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5/24/2019
1
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/
5/24/2019
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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
5/24/2019
8
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.