Polyvagal Theory and PTSD

Trauma, especially repeated trauma, leaves the body in survival mode. Living in survival mode alters the brain, essentially handicapping an individual’s ability to emotionally regulate, complete developmental tasks, socialize, learn, play, rest, and more. Individuals suffering from complex post-traumatic stress disorder (CPTSD) commonly experience difficulty creating and maintaining relationships, difficulty performing in the workplace, and may struggle with addictions and substance abuse. PTSD causes a shift in the nervous system’s equilibrium, meaning those with PTSD often live in a state of heightened anxiety and hypervigilance as their baseline level. Nervous system dysregulation makes the tasks of day-to-day life difficult and can put an enormous strain on the body, often resulting in poor health habits and outcomes with a range of comorbid psychological disorders such as panic disorder, depression, chronic pain, gastrointestinal disorders, and anxiety.

Stephen Porges theorizes in his 2011 publication, The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication and Self-Regulation, that by activating the parasympathetic nervous system, which he refers to as the “social engagement system”, individuals with PTSD can reregulate their nervous systems, integrate their trauma, and form connections with others.

When the body is repeatedly exposed to a severe threat it enters a state of hypervigilance, resulting in the consistent production of inflammatory stress hormones such as cortisol that raise the nervous system’s baseline arousal levels. The nervous system is trained via repeated exposure to trauma to detect threats while simultaneously protecting the body by dissociation. Individuals who have experienced reoccurring trauma exposure may live in a state of nervous system dysregulation and hyperarousal, making it difficult to differentiate between past threats and current threats. This may lead trauma survivors to fall into a state of hypervigilance in which they are unsure of who is trustworthy and who is not. Those with PTSD may feel as if past trauma is occurring in the present due to a consistently heightened stress response. The trauma essentially remains “locked” in the body.
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Through repeated exposure to trauma, the nervous system learns to adapt in order to ensure the individual’s survival. A body that has experienced reoccurring trauma is wired for survival in a traumatic environment.

Once the threat itself is removed or the individual is removed from the harmful environment, the body remains wired for survival despite the present reality of safety. For the traumatized individual, the threat remains imminent and the past blurs into the present.

Neurobiologically, an individual who has CPTSD has adapted to survive living under constant threat, leading to both hypervigilance and dissociative responses that may not be appropriate when such threats no longer exist in the individual’s everyday life. Living in “survival mode” may lead trauma survivors to detect threats when there are none, to feel uncertain of who is trustworthy and who is not, to misread present situations in the context of past trauma, and to engage in maladaptive coping behaviors that are no longer useful to their present day-to-day lives.

Much of the self-blame and toxic shame that many with CPTSD suffer from originates from confusion on why they cannot seem to emotionally regulate, connect with others, and “get over” the trauma. Understanding the biological basis of the symptoms alleviates much of the distress and frustration that many trauma survivors experience despite repeated efforts to overcome trauma symptoms.
Although common evidence-based interventions such as cognitive behavioral therapy (CBT) and exposure therapy are proven to greatly benefit those with PTSD symptomatology, the dysregulated state of the nervous system often makes cognitive functioning difficult and can impair the brain’s ability to fully engage with the interventions. Under stress, our ability to engage the prefrontal cortex and cognitively function is hampered. In essence, problems with emotional dysregulation, learning, attention, memory, and socialization are normal and natural reactions to existing in a traumatized state.
Therapists must educate clients in the functioning of their parasympathetic nervous system and changes in their neurological development due to trauma. This helps remove the common obstacles in trauma work of self-blame and shame. Therapists can help clients realize their CPTSD symptomatology isn’t them, it’s their body. Learning ways to actively engage the parasympathetic nervous system gives clients hope and a sense of self-agency over their lives.

Polyvagal theory posits that it is possible to use the parasympathetic nervous system as a means of consciously calming the body’s stress response, therefore reducing CPTSD symptoms, and ultimately restoring the body to a state of equilibrium.

The “social engagement system” (AKA the parasympathetic system) inhibits defense systems. When we are met with a threat in our environment, generally we first attempt to resume social harmony via the parasympathetic system. If the threat persists or worsens, the sympathetic nervous system becomes activated, resulting in any of the 4 common trauma responses: fight, flight, freeze, or fawn.
Polyvagal theory suggests ways in which one can make conscious efforts to engage the parasympathetic nervous system, such as breathwork, mindfulness, and cultivating self-compassionate thoughts that in turn impact the functioning of the parasympathetic nervous system.

Ways to Engage Your Parasympathetic Nervous System

• Take note of your body’s physical signs of stress. Are you breathing rapidly? Do you feel too hot or too cold? Dizzy? Sweaty? Shaky? Notice any bodily sensations that accompany triggers and stressors.
• Check in on your feelings. Observe them with curiosity.
• Practice some grounding techniques. Some examples: Feel the chair under your bottom or your feet touching the floor. Feel the texture of the fabric of your clothes. Breathe in for a count of 5 seconds, hold for 2, and release for 8 (or however long feels good to you).
• Speak kind words to yourself. Be encouraging, patient, and understanding-the way you would treat your friend, partner, or child.
• Find a calming scent, such as an essential oil, and focus on the fragrance.
• Spend time in nature. Observe the sway of grass in the wind, water rushing down a river, or the leaves in a tree.
• Admire artwork. Notice the colors, textures, patterns, shapes, etc.
• Have a mindful meal. How does your food look? What colors are on your plate? How does it smell? What texture does each bite have? 

References
Schwartz, A. (2018, August 17). The polyvagal theory and healing complex PTSD: Dr. Arielle Schwartz. Arielle Schwartz, PhD. Retrieved October 5, 2022, from https://drarielleschwartz.com/the-polyvagal-theory-and-healing-complex-ptsd-dr-arielle-schwartz/

Porges, S. W. (2011). The polyvagal theory: Neurophysiological foundations of emotions, attachment, communication, and self-regulation. W.W. Norton.

​Wagner, D. (2016, June 27). Polyvagal theory in practice. Counseling Today. Retrieved November 5, 2022, from https://ct.counseling.org/2016/06/polyvagal-theory-practice/
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