Accessing the Healing Power of the Vagus Nerve Self-Help Exercises for Anxiety, Depression, Trauma, and Autism

Accessing the Healing Power of the Vagus Nerve Self-Help Exercises for Anxiety, Depression, Trauma, and Autism

Stanley Rosenberg


I’m Stanley Rosenberg, an American-born body therapist living in Denmark.


This book proposes a new approach to healing based on my experiences as a body therapist working within the framework of a completely new understanding of the function of the autonomic nervous system—the Polyvagal Theory, developed by Dr. Stephen Porges.


The autonomic nervous system not only regulates the workings of our visceral organs (stomach, lungs, heart, liver, etc.) but is closely tied to our emotional state, which directly influences our behavior. Thus the proper working of our autonomic nervous system is central to our emotional as well as physical health and well-being.


“You learn techniques to understand principles. When you understand the principles, you will create your own techniques.” He also continually emphasized one principle: “Test, treat, and then test again.”- Alain Gehin


I practiced various forms of body-oriented therapies for more than thirty years, but I eventually realized that I was using the wrong map. When I learned about Stephen Porges’s Polyvagal Theory, his ideas expanded my understanding of how the autonomic nervous system functions, and immediately I had a better map.


Before the Polyvagal Theory, there was a widely accepted belief that the autonomic nervous system functioned in two states: stress and relaxation. When we have won the fight and neutralized the threat, or when we have gotten far enough away so that we are no longer in danger, our relaxation response kicks in. We remain in this relaxed state until the next threat appears.


Many believe that our society is getting more and more stressful every year, and that individuals are more stressed out as a result. They still feel stressed. In spite many resources, people continue to feel that they have not been helped sufficiently.


Perhaps the problem is that we have been using the wrong map. With the old understanding of the autonomic nervous system, we have not yet been able to find truly effective methods of stress management.


In my clinic, in addition to treating clients with craniosacral therapy, I gave individual sessions in Rolfing, which balances the myofascia (myo-means “muscle”; fascia refers to connective tissue). I also offered sessions in visceral massage to improve the function of the digestive and respiratory systems. As I worked with techniques from these various modalities, I observed changes in the client’s nervous system in terms of stress and relaxation during the course of a hands-on treatment.


When I first heard Stephen Porges lecture about his Polyvagal Theory in Baltimore in 2001, I had been working successfully with body-oriented therapies for almost thirty-five years. Porges’s theory, however, was right up my alley, and it gave me a whole new outlook on the autonomic nervous system. This in turn gave me a new and more effective way to help my patients.


Porges’s Polyvagal Theory brought about a revolutionary advancement in my understanding of the autonomic nervous system. According to this theory, five cranial nerves (CNs) must function adequately in order to attain the desirable state of social engagement. These five nerves are CN V, VII, IX, X, and XI, and they all originate in the brainstem.


I believe that the information and exercises in this book can be usefully implemented by almost anyone, from beginner to experienced craniosacral therapist, to improve cranial-nerve function in themselves and their patients, and to obtain relief from many unpleasant symptoms, conditions, and health issues—especially those that have been difficult to diagnose and heal.


The neurology of social engagement


Spinal nerves originate in the brain, make up part of the spinal cord, exit the spinal cord between adjacent vertebrae, and then go to various areas throughout the body. A spinal nerve is a mixed nerve, carrying motor, sensory, and autonomic signals between the spinal cord and corresponding regions of the body.


Some of the fibers of the spinal nerves weave together to make up the sympathetic chain, which runs the length of the spine from vertebrae T1 to L2. (T1 is the first thoracic vertebrae and L2 is the second lumbar vertebra). This chain supports the activity of the visceral organs and muscles when a person is mobilized by a threat of danger into a “fight or flight” response.


Cranial nerves, except for cranial nerves I (olfactory) and II (optic), originate in the brainstem, at the base of the brain. (See the illustrations “Brain” and “Cranial Nerves” in the Appendix.) They then make their way to various structures in both the cranium and the rest of the body. Some cranial nerves, for instance, innervate the muscles of facial expression, while others go to the heart, lungs, stomach, and other organs of digestion. Some cranial nerves go to the muscles that move the eyes, while others connect to cells in the nose to enable our sense of smell.


According to the Polyvagal Theory, when a person is feeling safe—not threatened or in danger—and if her body is healthy and functioning well, she can enjoy a physiological state that supports spontaneous social engagement behaviors. Social engagement, neurologically speaking, is a state based on the activity of five cranial nerves: the ventral branch of the vagus nerve (cranial nerve X), and pathways within cranial nerves V, VII, IX, and XI.


When working together properly, the activity of these five nerves supports a state that enables social interaction, communication, and appropriate self-soothing behaviors. When we are socially engaged, we can experience feelings of love and friendship. And when individual members of a group can come together and cooperate with others, it enhances everyone’s chances for survival.


This new understanding of the multifaceted roles of the cranial nerves, and particularly their connection with the state of social engagement, enabled me to consistently help more people with an even wider range of health issues. All I had to do was to determine whether these five cranial nerves functioned well and, if not, to use a technique to get them to function better.


Restoring social engagement


I have written this book to make the benefits of restoring vagal function available to a broad range of people, even if they have no prior experience with craniosacral or other forms of hands-on therapy. Readers can acquire a unique set of easy-to-learn and easy-to-do self-help exercises and hands-on techniques that should enable them to improve the func-tion of these five nerves in themselves and others. I used the principles behind Alain Gehin’s work to develop these techniques.


Our long-term goal is to encourage the autonomic nervous system to return naturally, on its own, from a state of stress (spinal sympathetic activation) or depression (activity in the dorsal vagal circuit) to a state of social engagement, as soon as conditions change for the better and we return to feeling physically and emotionally safe.


PART ONE


Anatomical Facts Old and New: The Polyvagal Theory Overcoming Health Challenges: Are You Fighting the Heads of the Hydra?


The mythical Hydra is a metaphor for the frustration of treating one symptom only to have one or more others crop up in its place. Like the multiple heads of Hydra, multiple health issues plague many of us, and chasing symptoms one at a time with a medicine or an operation for each may give temporary relief but does not necessarily root out the source.


We might take a pill for one health problem, another pill for another problem, and a third to counteract the side effects of the first two pills. We may even take multiple different pills every day. But often the pills only help temporarily, if at all, and sometimes we have to continue to take them for the rest of our lives. Our society primarily relies on two approaches in conventional medicine: biochemical (drugs) and surgical. These powerful tools are valuable in some cases and have helped many people, including myself.


Surgical operations can be life saving. But even the best of operations leave scar tissue, which can restrict movement by making it more difficult for layers of muscles and connective tissue to slide freely on adjacent layers.


Also, there are many symptoms, conditions, and health issues that are not debilitating or life threatening; often, lacking viable alternatives, we try to treat these issues with the usual medical approach of prescription drugs and/ or surgery. These may not be the best solutions, however. In many cases they do not work as effectively as we wish, and often they produce undesirable side effects.


Like fighting the Hydra, our symptom-suppression often just results in more symptoms popping up. For achieving lasting health, by contrast, there is a largely untapped potential in understanding how the nervous system works and approaching difficult health issues in a new way.


Since the autonomic nervous system regulates important functions of the body such as circulation, respiration, digestion, and reproduction, a wide range of consequences can ensue if the vagus and other cranial nerves are not working properly.


Chronic physical tensions

-Tense/ hard muscles

-Sore neck and shoulder muscles

-Migraines

-Back pain

-Tightly clenched teeth

-Grinding teeth at night

-Eye or facial tensions

-Cold hands and feet

-Unwarranted sweating

-Tenseness after exertion

-Arthritis Nervousness

-Dizziness

-Lump in the throat


Emotional issues

-Irritability, anger

-Feeling “down” Feeling of hopelessness

-Lack of energy

-Tendency to cry easily

-General anxiety

-Feeling of heaviness

-Extended periods of depression

-Fearfulness

-Nightmares

-Restlessness

-Difficulty sleeping

-Excessive worries

-Difficulty concentrating

-Forgetfulness

-Frustration

-Excessive daydreaming and fantasizing


Heart and lung problems

-Chest pains

-Asthma

-Hyperventilation

-Shortness of breath

-Irregular heartbeat

-High blood pressure


Visceral-organ dysfunctions

-Poor digestion

-Constipation

-Irritation of the large intestine

-Diarrhea


Stomach problems

-Hyperacidity, ulcer, heartburn

-Loss of appetite

-Excessive eating

-Immune-system problems

-Frequent influenza

-Minor infections

-Allergies


Behavioral problems

-Frequent accidents or injuries Increase in drinking or smoking

-Excessive use of medicine with or without prescription

-Autism, ADHD, Asperger’s syndrome

-Interpersonal relationships

-Excessive or unreasonable distrust

-Difficulty in reaching agreements

-Loss of interest in sex

-Mental issues

-Excessive worrying

-Difficulty concentrating

-Difficulty remembering

-Difficulty making decisions


Other problems

-Excessive menstrual pains

-Skin problems


Given the challenges and stresses that we face in our lives, everyone is troubled by one or more of these symptoms from time to time. At first glance, this list seems to include unrelated problems—we could classify some of them as “physical,” “physical,” some as “mental,” others as “emotional,” and still others as “behavioral.”


Making such distinctions by grouping symptoms is not helpful in this context, however, and distracts from the observation that the underlying physiological cause is essentially the same. Usually people have more than one of these symptoms at the same time. The scientific term for this is comorbidity.


The symptoms can disap-pear and recur at irregular intervals. If the symptoms occur rarely and are not debilitating, they are not so much of a problem. However, if the problems occur often, or most of the time, it is advisable to address them.


Rather than treating individual symptoms as separate issues with a pill to be taken for each one, it would be preferable to find a common thread that links them. Perhaps we can we find a simple, effective treatment that can mitigate or terminate these many seemingly separate issues—perhaps we can find the Hydra’s mortal head.


One of the cranial nerves “wanders” through the body, coursing from the brainstem into the chest and abdomen to regulate many of the visceral organs. It innervates the muscles of the throat (pharynx and larynx), and the organs of respiration (lungs), circulation (heart), digestion (stomach, liver, pancreas, duodenum, small intestine, and the ascending and transverse sections of the large intestine), and elimination (kidneys). Because this nerve is so long and has so many branches, it was named the “vagus” nerve, from the Latin word vagus, meaning “vagrant, wanderer.”


The vagus nerve helps to regulate a vast array of bodily functions necessary for maintaining homeostasis. Whereas the sympathetic chain extends from the spinal nerves and supports the state of stress and mobilization for survival, several of the cranial nerves support non-stress states. One of the primary functions of the cranial nerves is to facilitate rest and restitution. They also enable the senses of sight, smell, taste, and hearing, as well as the sense of touch on the skin of the face. In mam-mals, some of the cranial nerves work together to facilitate and promote social behavior.


The various functions of cranial nerves


As the fibers within a conduit often have different functions, a cranial nerve may have multiple functions as well. When we first look at the various cranial nerves, their functions seem to be unrelated. For example, one of the nerves helps us swallow, another tightens a muscle that rotates the eyeball toward the midline, and a third helps to regulate blood pressure.


However, though it is not usually noted in the study of anatomy, all twelve cranial nerves have one thing in common: they are all involved in helping us to find food; chew, swallow, and digest; and eliminate undigested food as waste.


The olfactory nerve is thus the only cranial nerve that transmits infor-mation (smell) directly to the cerebral cortex without relaying it through another part of the central nervous system. Interestingly, this part of our “old brain” is instrumental in the formation of memory, which makes sense from the standpoint of survival. This is why smells make up some of our strongest and most evocative memories.


CN II, the optic nerve, also origi-nates in the forebrain. It transmits signals from the rods and cones in the retina of the eye to a synapse, and across that synapse to the visual centers in the back (occipital) lobe of the cerebral cortex. The brain interprets these nerve impulses into what we see.


Moving our eyeballs in different directions expands our field of vision. The small muscles that move the eyeballs are controlled by three other cranial nerves: CN III (oculomotor), IV (trochlear), and VI (abducens). These allow us to roll our eyes up, down, right, or left.


The secretion of saliva is controlled by the CN V (trigeminal), CN VII (facial), and CN IX (glossopharyngeal) nerves that innervate the salivary glands.


To mix the food with saliva, we use CN V (the trigeminal nerve) to innervate the muscles of mastication, opening and closing the jaw and grinding the food with a side-to-side movement.


We use CN XII (the hypoglossal nerve) to move our tongue to shift the food around in the mouth, and on and off the surfaces of our teeth.


We use CN VII (the facial nerve) to relax and tighten the muscles of the cheeks, creating a pouch for the food and emptying it to move food back onto the grinding surfaces of the teeth. We also help move the food around with the muscles of the lips, which are also innervated by CN VII.


For the actual tasting of food, we use the taste buds on the tongue, which connect to branches of three cranial nerves: CN VII (the facial nerve), CN IX (the glossopharyngeal nerve), and CN X (the vagus nerve).


We swallow food with muscles in the throat that are innervated by CN IX, the gloss-opharyngeal nerve, and tongue muscles innervated by CN XII, the hypo-glossal nerve, as well as other muscles innervated by CN V and CN VII.


The upper third of the esophagus is innervated by the ventral branch of the vagus nerve, while the rest of the esophagus is innervated by the dorsal vagus branch.


Our gag reflex is controlled on both ends of the esophagus, by the glossopharyngeal nerve (CN IX) at the top and the vagus (CN X) lower down. It’s easy to see how complicated the act of swallowing actually is, requiring the coordinated function of many cranial nerves!


Many animals locate possible prey using their finely attuned sense of hearing. Most anatomical sources consider CN VIII, the auditory nerve, 7 to be the only cranial nerve that facilitates hearing. However, in mammals, the trigeminal (CN V) and facial (CN VII) nerves also have important roles to play in listening and in understanding human speech by regulating the middle-ear muscles.


In addition to eating, several other functions are performed by the cranial nerves. The visceral afferent (sensory) branches of cranial nerves V, VII, IX, X, and XI gather information from our visceral organs: Are we safe, threatened, or in mortal danger? Does our body feel healthy, or is there an imbalance, pain, dysfunction, or illness? If we are safe and healthy, these nerves facilitate the desirable state of social engagement.


Cranial Nerve Dysfunction and Social Engagement

We consider “normal” human behavior to be an expression of positive social values. Our actions should be beneficial for our own survival and well-being, as well as for the well-being of others.


An organism can also be plagued by chronic physical challenges. The body’s stress-responses are reasonably good at handling these sustained disasters. But ,essentially, we humans live well enough and long enough, and are smart enough, to generate all sorts of stressful events purely in our heads. -Robert M. Sapolsky


Unfortunately, some of us are not socially engaged most of the time; if we lack the necessary resilience to spontaneously come back to a state of social engagement, we become stuck in sympathetic-chain or dorsal vagal states. In these states it is often hard for other people to understand our values, motivation, and behavior. Our actions seem irrational, often run counter to our own best interests, and can be destructive to ourselves and others. If we are not socially engaged, it makes life difficult not only for ourselves but for those around us.


When one branch of a cranial nerve is under direct physical pressure, not only that branch but other branches of that nerve can become dysfunctional. Thus a dislocation between the sphenoid and palatine bones can result in dysfunction of the nerves to the face and middle ear; this is enough to block the entire social-engagement nervous system.


The ninth, tenth, and eleventh cranial nerves


One of the two branches of the tenth cranial nerve (the ventral vagus) arises in a structure called the nucleus ambiguus in the brainstem, along with the ninth and eleventh cranial nerves. The dorsal branch of the vagus nerve originates on the floor of the fourth ventricle near the back of the brainstem. (A ventricle is not a physical structure but a space between the lobes of the brain, filled with cerebrospinal fluid. There are four of these ventricles, interconnected with each other via small canals.)


Both branches of the vagus nerve, along with the ninth and eleventh cranial nerves and the jugular vein, pass through the jugular foramen, a small opening in the base of the skull between the temporal and occipital bones. Fibers of both the ninth and eleventh cranial nerves weave themselves into the fibers of the tenth cranial nerve. My anatomy teacher, Professor Pat Coughlin, told our class that in modern interpretations of anatomy, an increasing number of teachers consider CN IX and CN X to be two parts of the same nerve.


Just as the fibers of the nerves are woven together, their functionality seems to be interrelated as components of the social engagement nervous system. For clinical purposes of bringing the nervous system into a state of social engagement, I find it simplest to approach the ninth, tenth, and eleventh cranial nerves as if they were one nerve. When a patient presents symptoms indicating a dysfunction in one, there is almost always a dysfunction in the other two. If, after treatment, the patient shows improvement in the test for vagal (CN X) function, the symptoms attributed to dysfunction of the ninth and eleventh cranial nerves usually disappear as well.



More on the ninth cranial nerve


This nerve has both afferent (sensory) and efferent (motor) fibers. The efferent branch innervates a single muscle, the stylopharyn-geus, which is involved in swallowing.


The ninth cranial nerve receives sensory information from the tonsils, the pharynx, the middle ear, and the posterior third of the tongue. It is also part of the mechanism for regulating blood pressure: it has afferent branches in the carotid sinus, located in the base of the neck near the carotid arteries, and its sensory fibers monitor blood pressure in order to influence the heart and the tonus of the muscle cells in the arteries.


This nerve also monitors oxygen and carbon dioxide levels in the blood, to adjust the breathing rate. It is also responsible for stimulating secretion from the parotid gland, the large salivary gland in front of the ear.


The tenth cranial nerve (the vagus)

The tenth cranial nerve is a vital part of the autonomic nervous system.

We now know that the two branches of the vagus nerve—ventral and dorsal—arise at different places and have very different functions.

An understanding of the two pathways of the vagus nerve provides treatment options for a wide variety of health conditions.


The sub-diaphragmatic (dorsal) vagus branch

The dorsal branch of the vagus nerve has motor fibers that innervate the visceral organs below the respiratory diaphragm: the stomach, liver, spleen, kidneys, gall bladder, urinary bladder, small intestine, pancreas, and the ascending and transverse segments of the colon. Therefore, this branch has sometimes been called the “sub-diaphragmatic branch of the vagus nerve.”


Other functions of the ventral branch of the vagus nerve

The ventral branch of the vagus nerve originates in the brainstem, at the top of the spinal cord under the brain. It stimulates rhythmic constriction of the bronchioles, facilitating the extraction of oxygen, while the brainstem area controlling dorsal vagal activation may result in chronic constriction of the airways, making it difficult for air to get through. (This is part of the mechanism that is activated in a state of shutdown or shock. This narrowing of the bronchioles also occurs in COPD, chronic bronchitis, and asthma.)


The ventral branch of the vagus nerve innervates many of the small muscles in the throat, including the vocal cords, larynx, pharynx, and some muscles at the back of the pharynx (the levator veli palatini and uvular muscles).


The eleventh cranial nerve The eleventh cranial nerve, or “accessory nerve,” is one of the keys to the well-being of the entire musculoskeletal system. Because it innervates the trapezius and sternocleidomastoid (SCM) muscles, which enable the movement of the head and neck, tension in either of these muscles on one side pulls the shoulder, spine, and entire body out of alignment.


Nerve Loop


Branches of the spinal and cranial nerves are traditionally categorized into motor and sensory functions, but this is an oversimplification. If we look more closely at the individual “motor nerves,” we observe that some of their fibers are motor fibers—but that they also contain sensory fibers that report the state of tension in a muscle back to the brain.


We now know that the majority of fibers in “motor nerves” are actually sensory. This combination of sensory and motor nerve fibers provides a feedback loop that allows us to use the motor fibers to tense a muscle while sensory fibers simultaneously send information back to the brain regarding the changing level of tension in the muscle. This allows us to calibrate the tensing of the muscle—a much more powerful and efficient approach than if the muscle could only tense fully or not at all, which would be the case if we had no sensory-fiber feedback.


Under normal conditions, the spinal nerves facilitate easy, well-coordinated, graceful movements, and the muscles fire using the minimum amount of energy to achieve the desired movement. However, if the body is in a state of stress and all the muscles are more tense than necessary, this natural coordination is often lost, and movements become uncoordinated, awkward, or weak.


The spinal sympathetic chain


Branches of the spinal nerves go to specific bodily structures: the skin (dermatomes), the muscles (myotomes), the visceral organs (viscerotomes), and the ligaments, fascia, and connective tissue (fasciatomes).


Some of the spinal nerves go to the internal organs. For example, the nerves from thoracic vertebrae T1 and T4 go to the heart, the nerves from T5 and T8 go to the lungs, T9 goes to the stomach, and T10 goes to the kidneys. Other nerves serve other structures including the bladder, genital organs, and intestines.


The sympathetic chain extends the length of the vertebral column between T1 and L2, connecting to these spinal nerves. Most of the sympathetics, which project to visceral organs and to the head, are accompanied by arteries to their destinations.


When we face a threat to our survival, there is a surge in the activity of the entire sympathetic chain, spreading the fight-or-flight response to mobilize the resources of the entire body. This response is immediate and total, which is appropriate if we are threatened or in danger. The muscles tense to prepare for movements needed to fight or flee.


Some organs innervated by these sympathetic nerve fibers increase their level of activity in order to support this mobilization. For example, the heart beats faster to supply more blood to the muscular system. The blood pressure increases to be able to pump more blood into tense muscles. The liver releases stored-up sugars into the blood to make extra energy available for the muscles to burn.


The survival stress response from the sympathetic chain causes the muscles of the airways to open to the maximum, improving our breathing capacity and taking in the maximum amount of oxygen in order to be fully mobilized to fight or run.


At the same time, other organs (primarily those involved in digestion) are slowed or stopped. There is a loss of appetite, the movement of food in the intestine slows or stops, and the person might experience a sensation of “butterflies” in her stomach.


The Enteric Nervous System


The enteric nervous system is a network of nerves interconnecting the visceral organs. We know next to nothing about these nerves; because they are so interwoven with each other, with the visceral organs, and with the connective tissue between the organs, it has been impossible so far for anatomists to fully trace the pathways of the enteric nerves.


Therefore, we do not find them well represented in most anatomy books. Furthermore, we know almost nothing of how the enteric nerves function. At best we can guess that the enteric nerves in some way help the different visceral organs to communicate with each other in order to coordinate the very complex process of digestion.


The Three Circuits of the Autonomic Nervous System


The auto-nomic nervous system consists of three neural circuits:

-The ventral branch of the vagus nerve (positive states of relaxation and social engagement)

-The spinal sympathetic chain (fight or flight)

-The dorsal branch of the vagus nerve (slowdown, shutdown, and depressive behavior).

These three circuits regulate our bodily functions in order to help us maintain homeostasis.


The Polyvagal Theory also presents another dimension to our under-standing of the autonomic nervous system. The autonomic nervous sys-tem not only regulates the function of our inner organs; these three circuits also relate to our emotional states, which in turn drive our behavior.


(Insert Descartes Error)


(Insert the secret life of the brain)



The Five States of the Autonomic Nervous System

Biobehavior: the interaction of behavior and biological processes

Unlike the old model of the autonomic nervous system, which focused exclusively on its regulation of the function of the visceral organs, the new model relates each of these three neural circuits with an emotional state. In addition to these three states, we have two hybrid states, each of which combines two of the individual circuits, for a total of five possible conditions of our autonomic nervous system.


The three neural pathways of the ANS:


The social-engagement nervous system. It involves activity in the ventral branch of the vagus nerve (CN X) and four other cranial nerves (CN V, VII, IX, and XI). The ventral branch of the vagus nerve relates to positive emotions of joy, satisfaction, and love. In terms of behavior, it expresses itself in positive social activities with friends and loved ones.


The second of the ANS’s neural pathways is the spinal sympathetic chain, which is activated when our survival is threatened. This state of “mobilization with fear” arises when we are not safe, or do not feel safe. The spinal sympathetic chain relates to emotions of anger or fear, which can express themselves in behaviors such as fighting in order to overcome the threat or fleeing to avoid a threatening situation.


The third neural pathway is the dorsal branch of the vagus nerve. This pathway is activated when we face an overwhelming force and imminent destruction. When there is no point in fighting or running away, we con-serve what resources we have—we immobilize. Activation of this pathway fosters feelings of helplessness, hopelessness, and apathy, manifesting in withdrawal and shutdown. This state can be described as “immobiliza-tion with fear.”


The fourth state is a hybrid that supports friendly competition, or “mobilization without fear,” which is appropriate when we engage in competitive sports. This state combines the effects of two neural circuits: activation of the spinal sympathetic chain allows us to mobilize our-selves in order to achieve our best performance.


The fifth state is also a hybrid of two neural circuits. Activity in the dorsal branch of the vagus nerve, when combined with that of the ventral branch of the vagus nerve, supports feelings of intimacy and intimate behavior. This state, which we could call “immobilization without fear,” is characterized by calm, trusting feelings, allowing us, for example, to lie still and cuddle with a loved one.


(Insert Attachement Styles)


Regulation is the term used to describe our ability to manage our emotional state, to calm ourselves during times of heightened emotion—when we become fearful, deeply sad, angry, or frustrated. Regulation is a learned process, one we integrate into our own lives by observing others and, importantly, through the attachment phases with our early caregivers.

For example, an infant may hear a loud noise or become spooked by the sudden movement of a pet that wants to play. The infant perceives these small disruptions as potential threats to his survival. Unable to “fight back” (or do anything to stop the pet), the infant cries out for a caregiver to intervene and rescue him from the situation. If the parent is attuned to the infant, she will pick up the baby, provide a physical embrace, and use soothing language to help calm the child’s neurological fight-or-flight response.

These interactions between parent and child will shape the child’s ability—or inability—to regulate his own emotions later in life. This process is called co-regulation because the parent steps in as a mentor and external source of soothing when the child feels distressed.

- Nurturing Resilience

(Insert POLYVAGAL theory in Therapy)


The Vagus Nerve


Physical well-being and emotional well-being are intimately linked. If we have a headache, it can be difficult to be happy, joyful, and interested in connecting with other people.


On the other hand, when we have had a sound night’s sleep, some exercise, and a good meal, we feel on top of things and naturally want to be sociable. This connection is well known. However, not many of us know that a nerve called the vagus helps regulate most of the bodily functions necessary for our health and emo-tional well-being. This nerve must function properly in order for us to be healthy, feel good emotionally, and interact positively with family, friends, and others.


When the ventral branch of the vagus nerve and the associated four cra-nial nerves function properly, human beings and other mammals enjoy the desirable state of social engagement. To be socially engaged, we need to feel safe, with no need to overcome or avoid any external threat by fighting or fleeing; we also need to be physically healthy.


When we are socially engaged, we do not need to do anything, or to change anything; we can afford to be immobilized without fear (relaxed). We can maintain a vibrant tone without being collapsed or overly aroused. (BE)


If we have a well-functioning nervous system and are socially engaged, we might naturally meet a new situation with openness, trust, and positive expectations. We feel safe, and might first try to communicate, cooperate, and share. Even in the face of a threat, our behavior might still be open and friendly at first. Sometimes this positive, prosocial behavior can also make the other person feel safe, which in turn might be enough to defuse a potentially threatening situation.


However, if this prosocial behavior is not enough to neutralize the threat or danger, our evolutionarily most recent neural mechanism—the social engagement circuit—is the first to be abandoned. We leave the realm of rational thought and conscious choice, and all of our energy goes into instinctive, defensive responses. (Do)


If our autonomic nervous system feels that a situation is unsafe, our response can shift down one phylum, from social engagement to the level of reptiles with a strong spinal sympathetic chain response, and we might fight to overcome the threat, or flee to avoid it. (DO)


If the situation is so extreme that fighting or fleeing is not enough, we may shift down even further and shut down or collapse into a dorsal vagal state of withdrawal, dissociation, and shutdown. (Result)


The Polyvagal Theory describes how a surge in the activity of the dorsal branch of the vagus nerve is a defensive strategy that causes a physi-ological state of shock or shutdown to help us cope with traumatic events, extreme danger, or imminent destruction, whether real or imagined, by suddenly collapsing and shutting down.


(INSERT THE FivE LEVELS OF ATTACHEMENT AS IT RELATES TO CONCEPTS OF SELF)


( INSERT THE CONEPT AS A STORY FOR FIDNING FOOD FROM ISHMEL)


(INSERT BOOK ABOUT NARRATIVE, SELF)


( INSERT CONCEPTS OF NARATIVE AND TRAUMA)


Giving up or feigning death can be lifesaving; by not moving, we might avoid the attention of a predator or enemy. Physiologically, immobilization also conserves energy. However, remaining chronically in a dorsal vagal state when there is no longer any threat or danger robs us of our clarity, productivity, and joy of living until we can get back into a state of social engagement.


In our culture, we have become preoccupied with problems stemming from stress. Unfortunately, we have remained largely unaware that another danger to our health arises from the widespread condition of chronic activation of the dorsal vagus circuit. When dorsal vagal activity is less extreme but chronic, its emotional correlate is characterized by depressive feelings.


For the purposes of this book, I prefer to use the terms “depressive feelings” and “depressive behavior” or “activity of the dorsal branch of the vagus nerve,” and to generally avoid the term depression, which is a medical or psychological diagnosis. People with a diagnosis of depression, or people in a depressed state, typically lose interest in activities that once were pleasurable.


They over-eat, experience loss of appetite, or have digestive problems. They have reduced energy, and they become inactive, introverted, apathetic, help-less, and asocial. They can feel sad, anxious, empty, hopeless, worthless, guilty, irritable, ashamed, or restless. They may experience lethargy, lack of energy, and a lack of goal-oriented activity. They can have problems concentrating, remembering details, or mak-ing decisions, and are often plagued by the aches and pains of fibromyal-gia. They may contemplate, attempt, or commit suicide.


These can all be symptoms of activity in the dorsal branch of the vagus nerve. The medical literature has generally focused on the physiology of chronic stress, with less attention given to the physiology underlying chronic depression. But when people come to my clinic with a diagnosis of depression from a psychologist or psychiatrist, or when they exhibit depressive behavior, I find that that their problem is usually accompanied by a state of activation of the dorsal branch of their vagus nerve.


If the transition into a dorsal state has involved a sudden surge in dorsal-branch activity, the event can be described as a shock or trauma, and we can describe its effect as “shutdown.” When a person faces an overwhelmingly dangerous situation and/ or the possibility of imminent death, it is a natural reaction to dissociate from one’s own body, from the here and now; to shut down physically, physically, emotionally, and mentally; and perhaps even to faint. Ideally, when the danger has passed, we should move out of this state and back to social engagement; we should “come back to our senses.”


However, many people get stuck at some level of this state of immobiliza-tion with fear. In this case, it is appropriate to suspect that there is chronic activation of the dorsal vagal circuit. Prior to the Polyvagal Theory, depression and depressive behaviors issues lacked a physiological model in terms of the nervous system. It neither fit into the category of stress nor that of relaxation. Perhaps this is why it has been so difficult to find safe, non-addictive, and effective treatments for conditions such as depression.


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When we are in a dorsal vagal state, we often have pains that move around to different places in the body. Most people believe that pain in the body comes from tight muscles, and therapists usually massage the body where it hurts and/ or it where muscles are hard. But often, when a massage therapist alleviates pain at one place, another pain arises some-where else.


Often, after a traumatic event, we say that we do not remember what happened. Our brain is incapable of forming verbalizations or visualiza-tions about what had been going on at the time because we were reacting from a different, more primitive part of our brain and nervous system.


Dissociation is a widespread problem. It can be characterized as ongoing activity of the dorsal vagus nerve that keeps us in a physiological state of fear. We may be present in a group but not take part in a conversation; we may be lethargic and lack empathy. We might talk a lot but say nothing meaningful about ourselves or our situation. We cannot set goals or take actions to bring about changes that could help us in life. This depressive mindset is supported by chronic activity of the dorsal branch of the vagus nerve.


However, if we are without fear, dorsal vagal activity has quite a different effect. The state of immobilization without fear, based on dorsal vagal activity combined with the activity of the cranial nerves of social engagement, provides the physiological foundation for rest and restitution, and supports intimacy.


Effects of ventral vagus activity


In the entire animal kingdom, only mammals have a ventral circuit, which is the ventral branch of the vagus nerve. To activate this ventral vagal circuit, the individual must both be and feel safe in terms of the environment, as well as in terms of feedback from the proprioceptive nerves that monitor what is going on in the body.


The ventral vagal circuit can be active when we are physically active, or when we are immobile. It gives rise to the state of social engagement, together with four other cranial nerves (CN V, VII, IX and XI). Social engagement goes far beyond the simple concept of “relaxation” in the old model of the autonomic nervous system, with its two-state vacillation between stress and relaxation.


The ventral vagal state allows us to rest and restore ourselves. We are not in a state of fear, and we can choose to be immobile. We can sit in a rocking chair on the back porch on a warm summer evening with someone we like, and watch the sun go down. We can listen to music. We can daydream or meditate. When we are not socially engaged, on the other hand, we can experience many negative physical and emotional symptoms such as the state of sympathetic nervous system mobilization, characterized by fight or flight, or dorsal vagal immobilization (frozen and/ or with depressed behavior).


Stress and the Sympathetic Nervous System


I prefer to use Stephen Porges’s description of the fight-or-flight state as “mobilization with fear,” and will try to hold to the biological model of stress: the sympathetic nervous system’s response (mobilization with fear) to an external event or internal state, maximizing its potential to fight or flee.


The neurology underlying this state is major activation of the spinal sym-pathetic chain. As a defensive strategy, this produces a powerful muscular response with the potential for making an extraordinary effort to save our life (and/ or someone else’s) in a threatening situation.


Ideally, when the threat passes, activation of the sympathetic chain should also dissipate. If our nervous system is resilient and flexible, our nervous system should naturally return to a state of social engagement. If this does not occur, and activation of the sympathetic chain becomes chronic, it is not good for our physical and emotional health or our social relationships.


Activation of the sympathetic chain is not limited to a defensive strat-egy. When we are safe and our autonomic nervous system is functioning optimally, there is a slight activation of the sympathetic nervous system on every inbreath, causing our blood pressure to rise and our heart to beat a little faster. The pulse feels a little stronger to the touch. When we breathe out again and this slight sympathetic activation stops, the heart rate and the blood pressure decrease. Our heartbeat should slow down on the outbreath, and our pulse should feel softer.


A new understanding of stress

Although many people talk about being stressed, a large percentage of them are not actually stressed in terms of spinal sympathetic chain activity. Physiologically, some of them are actually in a state of dorsal vagal activity (shutdown or withdrawal); in emotional terms, they are in a depressed state.


This condition can be the result of a traumatic incident sometime in the past. They may have a diagnosis of post-traumatic stress even if they are not physiologically in an actual state of sympathetic-chain stress. According to the Polyvagal Theory, their state is better described as activation of the dorsal branch of the vagus nerve, and these individuals may accordingly suffer from lethargy and immobilization.


The way to move people out of both states—stress with accompanying fight-or-flight behaviors (mobilization with fear) and depressive feelings behaviors with shutdown (immobilization with fear)—is to activate the ventral branch of their vagus nerve. The three circuits of the autonomic nervous system are hierarchical, with a step-like progression from one state to the next, according to the evolutionary development of the autonomic nervous system in vertebrates.


(Insert POLYVAGAL theory in therapy deb)


When our autonomic nervous system is in a state of stress or shutdown, we often have problems with our health, our relationships, and our emotional states.


In my clinic and practice, if testing shows the ventral branch of the vagus nerve to be dysfunctional (see Chapter 4), my first goal is to get this nerve to function properly. Over the years, I have used different techniques to help move people out of stressed or depressed states and restore their ventral vagal branch function. For the last few years, I have found it sufficient to have my clients help themselves by practicing the Basic Exercise.


“But you’re not a doctor!” some people may say. No, I am not. In my clinic, I do not make any form of medical diagnosis, or treat disease. Giving a diagnosis and treating disease with prescription drugs fall solely within the responsibility of a well-trained medical doctor.


All I can do in this context is screen and intervene on the function/ dysfunction of the ventral branch of the client’s vagus nerve and the other four cranial nerves necessary for social engagement.


Many people who come to me have already been diagnosed by a medical doctor. I do treat people who have been given a medical diagnosis, primarily to improve the function of their nervous system. It has been my experience that bringing their autonomic nervous system into a state of social engagement and moving them toward optimal health has a positive effect and helps many of them with various medical issues. This complimentary care is encouraged by a few physicians that are familiar with this work.


My approach has helped many people with a wide range of problems including stress, psychological depression, migraines, fibromyalgia, dif-ficulty in concentrating, remembering, or sleeping, problems with diges-tion, stiff neck, and back and shoulder pain.


We live in a world where everything is constantly changing, inside and outside of us. Our survival, wellness, and happiness depend on having a flexible autonomic nervous system that regulates us in order to respond appropriately to changes in our environment and our own organism.


Chapter 3

Neuroception and Faulty Neuroception


Neuroception takes place in the primitive parts of the brain, beyond our conscious awareness. It can be likened to a good watchdog that is always on guard, allowing us to focus on things other than survival, or to sleep soundly, and rousing us only when intrusions could compromise our survival.


Based on the signals from neuroception, well-defined neural circuits are activated to support the state of social engagement and friendly communication behaviors when we are safe; the defensive strategies of fight or flight when we are threatened; and shutdown when we are in serious danger.


However, neuroception can be faulty, and when it does not work as it should we can find ourselves in deep trouble. Instead of clearly perceiv-ing what is actually there, we distort what is going on.


There can be countless reasons for faulty neuroception. Our percep-tion might be blinded by anger, fear, jealousy, or apathy, or we might be locked into a traumatic memory. We may be fixated in a state of shock; we may be hungry and have low blood sugar; we may be tired, in physical pain, or suffering from an illness.


We might be feeling perfectly normal and then suddenly be triggered by something that reminds us of a traumatic event in our past—and react to this memory as if it were happening in present time. We might not actually be threatened or endangered, but our nervous system may be stuck in the past, poised to fight or flee at the slightest trigger from the environment.


(Insert Getting Past Your Past)


The nervous system should be flexible, enabling our whole organism to adapt to the present situation and to support different kinds of behav-iors depending on whether the situation is safe, threatening, or danger-ous.


In cases of chemical interference (such as prescription medicines, other drugs, and alcohol), information comes in from the environment through our senses, but the neural circuits do not process the information normally, and our physiology does not respond appropriately. Alcohol, for example, alters the way we feel and thus the way we act. Many drugs—prescription medicines as well as illegal and recreational drugs—also put us into an abnormal physiological and experiential state.


Personal problems in our complicated, modern, civilized human life are not usually physically dramatic and usually last longer than a few seconds. We may not be threatened physically, but we are often challenged emotionally or mentally.


Furthermore, unlike many wild animals, human beings do not usually shake off their traumas as soon as the threat or danger is gone. Ideally, we should be able to “reset” our nervous system and get a fresh start.


(Insert TRE Summary)


The conscious and unconscious memory can remain in our nervous system for months, years, or even for the rest of our lives. If we have not shaken it off, we can suffer from recurring inappropriate behaviors and ongoing physical symptoms of stress and shutdown.


Today there are many systems, including Pilates, yoga, martial arts, and mindfulness meditations, that help restore people to their sense of their body. If my clients have such a way of sensing their body, I ask them to use that.


If I am giving them a massage, I can ask them to keep their attention on where my hands are touching their body. This is especially important for people in a state of withdrawal and dissociation—getting them back into a sense of their body becomes my first priority. I do not actually need to do anything.


In that moment, when I have my hands on them, I am not trying to fix things or bring about any changes in their muscu-loskeletal structure. I am not relaxing a muscle, freeing the movement in a joint, adjusting the spine, or releasing connective tissue. Instead, my hands remain at the same place.


(INSERT SE PETER LEVINE)


Sensing our own bodies and staying grounded helps us to remain in a ventral vagal state. Awareness of our body can help us avoid getting carried away by emotions that can lead to faulty neuroception.


(Insert Somatic Psychotherapy Summary)


Chapter 4

Testing the Ventral Branch of the Vagus Nerve

Simple Evaluation from Facial Observation


According to Stephen Porges, social engagement requires the ability to both look and listen. When you are talking with someone, you can sense whether or not he is socially engaged by how much he looks at you, how well he listens to you, and how well he can understand what you are saying.


When you make eye contact with another person, look for spontane-ous facial expression in the middle third of her face (between the bottom of her eyes and the top of her mouth). The small movements here are an indication of social engagement (or lack of it) and the flexibility of her emotional responses.


We tend to think of people as unchanging identities. However, their interactions with other people are affected by their mood, which is affected by the state of their autonomic nervous system at that moment.


In my clinic, in addition to observing aspects such as these, I like to start all my treatments by testing for function of the ventral vagus nerve branch.


Then, after the client does the Basic Exercise, or after I treat her with my hands, I test again for ventral vagal function to be sure that we have achieved the desired results. This information is useful in a clinical setting; the procedure described below in a later section of this chapter, which makes it possible to evaluate our own ventral vagal function, is also useful for self-diagnosis and self-care as well as helping others.


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In scientific research on the autonomic nervous system, there is increas-ing awareness of heart rate variability, which may offer us another way to assess vagal nerve function.


I have learned that if there is not adequate ventral vagal function, therapeutic interventions are less likely to stick. However, when vagal function is successfully restored, my clients often experience improve-ments in other areas of their lives—not only in terms of the health issue that they came in with, but also at work, with their families, and in social relationships with others.


Testing another person for social engagement can be valuable if you are working as a teacher, body therapist, psychologist, psychiatrist, or coach.


This test evaluates the movement of one of the muscles innervated by the pharyngeal branch, called the levator veli palatini muscle. From my experience, I find that the condition of this branch is a good indicator of the function of other branches of the ventral vagus nerve as well.


(Insert Link to PDF with Assesment of the Vagal Nerve function)