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Porges-Gains

The research and discoveries to which Dr. Porges has dedicated his career are integral to the work of iLs. People of all backgrounds will find this interview fascinating, not to mention enormously helpful, in understanding Porges’ Polyvagal Theory.

We have split this podcast into 4 sections, and are also hosting the entire interview:

  • Summary: Polyvagal Theory and the Social Engagement System
  • iLs in the context of the Polyvagal Theory
  • Practical Advice for Clinicians
  • The Passive and Active Pathways of the Social Engagement System

A transcript is also below if you’d like to read along.

 

Randall Redfield:

Good day everyone. My name is Randall Redfield, Co-Founder and CEO of iLs and I’m  joined by Karen Onderko, iLs Director of Research and Education. We are honored to be speaking with Dr. Dr. Porges today. For those unfamiliar with Dr. Porges, he has been a pioneer in developmental psychophysiology for decades. He is best known for his Polyvagal Theory published in 1995, perhaps less known is the fact that Dr. Porges was the first to quantify and use heart rate variability in psychophysiological research. He is a Professor of Psychiatry at UNC Chapel Hill, distinguished university scientist at Kinsey Institute in Indiana University Bloomington and Emeritus Professor of Psychiatry at University of Illinois, Chicago and Professor Emeritus of Human Development at the University of Maryland, College Park. On behalf of my colleagues at iLs and thousands of therapist we have trained, many of whom have followed your work over the decades, it is truly a pleasure to have this opportunity to speak with you.

Dr. Porges:

Thank you very much.

Randall Redfield:

I want to start out with a question that would put the whole conversation in context. If you would please give us summary of your Polyvagal Theory and its relationship to the Social Engagement System, just a nice light question to start with there.

Dr. Porges:

This is always problematic if that’s the first question. There may not be time for any other questions.

Randall Redfield:

As I was reading it all, I was thinking, “This could take a couple of hours.” Just a summary if you would.

Dr. Porges:

One would think that I would have kind of a script to go right into it and the answer is I don’t. I’m always trying to figure out a way of describing what the theory is in the way that people will understand it. The theory really emphasizes that our human social behavior and our affect emotional states, how we regulate our body are in part dependent upon our evolutionary heritage. What the theory really articulates is the fact that we evolve from more primitive vertebrates. As we evolve, we repurpose different features of their nervous system in regulating our visceral or bodily state and this became the Polyvagal Theory because it identified in mammals – and we are mammals – three hierarchically organized neural circuits that regulate behavioral state. Now, that’s a very packed statement. What it means is that we have newer circuits and older circuits and they are hierarchically organized, meaning, we use the newer ones first. And the newer one is really a way of regulating our heart, calming our viscera that’s linked to the nerves that regulate our face, so that becomes our Social Engagement System.

It’s extremely relevant to iLs because those nerves that regulate the muscles in the face also regulate muscles in our middle ear structures so that when our faces are animated and we are happy, the neural tone to the middle ear structures improves and increases. It starts to block the impact of low frequency distracting sounds and enables us to understand and hear human voice. Again, to many of you who work in this area, you realize that when people’s faces are flat or they look scared, they have difficulty in processing what’s being said to them. What most people don’t realize is that difficulty in processing really is due to the fact that the information – the acoustic features of voice – isn’t even getting into their brain. It’s bouncing off the ear drums. It doesn’t matter if you yell at them, talk louder, which is often the parental or instructor’s reaction when someone isn’t processing. It just makes things worse because the system is really a system that reacts to features of safety.

Let me just give you a quick summary here. The Polyvagal Theory basically articulates that there are three different neural structures, which have different adaptive functions. The first one which we are describing is really a system that enhances social communication and it’s probably the core feature of what iLs is about. It’s the ability to process human speech, to understand facial expression and in doing that, in a reciprocal interaction; it’s also calming and soothing our physiological state through a newer, uniquely mammalian, vagal pathway. That vagal pathway down-regulates basically what most people call arousal. It down-regulates the sympathetic nervous system. It’s calming. When we don’t have that system working, we are really a reactive individual. We are mobilized. We are in defensive state. What I really want everyone to think about is this dialectic between being safe and being defensive.

When your nervous system is defensive, you really have two choices – or the nervous system has two choices. One is to be aggressive, to fight, and that retunes your ears to listen to low frequency sounds which are predator (sounds). If that doesn’t get you into safe places, you want to, in a sense, disappear or become inanimate and that’s what reptiles do under defense. There’s an old unmyelinated primitive vagal system that shuts you down. Polyvagal Theory articulates, gets its name from the fact that there are two vagal pathways. One linked to social engagement behaviors which are calming, soothing, and foster social communication and one that makes you inanimate, shuts you down. It’s metabolically conservative. In middle of that evolutionary history of our autonomic nervous system is our sympathetic or arousal fight/flight system. That’s really the nut shell.

There’s actually one other point and that is our nervous system moves to these different circuits, these different levels when it detects features of safety or features of predator or features of danger. It does this not through any conscious awareness, but through a process that I call neuroception because it’s actually on a reflexive level. We are detecting features of danger or safety. Sorry about the long answer.

Karen Onderko:

It actually could be so much longer. There’s a lot to unpack in what you’ve just said.

Dr. Porges:

It could be two days, but we’ll try to be succinct.

Karen Onderko:

The path that you’ve found yourself on, you’ve spent your whole career really getting to this point. Is that forty years I’m guessing? It’s always interesting to understand how someone got on the path that they did and in your case I’ve read that you worked with neonates.

Dr. Porges:

It’s actually an interesting question that actually precedes even the venture into a true academic scientific career. I was asked this question on an email over the weekend. A person was writing a book and was using a lot of my ideas and wanted to know on a personal level how I could work so many decades on the autonomic nervous system. I wrote back in this email and actually I said many things including … I said my passion was for personal discovery or I was passionate about personal discovery. The issue is I was always interested in feelings and there really wasn’t a science of feelings. I always was interested in a sense the dialectic between feelings and the ability to do rational thinking, to be cognitive, to function. Basically, I think this is the dialectic that most adolescent males, if not females, go through and that is trying to, in a sense, control your feelings.

This actually becomes a very interesting story because I think it leads to strategies of dissociation. I think this is maybe why there’s a vulnerability in women because I think women in general have been extraordinarily successful maybe through transcultural or transgenerational issues about, in a sense, learning not to feel their body. You now have this dialectic where society and culture says, “don’t feel your body” and what does that do? It basically turns off the feedback loops and you survive very well. You get good grades, but you disconnect how your body is monitoring or being monitored by your brain. I was always interested in feelings and feelings are really the autonomic nervous system and that led to this whole career of studying physiological state.

I think the issue of what’s missing – and this will really be the important point, or an important point, and that is, I think most of clinical practice – whether we talk about medicine or any of the allied health areas – dismisses, or is totally ignorant of, the role that physiological state plays as an intervening variable. That’s a scientific term, but what it means is that physiological state is either an enabler of treatment or a disrupter. It either helps or gets in the way. Visualize trying to talk to a child, who is crying and screaming. Well the words are not going to be very effective. And visualize that disruptiveness as being played out throughout the whole nervous system and you are trying to now input some information to do calming. What I really want to emphasize is that there’s a difference between treatments that are organ specific (like we do in medicine) versus treatments that deal with the function, which is the neuroregulation.

Randall Redfield:

You just touched on part of the answer to my next question, but I wanted to ask you, if you would, to connect the dots for our listeners between the results that they are seeing with iLs and the Polyvagal Theory. We are seeing results in learning language and emotional state as well and it would be great to hear how you put that.

Dr. Porges:

If you embrace an understanding of the structures involved in the Social Engagement System and you functionally exercise those structures, meaning, neural exercise – and listening interventions are neural exercises. Social behavior is a neural exercise. Then, you start to enhance the neuroregulation of the middle ear structures. That changes the neuroregulation of the facial muscles. It also enhances the neuroregulation of the heart. What you start seeing is this whole complex, basically this composite behavioral change in individuals where they now are engaging. They look at people. It also changes the neuroregulation of the muscles that regulate vocalizations and this is something that I think needs to be discussed within the whole area of auditory interventions and that is what is happening to the pitch and intonation of the people’s voices when they are going through listening interventions.

Another outcome variable is not merely whether or not they are hearing or processing speech and language better, but are their voices now conveying affective emotional states better because it’s the same neural system that’s involved. The Polyvagal Theory is the linchpin that basically says listening is related to affective expression and it’s related to physiological state. And, when you get those things in the more optimal conditions or setting points, then the ability to learn, the ability to plan starts becoming much, much better.

Karen Onderko:

It’s so true that the results that our therapists see with clients are significant improvements in behavioral regulation and mood and generally their overall levels of happiness. No one comes in to a clinic saying, “my child is not happy” when they have dyslexia or they’re on the spectrum. But they very consistently claim that to be a response from therapy.

Dr. Porges:

Let me elaborate on those observations. If you think about the way that our nervous system evolved and if you understand the evolutionary success of mammals or at least why they were successful, mammals had to co-regulate. They couldn’t regulate their own behavior and their own physiology. When a baby is born, it can’t get food, it can’t regulate its own temperature. It has to be co-regulated with another and this co-regulation goes through our entire lifespan. So if we are unable to co-regulate our bodily state, we are very unhappy. It basically puts us into a physiological state of defense and so rather than say happy versus unhappy, say are we physiologically and behaviorally safe or are we in a state of defense?

When we’re in a state of defense, we don’t socially communicate and we are in a wrong physiological state. Our nervous system is now totally attuned to detect intrusion like a predator and this goes back to the auditory system. It’s now tuned to detect low frequency sounds. It’s tuned to do this primarily through bone conduction because bone conduction is how reptiles hear. Mammals hear with airborne sounds because airborne sounds are softer, less energy, and they are of higher frequencies. If we understand the evolution of how mammals survive, they were literally communicating in a different acoustic niche, a different bandwidth that enabled them to communicate without being heard by the predator reptiles. Mammals were very small. They were articulating or vocalizing. They weren’t speaking words. They were conveying their physiological state through their vocalizations to the organisms of their species conspecifics. They were communicating whether they were safe to come close to, to co-regulate, to pair bond, to reproduce or were they dangerous to come close to.

In our society, we have the same thing occurring all the time. People’s voices are cues to our nervous system of whether or not we are safe to come close to them. Many of the children that your clinicians work with are children whose voices are conveying that they’re not safe. They’re modulating their voice through loudness, yelling, and not through frequency modulation. It’s not melodic the way they speak because nervous systems detect melodic voices as safety. The mother singing to her baby. It calms the baby, not because the baby learned to be calmed by melodic voices, but because the nervous system evolved to interpret to what I’m calling neuroception that melodic voice as safety and it still works.

Karen Onderko:

On that note, for our therapists who are working with these children, do you have any practical advice separate from the therapy for helping to calm or helping to engage them?

Dr. Porges:

I think our priorities tend to be a little bit distorted in how we intervene and treat children or adults or anyone whether it is a medical intervention or it’s an allied health intervention. We tend to be ignorant or naïve about the effects of physical context on the physiology of the clients. What we have to appreciate is that the sensory world of many of the clients, many of the children, is not the sensory world that we live in. We can’t say that it doesn’t bother me those sounds, it shouldn’t bother the child. We don’t know. If the child’s nervous system is tuned to a different way, then the low frequency sounds are being functionally amplified by ten, twenty, or even as much as thirty dB relative to how a normal ear functions. We get confused.

We use decibel meters and those decibel meters are often using scales that are designed based upon normal ears, not on sound pressure level. There’s low frequency sounds that are disruptive. The first thing that I’m saying is that the physical context of the clinical environment is critical to the effectiveness of the intervention because if the clinical environment is bombarding low frequency sounds, then the physiological state of the client will be so disrupted that the intervention won’t work.

Karen Onderko:

That’s such a beautiful point about having empathy. I’ll put up on the website; there are  lots of videos that have been created by different organizations that give a sense for what it might be like to have a sensory processing disorder or to be on the autism scale. It’s worth taking look at some of those and getting a sense of what that might feel like.

Dr. Porges:

If low frequency sounds are accounting for so much more of the acoustic energy in human voice, it doesn’t matter how well-developed your cortex is or your auditory cortex. It just can’t extract it. It’s just going to be embedded. We are asking at times the wrong question and creating the wrong task when the task could be relatively simple: that is, create environments that are quiet and they will be self-soothing. The acoustic environment is critical.

Randall Redfield:

Particularly for the autism population, what you are saying sounds crucially important. With the main therapeutic approach in the United States being ABA for children on the spectrum, it sounds like your message has a lot of relevance there. Can you connect that for us a little bit and talk about your training that you have coming up on Cape Cod in August? I’m not trying to set you up to pitch your training. I’m just curious if that’s what you’re going to be talking about – if that’s part of the purpose of the course.

Dr. Porges:

I’ve taught for the past few years at the Cape Cod Institute. What we do there is we have clinicians, primarily clinicians, and they come … It’s three and a half hours every morning for five days and then they spent the afternoons on the Cape. It’s quite a nice environment and we’ve had really wonderful classes. Of course, the people coming are clinicians and many of them either work with autistic children or trauma. We are now going to blur this whole issue of trauma and autism, not as a causal feature for autism, but as having some common core features. One of the issues using diagnostic categories is that diagnostic categories try to basically want you to assume that there’s specificity. This is true in terms of research. The National Institutes of Health, when they wanted to do research or have been funding research on disorders, they are interested in whether you can create a biomarker or biological signature of a disorder.

They were never interested in common core features that were really common to many, many psychiatric disorders and even people without true diagnosis. State regulation happens to be one of those common features. The issues of tantrums, the issues of hypersensitivities to sound, the issues of ability to co-regulate with another individual, the issue of poor eye gaze, poor facial expressivity and lack of intonation of voice. These are all the features of the Social Engagement System and they are basically features of many diagnostic categories. Even though we are talking about autism or trauma, we are basically talking what are the observables, the phenotypical expression of these and a lot of them have these features.

Those features, since they are regulated through what I call the Social Engagement System, may optimistically be rehabilitated and this is really what the message is. If you understand the mechanisms of these, can you rehabilitate them? And if you really rehabilitate them, what happens to the child? What happens to the adult? What happens to the range of behavior? What happens to the optimization of the human experience for the child, the parent, the teacher. If we keep focusing on, in a sense, giving cues to the nervous system of evaluation and danger, which is the same thing, the nervous system will not be able to express these features of safety. And with features of safety are: spontaneous social engagement; intonation of voice; facial expressivity; co-regulation; and, in a sense, a satisfaction with being.

Karen Onderko:

Wow! I’m not even sure where to go from here, but behavioral state clearly is a common response and the change that you see in it is a core feature of several kinds of disorders or reasons why people might be coming into a clinic. I believe that behavioral state is related to the probability of activation of a number of neural systems, executive functioning being one of them. Can you talk about your feelings about that connection?

Dr. Porges:

Sure. Again, the interest in science has really been very cortico-centric. Cortico-centric, meaning, focusing on areas of the cortex of which we are conscious of. Now, the cortex has a lot of areas, which we are not conscious of and areas, which interpret intentionality of behavioral movement in our environment and behavioral movement includes our biological movement, includes voice. So, higher level parts of our brain are interpreting these features that are cues of safety or danger. If they pick up issues of safety, they down regulate those defensive systems and functionally open the portals for executive function to occur. If the cues are of danger, it’s going to now stimulate those mobilization fight/flight responses and, in a sense, lessen the opportunities for executive function to be developed and to be expressed. We have to see this in terms of physiological state, adaptive function, and functionally, survival. What is our nervous system reading? Is our nervous system reading the environment that it’s a safe place, that we don’t have to watch our back or be concerned about someone coming up behind us?

Bringing that up, just mentioning that, I’m sure many of the children that your therapists work with have diagnoses of ADD and think about where they put the ADD child in the classroom. We have a child who has a low threshold and a hypersensitivity for things going around. They put him in front of the classroom, which is the worst place for that child as opposed to putting him with a chair against the wall. His nervous system now feels safe and he can look forward. We have to understand that a lot of the behaviors that are basically being driven by our physiological state are far from voluntary. They are, in a sense, promoting a whole cluster of defensive behaviors and those defensive behaviors interfere with executive function, interfere with social behavior, and interfere with digestion, which is probably something you haven’t brought up yet. But a lot of the kids you work with probably have digestive issues because the gut doesn’t work well when it’s in a state of defense.

Randall Redfield:

I love your example of the child in the front of the classroom being put there. What you are saying, if I understand you right, is that the vulnerability produces such defensiveness in that place in the front of the classroom that that outweighs the advantages that might be gained communication-wise from that child sitting there. Can you talk about those two?

Dr. Porges:

Actually, I want to go back to the ABA that you mentioned because it just reminded me that two years ago I was invited by the ABAI which is the Association for Behavior Analysis International to give a B. F. Skinner talk. A B. F. Skinner talk, they view it as the highest honor that any scientist could be given who is not a member of their society. My talk was Behavioral Modification Through the Lens of the Polyvagal Theory. I said there’s nothing wrong with behavioral mod if you understand that physiological state is the intervening variable. So that if you, in a sense, worked on an intervention to calm and make the child feel safe and manipulate their physiological state, then ABA would be very efficient. But, what they are trying to apply ABA to are children whose physiological states are very, very challenged and that becomes a very inefficient strategy because the physiology, the physiological state interferes.

Karen Onderko:

Thinking about physiology and thinking about biomarkers and NIH wanting to see measures, heart rate variability, that’s a measurement that you really brought into the mainstream. Can you talk about that a little bit?

Dr. Porges:

Heart rate variability –and there’s a specific component of it called Respiratory Sinus Arrhythmia. Respiratory Sinus Arrhythmia is a spontaneous oscillation in heart rate that occurs at approximately our breathing frequency and it occurs that way because there’s an ongoing gating of this vagal impact on the heart’s pacemaker. We are actually able to observe the influence of the vagus on the heart because it gets modulated on each breath. I’ve been doing heart rate variability for decades. Initially, I was looking at it as a marker for cognitive processing and sustained attention and then I started to see it as an individual difference that was reflecting more positive health outcomes.

The path that I was led on – or the data led me to – was not to look at heart rate variability as a marker, but to try to figure out the underlying mechanisms of why would it be related to behavior, why would it be related to cognition and why would healthier people tend to have more heart rate variability. That’s actually how the Polyvagal Theory evolved. It basically brought it all back together. It was basically saying that the window to the neural regulation of the heart as part of this Social Engagement System. That window, you can observe it dynamically through measuring Respiratory Sinus Arrhythmia – these oscillations of heart rate variability. So that if you got improvements in facial affect, affect recognition, intonation of voice, better listening, vagal regulation of the heart to this pathway should also change. And that’s what my research is demonstrating.

Randall Redfield:

Do you imagine that in the future heart rate variability might be a standard measurement taken at routine doctor’s visits or at schools?

Dr. Porges:

This is an interesting issue and this brings me back to the 1980s. In the 1980s, I actually had a patent on a process that extracted Respiratory Sinus Arrhythmia in real time. I thought this was really exciting because then I thought people could use this in the clinical setting. What I failed to understand was the conceptualization that people have and I realized that the psychoeducational components were missing. People, even today, there are tens of thousands now of articles with heart rate variability, but the people who are using it don’t understand what the variable is. They don’t even understand how to quantify it or they think that one method of quantifying is equivalent to another and they are not. They have different statistical properties and they extract with more or less validity, this underlying neural control.

What I’m really saying is people tend to apply techniques without understanding what they’re extracting and I didn’t understand that in the beginning. I thought people would just be thrilled to have a measure and I didn’t realize that people didn’t understand the complexity of the measure. What we get with heart rate variability indices when they are done correctly and correctly doesn’t mean that they are peer reviewed. I don’t agree with a lot of the methods out there, not that they are not picking up something useful, but that they could be done better. What I mean by better, there’s a whole set of assumptions here about how you can extract a measure that represents this neural control of the heart. If you get the good measure, if you get it, then you can start monitoring dynamically. Going back to your question, if it’s done with precision and with appropriate technology, I think it’s extraordinarily important. I think it’s even predictive of cancer.

There are couple articles that came out recently that I thought were extraordinarily exciting that said that basically with prostate and with breast cancer, the heart rate variability was a better indicator of outcome than Gleason scores which is the biopsy. In a sense saying that if you had low heart rate variability, Gleason score was the ticket. It basically said whether you’re going to go live or not or do well. If you had high heart rate variability, there was less predictability. If you go back and try to figure out what is this heart rate variability telling you, it’s telling you that the autonomic nervous system has a reasonable surveillance of its visceral organs and it’s dynamically adjusting to these changes. And that’s health, that’s homeostasis.

Karen Onderko:

That variable which can be interpreted in many ways and sometimes inappropriately is yet the single variable that’s being used to measure the success of teams of scientists, your team being one of them, competing for the Palo Alto Longevity Prize.

Dr. Porges:

That’s another discussion. My interest in that was really not to look at longevity, but to actually go for their other prize, which involved homeostasis. Basically, it’s a resilience issue. What I wanted to do is rehabilitate. In a sense, using a rodent model of how do you take an organism that is normally autonomically functioning, meaning a social organism.  Put it into an environment of life threat with a natural predator which for many of these rodents, they’ll shut down, they’ll become inanimate which, according to Polyvagal Theory, puts them into this very, very low or very primitive, basically a reptilian physiological response of basically becoming inanimate and try to rehabilitate them and bring them back to the normal level.

There was one point that was missing from my earlier dialogue and that is even though humans or mammals evolved eloquently or exquisitely to move back and forth between mobilization and social behavior. That system is very well-developed. We call it play that we mobilize them and we make face to face contact. We smile, we talk and everything is fine. But, if we play and hit someone and we don’t make face to face, we get fights – whether they are professional athletes or children. What you’ll find out from your clients is that some of the children want to play, but other children don’t want to play with them because they are not getting the cues of safety, of communication, and the other children don’t want to get hurt basically.

The main point I want to get to is that when you are put into life threat, you go into a different physiological state that we don’t seem to have evolved a pathway to get out of very easily. That’s why experiencing life threat for many people changes their life forever. And this is where the interest or the concern about post-traumatic stress disorder, but it’s not the diagnosis. It’s the physiologic response to life threat. If the life threat is how our nervous system interprets things, it’s not someone holding a gun. It’s whether or not our body interpreted it as life threat. If you go into that state, you’ll have all kinds of clinical symptoms that some of your listeners may understand and that is the people might have issues of irritable bowel. They may have gastric problems.

Older people may have great difficulty feeling physiologically safe enough to even have sexual relationships or to be touched. Their body may react even though they want to be touched and want to be held. You may have all these defensive systems coming in and there are always going to be defensive systems of shutting down our biology. So defecation, passing out and even features like fibromyalgia which is going to be very frequent with older people who have these types of experience is in part due to the sensory part of the vagus, which is monitoring all these organs. The system is a dynamic biofeedback system in itself and when it gets disrupted, it just shuts down. The basic point here is that we can have a defense system that shuts us down. And the real issue is how do we get people back to safety.

My strategy in this project is that the nervous system goes back to safety when it hears acoustic cues of safety. That’s the secret of mothers. It also will go back if it gets neurochemical cues of safety including cues from the gut. I have two other collaborators. One is Bob Naviaux who is at UC San Diego and he is studying the effects of the biome and how it signals the vagus. When you have trauma or stresses, the biome is signaling the brain that it’s in bad shape, something bad is happening. There are certain drugs that functionally trick or tell the afferents, the sensory part of the vagus, that everything is fine. My other collaborator is Sue Carter, who is my wife and she works with oxytocin. Oxytocin works in the brain stem to tell those areas of the brain that are used for defense that you don’t have to be defensive anymore. And that’s, in part, about giving child birth. Giving child birth was utilizing systems that were defensive and then co-opting them with oxytocin to allow subdiaphragmatic organs now to create or allow a child to be born.

Randall Redfield:

I have a few thoughts coming to me at the same time. One of them is talking about heart rate variability in trauma. Is heart rate variability used as a measure for trauma or is that something that it’s not there, but should be?

Dr. Porges:

It’s not there, but should be. Even with the variety of methods used I’ve already said that I am not comfortable with. Even if you accept those, the meta-analyses demonstrate that heart rate variability is suppressed in trauma. It’s actually big findings or large effects. The question now is that’s a portal. If we take this and put it back into context of the Social Engagement System, PTSD is also a disorder of all the features of the Social Engagement System. I’m really saying that heart rate variability is the visceral part of it, but the face carries the other part, the striated muscles of the face and head, facial expressivity, the intonation of voice, the ability even to listen to what people are saying without going into rage. This system is there. The heart rate variability in trauma should be one of the first variables that people look at so, yes, I agree.

Karen Onderko:

Your body of work has such a clear thread to it and then, in your personal life, you are married to one of the leading researchers in the field of oxytocin and that speaks to co-regulation and that’s not coincidental, I’m sure.

Dr. Porges:

Interestingly, Sue’s work, Sue Carter who’s my wife and we’ve been married for a long, long time. I can’t say how long. There are couple important points here. One is that we had totally independent research programs and then about twenty years into our research, we basically acknowledged that we were studying the same processes with different variables. We were actually studying similar areas of the brain stem and I was looking at autonomic outflow and she was looking at the neurochemistry. Now, Sue’s research and discovery; she is the first person who discovered the relationship between oxytocin and social behavior. That’s her work. That’s where it all came from.

Our interpretations tend to be a little different. She is very focused in her mind like a lot of people who do study neurochemistry and neuroendocrinology that it’s the peptide or the hormone that is doing the function. I see them basically only as mediators or modulators of the areas of the brain stem that control the autonomics. The work still has to be done. It’s like we are talking earlier about an interest in executive function or areas of the brain. The behavior has to come out of the brain. It just doesn’t reside in the brain so you have to get involved with motor neurons and those motor neurons can either be skeletal behavior or they can be visceral changes, autonomics.

My focus has been on the visceral primarily because the visceral also creates tremendous feedback back to the brain. This is something that I didn’t mention, but the vagus, which is a very much part of the Polyvagal Theory is primarily a sensory nerve, even though everyone talks about it as a motor nerve. 80% of the fibers are sensory. It is the surveillance system of our body. So, Sue’s work and my work are basically very complementary. The areas are really about the interplay, the intertwining of neurochemistry with neuroautonomics. In my own mind, when I talk about the autonomic nervous system, I talk about it very differently than other people. I don’t see it as solely the autonomic nervous system. I see it as an expanded neuroautonomic that includes neuropeptides, neuroendocrine, and even neuroimmune because those sub-disciplines are overlapping in terms of the areas of the brain and the structures that they are talking about.

Karen Onderko:

It’s fascinating. Your marriage is a beautiful metaphor for your work in that it’s intertwining and cooperating and which came first…

Dr. Porges:

Our oldest son basically has incorporated both our work together and put brain imaging on top of it.

Karen Onderko:

It’s terrific.

Dr. Porges:

We have a product.

Karen Onderko:

It continues.

Dr. Porges:

It continues, right: next generation.

Karen Onderko:

You have a book that you’ve been working on, Clinical Applications of the Polyvagal Theory.

Dr. Porges:

Yes. And if I weren’t talking today, I’d be working on it. It’s coming along, but I’m also putting together another companion book with that that will be published by Norton as well. The companion book is actually written by clinicians who have been informed by the Polyvagal Theory. The important part that I really want to mention is that I’m not a clinician. As I said before, I’m not licensed to do anything other than empowered to talk and do science. When I give my talks and I’ve been very much informed by the clinical community and been a student of the clinical world, I have always been asked about “How can we use this? How can it be used?” And I’ve always been extremely cautious.  Not being a clinician, I don’t want to appear to tell people I have clients or that these treatments work other than work within a laboratory-controlled study model.

I’ve been very, very concerned about this. Over the past, actually I would say, ten years, clinicians from all forms of all different disciplines have in a sense used the Polyvagal Theory or been informed by it and I decided I would have them write their stories. So they’re writing their chapters. There’s one going to be on neonatology, one in palliative care. There’s even a veterinarian who is writing a chapter. Several chapters are on trauma, one on heart disease, which is a personal story. There’s a variety of wonderful chapters by people who are using it to explain what they are doing and then I’m having another section of the book in which people who have created different disciplines themselves such as many of the body psychotherapy models and intervention models who have utilized Polyvagal Theory to explain what they are doing.  They’re writing, in a sense, long forwards. The book is trying to bridge the clinical world – that’s the companion book. My book is really trying to tell the story of the Polyvagal Theory in a language that’s not as dense as the first book.

Randall Redfield:

When do you expect that it will be coming out?

Dr. Porges:

That’s the big question. It should have been out already, but it hadn’t been written. It’s like one of those questions. I am seriously intending to have the book written and everything to the publisher this calendar year. That is my goal because the other comment that I frequently make, “Life is time limited.” I feel it’s something I want to do. It’s actually very interesting at various stages of one’s life. When you are younger, you want to do things because it leverages you and positions you to do other things. As you get older, you want to do things because you want to complete something. You want the sense of completion and I want this book to be a sense of completion because I want others to read it and have a better understanding.

Randall Redfield:

It will be out sometime next year probably, 2017?

Dr. Porges:

That’s the goal.

Randall Redfield:

Safe.

Dr. Porges:

I wouldn’t say safe, but that is the goal.

Randall Redfield:

In closing, I’m curious if there’s anything that you would like to express to the therapists, primarily the clinicians and educators, primarily speech, OT, audiology- the audience that’s using iLs – that would be of interest.

Dr. Porges:

Actually, I would like to get a couple of minutes and talk about some basic principles that I think would be very useful. I just wrote a chapter – and it really was a chapter on complementary and integrated medicine and how Polyvagal Theory, especially in Social Engagement System, was intertwined with that.

Randall Redfield:

To interrupt you, where would we find that chapter? Is that published or is it for your book?

Dr. Porges:

No. It’s not my book. One of the authors is Patricia Gerbarg and it’s going to be published by the American Psychiatric Association. It’s very important to that community because that APA, the psychiatric association will publish it. What I put into that chapter was really a discussion of what I call a passive and an active pathway. These are the two pathways of getting to that Social Engagement System. The passive pathway we talk briefly about which is really the environmental cues, the social engagement, the voice of the therapist, the setting conditions, the passive pathway to regulating physiological state. It basically says you can’t do any work unless you get that state calm. Now, the active pathway, once you get the state calm, now can you get involved with what I call voluntary behaviors or exercises. Listening and talking – listening and moving which is part of what your program has – these become incorporating active movements into the active pathway.

Breath control becomes another important when vocalizations. If we think about how we can change physiology, we can do this to help regulate calm states and get the Social Engagement System on board. We do it through a passive one and creating safety through removing low frequency sounds and perhaps superimposing prosodic sounds. And this was really my own intervention model, which was to use computer-altered human vocalizations to functionally amplify the prosodic features of voice because the body will accept it and calm down. The active pathway is really the interesting one because it leads us to concepts of resilience. Once we have that system calm, can we exercise that system to make it more resilient? And how do we do that? Often people will ask me how can I exercise it. I will say, “What about singing or wind instruments?” which incorporate vocalizations, breath, and listening. They start pulling together all these systems plus during exhalation, which is when you sing and when you talk and when you play a wind instrument. That’s when the vagal efferents, the motor part of vagus, calm us down.

Karen Onderko:

You are then essentially creating this upward virtuous cycle because you have the ability to recover from stressors and you have confidence from your ability to recover from stressors and then you have social engagement which is a two-way process and that’s also feeding your behavioral state…

Dr. Porges:

This is extremely important because we live in a world where the social contact is more virtual than face-to-face. With virtual, meaning texting, it’s asynchronous. It’s not even in real time and our nervous system craves the reciprocity, the synchronicity of face-to-face interactions.

Karen Onderko:

We are just not getting it enough.

Randall Redfield:

May I ask you a little bit about the modulated voice product that you are talking about that you’ve been working on for a number of years? What kind of voices, if you can go into any detail? I’m just curious how they are filtered. Are you focusing on speech language bandwidths?

Dr. Porges:

When we start talking about speech and language, we’ve already moved to a very high level. We are not asking the most primitive question and that is what are the acoustic features that trigger a sense of safety and shift that physiological state so that we can then process language so it becomes a second level. Everything in my intervention is based on the anatomy and physiology of the middle ear structures because the middle ear becomes literally this barrier between the acoustic information and what gets into our auditory nerve, what gets into the inner ear and goes to our brain. We evolve with this system so that it could be tuned for predator or tuned for social behavior. Now, remember, predator would take precedence.  It’s more important to know that there’s a predator in the environment than to say, “Oh, forget it. Let’s keep talking.” We just wouldn’t exist. Or, “Let’s chirp to each other” or something like that. The body shifts to defense and the question is: what are the cues that take it out of defense?

Those are in a sense based upon our neurobiology and their frequency is female voices and what I have primarily used in my intervention stimuli are computer altering female vocal music or male tenor. Because what is vocal music? Vocal music, to start with, is exaggerated vocal prosody. It’s exaggerated. It’s already amplified. Now, if you amplify it through an algorithm, the body or the brain says, “I have to listen.” Now, it will only do that if you remove all the other acoustic information from the environment and create that safe world. You have to create the passivity, the passive pathway has to go, has been triggered. Then, the system will come in and the real question with the populations that your clients and your therapists are concerned about is, what’s the flexibility? How much work is necessary to rehab? I always say I’m an optimist. There may be challenges in the neuroanatomy and in the neurophysiology, but we still haven’t touched the potential of what may be there.

I’ll give you a little project that I’m working on now. There’s a genetic disorder called Prader-Willi. Prader-Willi children tend to ingest lots and lots of food. It’s a genetic disorder. I talked at their research foundation and then I talked at their parent’s organization and I had never seen a Prader-Willi child until I was at the parent’s group, but they were interested in my model. I described the features of the Social Engagement System and when I gave my talk, I had a question mark on auditory hypersensitivities because, from my colleagues – and some of them were extremely renowned scientists working with this population – they had no understanding or no documentation or no awareness that Prader-Willi children had auditory hypersensitivities. They said, “they don’t; they have tactile.” I went there and I met some of the children and their voices lacked prosody and I’m giving my talk and have this question mark. After the meeting, a parent comes up, two parents, the parents come and said, “You described my child” and they pulled out a picture of their child with their hands over their ears.

In a sense, it was extraordinarily predictable. The Social Engagement System isn’t working. And then I learned at the meeting that one of the features of the Prader-Willi is they don’t coordinate suck, swallowing, and breathing which is also regulated by the same system. You ask me earlier about neonates. This is really the first step of developing is the coordination of suck, swallowing, and breathing. The Prader-Willi have difficulty and they are “failure to thrive” and then they are fed – tube fed – and that system is not getting the right feedback. They continue to eat. So I think the roots have been either the behavioral problems are that Social Engagement System which overlaps with the ingestive system and this is why you see a lot of features in the eating disordered individuals. They are using ingestion to regulate state and not social behavior. I think that clinicians – when they start to understand these features – can start working on triggering the systems.

Randall Redfield:

That’s fascinating!

Dr. Porges:

Thank you very much. Let me make just a comment. If it weren’t fascinating, why would I spend these decades on it? To me, it is in a sense part of the manual of what it is to be a human being and understanding that just grows and expands and enables us to ask different levels of questions that will change how we treat ourselves, our children and create our societies. What we have to think about is so much of medicine and treatment has been about surveillance and monitoring. Very little has been an understanding of how features of the environment disrupt or change physiological state and that physiological state like you’re asking about heart rate variability is your portal.

It’s your window to understand whether the physiology is safe, the homeostatic state is supportive of health growth and restoration or has it switched to defense. The way that we could modulate that is actually the strongest one from my perspective and why there’s this overlap with iLs is that the one that we can’t refuse is the acoustic one. We can’t close our ears. We can close our yes. What we see is attempts by individuals to close your ears by putting their fingers in their ears. We go back to this issue of ABA. What is ABA do with that and say, “Don’t put your fingers in your ears.” When the fingers are in the ears, the child is telling you that the sound is painful. Listen to the child. It hurts. It may not be painful to you, but it’s painful to the child. Yes, this is my passion. Thank you.

Randall Redfield:

Thank you very much for taking time to meet with us. This was tremendous and I’m sure many hundreds if not thousands of listeners are going to appreciate it. Thanks again.

Dr. Porges:

Thank you very much. It’s been a pleasure. Thanks.

 

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