encourage you to find the positives in a traumatic event and help identify the strengths developed along the way.
• EMDR Worksheet
  This worksheet supports practitioners using eye-movement desensitization to help clients cope with trauma by focusing on the positives.
• Imaginal Exposure Worksheet
  Use the Subjective Units of Distress Scale to score your anxiety while performing imaginal exposure.

More extensive versions of the following tools are available with a subscription to the Positive Psychology Toolkit©, but they are described briefly below:

SOBER Stress Interruption

Stress typically involves physical and mental tension in response to a perceived challenge or threat.

The SOBER technique consists of applying the following five steps for stress interruption:

• • Stop what you are doing. Take a moment, interrupting your usual reaction to stress.
  • Observe what is happening in your body and mind. Imagine you are standing back from the situation, observing how you think and feel.
  • Breathe. Settle your attention on your breath, noticing the movements of your body.
  • Expand awareness to your whole body and surroundings. Attend to the rest of your body, your experience, and what is happening around you.
  • Respond with awareness. Having taken a moment, choose how you wish to respond.

The tool aims to reduce habitual reactive behaviors to stressful stimuli, adopting intentional and more mindful choices.

Diaphragmatic Breathing (Belly Breathing)

Breathing is closely linked to our sympathetic and parasympathetic systems.

Diaphragmatic breathing is deep, coming from the belly, allowing for more air to be inhaled and exhaled.

• • Get comfortable. Find a cozy spot, sitting or lying down, and take a moment to feel the ground or chair supporting you.
  • Close your eyes or soften your gaze. Shut your eyes gently or look down with a soft focus to help you relax.
  • Check in with yourself. Tune in to how you feel now without judgment.
  • Begin belly breathing. Place a hand on your belly and focus on your breath. As you inhale, let your stomach naturally rise; as you exhale, let it fall.
  • Count your breath. Inhale to the count of four, briefly hold, and exhale to the count of six. Feel the sensation of your breath in your belly.
  • Stay mindful. If your mind drifts away, don’t worry. Acknowledge it, then gently bring your focus back to your breath. Continue this mindful breathing.

Remember to observe any changes in how you feel at the end of the exercise. When you hear the ending signal (like a bell), slowly open your eyes and return to the present moment.

If you’re looking for more science-based ways to help others manage stress without spending hours on research and session prep, check out this collection of 17 validated stress management tools for practitioners. Use them to help others identify signs of burnout and create more balance in their lives.

A Take-Home Message

Whether we view polyvagal theory as revolutionary or controversial, it can potentially transform how we think about physical and mental wellness.

The approach, based on a deep recognition of the balance between the sympathetic and parasympathetic divisions within the autonomic nervous system, offers new insights into treating depression, anxiety, and trauma (Wade, 2023; Neuhuber & Berthoud, 2022).

When everything is performing well, the two have an ongoing and bidirectional flow of energy and information. Still, it can be disrupted when we experience threat or trauma.

Psychological and physiological healing occurs when we retune our nervous system to become more balanced or homeostatic (Porges, 1995).

For you as a mental health practitioner, this can mean identifying and using treatments and interventions that encourage your clients to consider and listen to their vagal tone, supporting the regulation of their vagus nerve (Marmerstein et al., 2021; Siegel, 1999).

Such activities and exercises are readily available and can easily be incorporated into existing treatment programs and include mindfulness, deep breathing, and somatic techniques such as self-touch and vocalization.

While the polyvagal theory has its critics, it offers a safe and potentially transformative approach to wellbeing that supports balance within our own or our clients’ nervous systems.

We hope you enjoyed reading this article. Don’t forget to download our five positive psychology tools for free.