JUSTINLMFT Podcast with Dr. Stephen Porges

It was a real delight and honor to have Dr. Porges on the podcast. As you probably know, he is the creator of the Polyvagal Theory and author of “The Polyvagal Theory.”

Topics covered:

• “Understanding comes from feeling safe with ideas and thoughts.”

• “Polyvagal Theory enabled me to understand the portals we have to optimize the human experience.”

• Before PVT, the focus was on events versus feelings

  Feelings

• Emotion versus bodily experience

• Feelings sit on top of autonomic state

• Inverted triangle, bottom point is the brainstem and wider point are the higher brain structures

• “What higher brain structures can do are in part limited by the state that the brainstem is in.”

• ”Many of the observables in our human behavior are not intentional.”

• “We have feelings and we respond to them.”

  Empathy vs Compassion

• Empathy – we feel other people’s’ feelings

• “Empathetic pain” – If another feels pain, we may not be in a good position to support

• Evaluating pain, like “That’s horrible.”

• Compassion – respectful and acknowledging of another’s pain, but there to witness and support

• “People aren’t prepared to listen, to witness, in a compassionate way.”

  “Healing” the Vagus Nerve?

• Vagus nerve is a conduit

• Vagus isn’t the concern, it’s the feedback loop between organ and brainstem that is the concern

• Certain feedback loops or defense strategies can get stuck

• Comorbidities come along with an ANS that is in a defensive state

• Be careful of ‘hacking the system,’ there are more natural ways to perform neural exercises, like singing, socializing, rocking, pranayama yoga and playing

• Extend the duration of the exhale

  Other Fs…

• The responses are adaptive, not bad

• “Flop” is an adaptive response to death feign, part of the most ancient dorsal vagal circuit

• “Shutting down” is literally passing out, but not everyone does that, but will have immobilization features

• Hybrid and gradation of sympathetic along with immobilization

• A body that goes into immobilization features may actually mobilize in an attempt to resist immobilization

  Substance Use

• Addictive behavior is a strategy to regulate state

• True physical addiction is secondary to initial benefit of addictive behavior

• The addictive behavior is protecting the individual from shutting down

  Psychiatry

• Child psychiatry is about pharmacological manipulation

• Psychiatry is not looking at the social engagement system behaviors

• “Psychiatry needs a reeducation.”

• “The warmest home for the polyvagal theory… is in trauma.”

• Polyvagal Theory provides a narrative consistent with client reports

• “Drugs effect physiology,” they are looking to “down-regulate” arousal

• “Some drugs will calm people down and they will be isolated in their calmness.” Calmed down doesn’t mean socially engaged

• Vagal tone means the amount of information coming down the vagus.

• Psychiatric medications may remove efficiency of regulating physiological state

• Psychiatry needs to measure autonomic regulation of the individual on and off the drugs

  Dominant State

• Safe and social system needs to be accessible to reduce ambiguity of a cue

• “Freeze” is the mix of dorsal vagal immobilization plus sympathetic arousal

• “Shut down” is limp, “freeze” is rigid

  Clinical Disorders as Adaptations

• Adaptations are a shifting of the more global autonomic states

• Clinical disorders are a compromise to the social engagement system

• As a species, we evolved to co-regulate, if we take that out of the equation, you get self-regulatory behaviors that result in diagnoses

“I think what you would find is it really doesn’t matter what the diagnosis is. That they share some common features. And the common features have to do with state regulation. And in fact the manifestations… has to do with the strategies that the higher brain structures developed to regulate their state. And in a sense the personal narrative that evolved from those psychological or mental experiences.” -Dr. Stephen Porges

• A disruptor (like abuse or traumatic event) occurs that disrupts opportunities to co-regulate with a safe other

  Personal Narratives

• PVT brings the narrative that there is a reason someone is feeling the way they feel

• Higher brain structures (cognitive and sense of awareness) attuned body state, it will act as a container to the feelings

• Narrative will change when people become attuned to their state

• Narrative can be a container to physiological activity

• Our body’s reactions were heroic attempts to save our lives

  Dissociative Identity Disorder & Dissociation

• Alters may be seen as a polyvagal state, they have autonomic components

• Often, DID systems have no more than three alters

• Dissociation can be understood as decreased blood flow to the brain

• Dissociation is an adaptive feature in place of passing out; repeated passing out can result in injury or death

• Dissociation is common and there are gradations

Polyvagal theory is an evolving theory that others are adding to, it’s a framework of thought.