By Martina Egan Moog
The PVT has become an increasingly popular theory to explain bodily symptoms (such as ongoing pain, stress, fatigue) after psychological trauma.
It builds on the idea that our automatic nervous system is more elaborate than previously thought in order to steer us through the ups/downs of life. When we are actively responding to a stressful event we either “fight or flight”, by drawing on all sorts of resources that are available to us at the time. This state is governed by the sympathetic part of the autonomic nervous system (SNS). When we feel safe and supported we can “rest and digest” to restore those resources. This state is governed by the parasympathetic arm of the autonomic nervous system (PNS) through what is called the vagal pathway.
The PVT proposes that there are not only two but three different autonomic neural states in
response to psychological or physical challenges. The third state is a separate pathway through different branches of the vagal nerve.
Up the ladder/down the ladder
Consciously or subconsciously perceived levels of safety and danger are continuously monitored by the neural process of so called ‘exteroception’ (which includes all of our 5 senses) and ‘interoception’ (which refers to our inner body awareness, which includes emotions, memories). Those neural circuits serve to promote three distinct autonomic neural states that are linked to three different types of behaviours of social engagement (Sullivan et al 2018).
1. Green for GO - “Safe and Social” – the Ventral Vagal Complex orchestrates pro-social
behaviour (e.g. enhanced ability to listen, prosodic voice, facial expressivity,) and visceral
homeostasis (e.g. saliva and digestion are activated). A so-called “vagal brake” to the heart
(heart rate slows) is activated and allows for emergent phenomenon such as ‘love’ and
‘feeling connected’ to be more easily experienced.
2. Orange for ATTENTION DANGER - “Flight and Fight” (Hyperarousal) – the SNS increases
metabolic output into mobilisation strategies (e.g. increased muscle tone, inhibition of
gastrointestinal function, increased respiration rate). The emotional responses that govern
behaviour towards protection or safety are fear and anger, which behaviourally shows other
people e.g. to stay away. We might feel an elevated heart rate or high blood pressure.
3. Red for STOP - “Freeze and Shutdown” (Hypoarousal) – the Dorsal Vagal Complex (DVC) gets activated to protect us from overwhelming danger/terror that we both consciously and unconsciously can’t escape or fight. It is the phylogenetically oldest defence response and characterised by immobilisation strategies that reduce metabolic and respiratory demands (e.g. decreased muscle tone, decreased heart and respiration rate) to the point of feigning death. Behaviourally this is associated by dissociation, disembodiment and may include loss of consciousness in the face of potential death or intense pain.
Hence we can gage from our ability to connect with other humans in which neural state we currently are (Porges 2011). However, we as humans can also create two more blended neural states (Sullivan etal 2018). In both states we are socially engaged and are in the “green zone” but a subordinate neural state adds its attributes:
4. Green with a touch of Orange – “State of Play”, e.g. playing tiggy’s, cops and robbers – safe mobilisation
5. Green with a touch of Red – “State of deep relaxation and connection”, e.g. intimacy – safe immobilisation
The ability to self-regulate between “fight/flight”, “rest/digest” and “engage/play/learn” is a key to maintaining a balanced life and body. People who can successfully shift through those stages often show great resilience to whatever life throws at them. For this self-regulatory function to work adaptably it relies on accurate extero- and interoceptive communication about the state of the body and the external environment. Stress and any kind of emotional or physical trauma can significantly compromise those communication channels and hence our adaptability to adequately shift in and out of physiological states and social engagement systems.
It has been suggested that our brain is the filter through which we experience the world, and the autonomic nervous system is how we react to it. Environmental and bodily cues can instantaneous transform physiological processes and social interaction. It also explains why any kind of trauma is not just psychologically but also physiologically memorised (Payne and Crane-Godreau 2015).
From the theory to the clinic – so what can we do about it?
We believe that this autonomic neural process can be improved through curious and non-
judgemental awareness of where we might be currently “sitting on the ladder”. Once we are aware about our current physiological state, we can choose if/what we want to do about it or what we currently need to accept to be kind to us. Also, learning about more adaptive responses to body, mind and environmental cues can be helpful to gradually climb up the autonomic ladder.
Strategies that send a “safety” signal into the body are, for example:
Breath work: engaging in long and slow exhalation can purposely activate the “rest & digest” state of the vagal pathway. If we slow our breathing rate, we can slow the heart, if we speed up breathing it will speed up the heart.
Vocalisation, such as chanting, singing, playing wind instruments, recounting poetry, humming and sighing
Explorative and playful movement strategies (e.g. Feldenkrais, Yoga, dancing, Tai-chi etc), can influence a positive emotional state through safe mobilisation.
Meditation/Mindfulness
References:
Craig AD (2003). Interoception: the sense of the physiological condition of the body. Current Opinion in Neurobiology, 13:500–505.
Darwin, C. The Expression of Emotions in Man and Animals. D Appleton; New York, NY: 1872.
Khalsa, S., Cohen, L., McCall, T., Telles, S., (2016), The Principles and Practice of Yoga in Health Care, Handspring Publishing, U.K.
Legrain V, Ianetti GD et al (2011). The pain matrix reloaded. A salience detection system for the body. Progress in Neurobiology; 93, 111-124.
Muehsam, D., Lutgendorf, S., Mills, P. J., Rickhi, B., Chevalier, G., Bat, N., et al. (2017). The embodied mind: a review on functional genomic and neurological correlates of mind-body therapies. Neurosci. Biobehav. Rev. 73, 165–181
Payne, P., and Crane-Godreau, M. A. (2015). The preparatory set: a novel approach to understanding stress, trauma and the bodymind therapies. Front. Hum. Neurosci. 9:178.
Porges, S. W. (1995). Orienting in a defensive world: mammalian modifications of our evolutionary heritage - a polyvagal theory. Psychophysiology 32, 301–318.
Porges, S. W. (2003). The Polyvagal Theory: phylogenetic contributions to social behavior. Physiol Behav. 79, 503–513.
Porges, S. W. (2009). The polyvagal theory: new insights into adaptive reactions of the autonomic nervous system. Cleve. Clin. J. Med. 76, S86–S90.
Porges, S.W. (2011). The Polyvagal Theory: Neurophysiological Foundations of Emotions,
Attachment, Communication, and Self Regulation. New York: W.W. Norton.
Sullivan, M.B., Erb M., Schmalzl L., et al (2018). Yoga therapy and Polyvagal Theory: The convergence of traditional wisdom and contemporary neuroscience for self-regulation and resilience. Front. Hum. Neurosci. 12:67.
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