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Text für mich Chapter 4

Dezember 21, 2023

Neuroception

NEUROCEPTION:
A Subconscious System for Detecting Threats and Safety
STEPHEN W. PORGES
University of Illinois at Chicago
at a glance
• Neuroception describes how neural circuits distinguish
whether situations or people are safe, dangerous,
or life threatening.
• Neuroception explains why a baby coos at a caregiver
but cries at a stranger, or why a toddler enjoys
a parent’s embrace but views a hug from a stranger
as an assault.
• The Polyvagal Theory describes three developmental
stages of a mammal’s autonomic nervous system:
Immobilization, mobilization, and social communication
or social engagement.
• Faulty neuroception might lie at the root of several
psychiatric disorders, including autism, schizophrenia,
anxiety disorders, depression, and Reactive
Attachment Disorder.

What determines how two human
beings will act toward each other
when they meet? Is this initial
response a product of learning from
culture, family experiences, and
other socialization processes? Or is
the response the expression of a neurobiological process
that is programmed into the very DNA of our species? If
the response has a neurobiological basis, are there specific
features of the other person’s behavior that trigger either
feelings of safety, love, and comfort or feelings of danger?
Why do some children cuddle and warmly conform to
embraces, yet others stiffen and pull back from the same
overture? Why do some children smile and actively engage
a new person, while others avert their gaze and withdraw?
Does knowledge of human biology help us to understand
the triggers and mechanisms of these behaviors during
normal development? If we learn how behavioral
features trigger neural circuits that facilitate social behavior,
will we be better able to help children with severe
developmental disabilities, such as autism, improve their
social behavior?
By processing information from the environment
through the senses, the nervous system continually evaluates
risk. I have coined the term neuroception to describe how neural circuits distinguish whether situations or people are
safe, dangerous, or life threatening. Because of our heritage
as a species, neuroception takes place in primitive parts of
the brain, without our conscious awareness. The detection
of a person as safe or dangerous triggers neurobiologically
determined prosocial or defensive behaviors. Even though
we may not be aware of danger on a cognitive level, on a
neurophysiological level, our body has already started a
sequence of neural processes that would facilitate adaptive
defense behaviors such as fight, flight, or freeze.
A child’s (or an adult’s) nervous system may detect
danger or a threat to life when the child enters a new environment
or meets a strange person. Cognitively, there is no
reason for them to be frightened.
But often, even if they understand
this, their body betrays them.
Sometimes this betrayal is private;
only they are aware that their
hearts are beating fast and contracting
with such force that they
start to sway. For others, the responses are more overt.
They may tremble. Their faces may flush, or perspiration
may pour from their hands and forehead. Still others may
become pale and dizzy, and feel precipitously faint.
This process of neuroception would explain why a baby
coos at a familiar caregiver but cries at the approach of a
stranger, or why a toddler enjoys a parent’s gentle embrace
but interprets the same gesture from a stranger as an
assault. We can see the process at work when two toddlers
encounter each other in a playground sandbox. They may
decide that the situation and each other are safe if the
sandbox is familiar territory, if their pails and shovels have
roughly similar appeal, and if they (the toddlers) are about
the same size. The toddlers may then express positive
social engagement behaviors—in other words, they may
start to play.
“Playing nice” comes naturally when our neuroception
detects safety and promotes physiological states that support
social behavior. However, prosocial behavior will not
occur when our neuroception misreads the environmental
cues and triggers physiological states that support defensive
strategies. After all, “playing nice” is not appropriate or
adaptive behavior in dangerous or life-threatening situations.
In these situations, humans—like other mammals—
react with more primitive neurobiological defense systems.
To create relationships, humans must subdue these defensive
reactions to engage, attach, and form lasting social
bonds. Humans have adaptive neurobehavioral systems for
both prosocial and defensive behaviors.
What allows engagement behaviors to occur, while disenabling
the mechanisms of defense? To switch effectively
from defensive to social engagement strategies, the nervous
system must do two things: (1) Assess risk, and (2) if the
environment looks safe, inhibit the primitive defensive
reactions to fight, flee, or freeze.
By processing information from the environment
through the senses, the nervous system continually evaluates
risk. As evolution has proceeded, new neural systems
have developed. These systems use some of the same brain
structures that are involved in defense functions to support
forms of social engagement. Neuroception now may
encourage the development of social bonds and provide
the opportunity for reproduction.
Social Engagement and Defensive
Behavior: Adaptive or Maladaptive
Strategies?
Social engagement and defense behaviors may be adaptive
or maladaptive, depending on
the level of risk that is present in
the environment. From a clinical
perspective, the defining features
of psychopathology may include
either a person’s inability to inhibit
defense systems in a safe environment
or the inability to activate defense systems in a risky
environment—or both. Only in a safe environment is it
adaptive and appropriate to simultaneously inhibit defense
systems and exhibit positive social engagement behavior.
Faulty neuroception—that is, an inaccurate assessment of
the safety or danger of a situation—might contribute to the
maladaptive physiological reactivity and the expression of
defensive behaviors associated with specific psychiatric disorders.
In typically developing children, however, neuroception
detects risk accurately. Children’s cognitive
awareness of risk matches their “gut response” to danger.
When our nervous system detects safety, our metabolic
demands adjust. Stress responses that are associated
with fight and flight, such as increases in heart rate and
cortisol mediated by the sympathetic nervous system and
hypothalamic-pituitary-adrenal axis, are dampened. Similarly,
a neuroception of safety keeps us from entering physiological
states that are characterized by massive drops in
blood pressure and heart rate, fainting, and apnea—states
that would support “freezing” and “shutdown” behaviors.
How does the nervous system know when the environment
is safe, dangerous, or life threatening? What neural
mechanisms evaluate risk in the environment? New technologies,
such as functional magnetic resonance imaging,
have identified specific neural structures that are involved
in detecting risk. Specific areas of the brain detect and
evaluate features, such as body and face movements and
vocalizations that contribute to an impression of safety or
trustworthiness. Researchers have identified an area in the
cortex that becomes activated when we see familiar faces
and hear familiar voices. This process of identifying familiar
and trustworthy people and evaluating the intentions of
others based on “biological movements” of face and limbs
seems to be located in the temporal lobe of the cortex. If
neuroception identifies a person as safe, then a neural circuit
actively inhibits areas of the brain that organize the
defensive strategies of fight, flight, and freeze. Slight
changes in the biological movements that we see can shift
a neuroception from “safe” to “dangerous.” When this shift
occurs, the neural systems associated with prosocial behavior are disrupted and the neural systems associated with
defensive strategies are triggered.
In the presence of a safe person, then, the active inhibition
of the brain areas that control defense strategies
provides an opportunity for social behavior to occur spontaneously.
Thus, the appearance of a friend or caregiver
would subdue the neural circuits in the brain that regulate
defensive strategies. And as a consequence, closeness,
physical contact, and other social engagement behaviors
become possible. In contrast, when situations appear risky,
the brain circuits that regulate defense strategies are activated.
Social approaches are met with aggressive behavior
or withdrawal.
Immobilization Without Fear
As we have seen, humans have three principal defense
strategies—fight, flight, and freeze. We are familiar with
fight and flight behaviors, but know less about the defense
strategy of immobilization, or freezing. This strategy, shared
with early vertebrates, is often expressed in mammals as
“death feigning.” In humans, we observe a behavioral shutdown,
frequently accompanied by very weak muscle tone.
We also observe physiological changes: Heart rate and
breathing slow, and blood pressure drops.
Immobilization, or freezing, is one of our species’ most
ancient mechanisms of defense. Inhibiting movement
slows our metabolism (reducing our need for food) and
raises our pain threshold. But in addition to freezing defensively,
mammals immobilize themselves for essential prosocial
activities, including conception, childbirth, nursing,
and the establishment of social bonds. For example, when
an infant nurses, the mother has to restrain her movements.
When a child is embraced, the child is functionally
immobilized. Reproductive behaviors also involve a degree
of immobilization. However, immobilization with fear elicits
profound, potentially lethal, physiological changes (i.e.,
dramatic slowing of heart rate, cessation of breathing, and
dropping of blood pressure). Through the process of evolution,
neural circuits in the brain that were originally
involved in freezing behaviors were modified to serve intimate
social needs. Over time, these brain structures grew
receptors for this neuropeptide. Oxytocin is released during
the birth process and nursing. It is also released in the
brain during activities that help establish social bonds.
Thus, when we sense that our environment is safe, the
release of oxytocin allows us to enjoy the comfort of an
embrace without fear. But if our nervous system identifies
someone as dangerous, no oxytocin is released and we
struggle against the attempted embrace.
Social Engagement: The Preamble
to a Social Bond
To develop a social bond, it it not enough to inhibit
defense systems. People must also be physically close to
each other. This is true whether they are a mother and baby forming an attachment relationship or two adults
forming a social bond. There are, of course, major differences
between the contexts in which mother–infant
attachment and the social bonds of reproductive partners
are established. Consider mobility, for example. Due to
immature neural development, the baby has limited ability
to move either toward or away from the mother. In contrast,
two adults who may become reproductive partners
are likely to have similar behavioral repertoires.
If the creation of social bonds depended on voluntary
motor behaviors, then the human newborn would be
greatly disadvantaged: The neural regulation of the spinal
motor pathways is immature at the time of birth and takes
several years to develop fully. Fortunately, social engagement
does not depend on how well we can regulate our
limbs and move our bodies. Voluntary limb and trunk
movement require neural pathways linking the cortex to
spinal nerves (i.e., corticobulbar pathways). Social
engagement depends, rather, on how well we can regulate
the muscles of our faces and heads via pathways linking
the cortex with the brain stem (i.e., corticospinal pathways).
These are the muscles that give expression to our
faces, allow us to gesture with our heads, put intonation
into our voices, direct our gaze, and permit us to distinguish
human voices from background sounds. Corticospinal
pathways to spinal nerves regulate the muscles
that control the trunk and limbs; corticobulbar pathways
to cranial nerves regulate the muscles of the face and
head. The neural pathways from the cortex to these nerves
(i.e., corticobulbar) are myelinated sufficiently at birth toallow the infant to signal a caregiver (by vocalizing or grimacing,
for example) and to engage the social and nutrient
aspects of the world (by gazing, smiling, and sucking,
for example).
The neural regulation of the muscles of the face and
head influences how someone perceives the engagement
behaviors of others. More specifically, this neural regulation
can reduce social distance by allowing humans
(including infants) to:
• Make eye contact;
• Vocalize with an appealing
inflection and rhythm;
• Display contingent facial
expressions; and
• Modulate the middle-ear muscles
to distinguish the human voice from background
sounds more efficiently.
Alternatively, when the tone of these muscles is
reduced, which occurs spontaneously in response to a neuroception
of danger or a life threat in the external environment
(e.g., a dangerous person or situation) or the
internal environment (e.g., fever, pain, or physical illness)
environment:
• The eyelids droop;
• The voice loses inflection;
• Positive facial expressions dwindle;
• Awareness of the sound of the human voice becomes
less acute; and
• Sensitivity to others’ social engagement behaviors
decreases.
It is important to remember that neuroreception of
danger or a threat to life can occur with respect to the
external environment (e.g., a dangerous person or situation)
or the internal environment (e.g., fever, pain, or
physical illness). Even flat (rather than angry) facial affect
might prompt a neuroception of danger or fear and disrupt
the development of normal spontaneous interactive and
reciprocal social engagements. For example, the flat affect
of a depressed parent or the flat affect of an ill child might
trigger a transactional spiral that results in compromised
emotional regulation and limited spontaneous social
engagement.
Polyvagal Theory: Three Neural
Circuits That Regulate Reactivity
Where do humans’ intricate neurobehavioral systems
for prosocial and defensive behaviors come from? As we
have suggested earlier, mammals—including humans—
must distinguish friend from foe, evaluate the safety of the
environment, and communicate with their social unit.
According to the Polyvagal Theory (see Porges, 1993,
1995, 1997, 1998, 2001), mammals—especially primates—have evolved brain structures that regulate both social
and defensive behaviors. In other words, evolutionary
forces have molded both human physiology and human
behavior. As the vertebrate nervous system became more
complex during the course of evolution, its affective and
behavioral repertoire expanded. A product of this phylogenetic
process is a nervous system that provides humans
with the ability to express emotions, communicate, and
regulate bodily and behavioral
states.
The Polyvagal Theory links
the evolution of the neural regulation
of the heart to affective experience,
emotional expression,
facial gestures, vocal communication,
and social behavior that is
responsive to the behavior of others. The theory points
out that the neural control of the heart is neuroanatomically
linked to the neural control the muscles of the face
and head.
The Polyvagal Theory describes three stages in the
development of a mammal’s autonomic nervous system.
Each of the three major adaptive behavioral strategies is
supported by a distinct neural circuit involving the autonomic
nervous system:
1. Immobilization
• Feigning death, behavioral shutdown.
• The most primitive component, shared with most
vertebrates.
• Dependent on the oldest branch of the vagus
nerve (an unmyelinated portion originating in an
area of the brain stem known as the dorsal motor
nucleus of the vagus).
2. Mobilization
• Fight–flight behaviors.
• Dependent on the functioning of the sympathetic
nervous system, a system associated with increasing
metabolic activity and increasing cardiac output
(e.g., faster heart rate, greater ability of the
heart to contract).
3. Social communication or social engagement
• Facial expression, vocalization, listening.
• Dependent on the myelinated vagus, which originates
in an area of the brain stem known as the
nucleus ambiguus. The myelinated vagus fosters
calm behavioral states by inhibiting the influence
of the sympathetic nervous system on the
heart.
Infants, young children, and adults need appropriate
social engagement strategies in order to form positive
attachments and social bonds. At the University of Illinois
at Chicago, we have been developing a model that links social engagement to attachment and the formation of
social bonds through the following steps:
1. Three well-defined neural circuits support social
engagement behaviors, mobilization, and immobilization.
2. Independent of conscious awareness, the nervous system
evaluates risk in the environment and regulates
the expression of adaptive behavior to match the
neuroception of an environment that is safe, dangerous,
or life threatening.
3. A neuroception of safety is necessary before social
engagement behaviors can occur. These behaviors
are accompanied by the benefits of the physiological
states associated with social support.
4. Social behaviors associated with nursing, reproduction,
and the formation of strong pair bonds requires
immobilization without fear.
5. Oxytocin, a neuropeptide involved in the formation
of social bonds, makes immobilization without fear
possible by blocking defensive freezing behaviors.
Neuroception and Mental
Health Disorders
So far, we have been discussing neuroception that
works. Ideally, a baby’s neuroception of her environment
shows her a safe place to explore. But even if her neuroception
warns her—accurately—of danger from a “frightened
or frightening” caregiver, the baby can take some defensive
measures, even though they are likely to be ineffective and
are almost certain to be psychologically costly. What happens
when neuroception itself is impaired? From a theoretical
perspective, faulty neuroception—that is, an inability
to detect accurately whether the environment is safe or
another person is trustworthy—might lie at the root of several
psychiatric disorders:
• Areas in the temporal cortex that are assumed to
inhibit fight, flight, or freeze reactions are not activated
in people with autism or schizophrenia, who
have difficulty with social engagement.
• Individuals with anxiety disorders and depression
have compromised social behavior; difficulties in regulating
the heart rate, as reflected in measures of vagal
control of the heart; and reduced facial expressiveness.
• Maltreated and institutionalized children with Reactive
Attachment Disorder tend to be either inhibited
(emotionally withdrawn and unresponsive) or uninhibited
(indiscriminate in their attachment behavior;
Zeanah, 2000). Both types of behavior suggest faulty
neuroception of the risk in the environment.
Recent research on children raised in Romanian
orphanages has stimulated interest in Reactive Attachment
Disorders and in finding ways to remediate the devastating
disturbances in their social development. If the behavior of these children suggests faulty neuroception of
risk in the environment, are there features in the environment
that might help the children feel safer and then
begin to move toward more normal social behavior?
A recent study of Romanian toddlers being raised in an
orphanage (Smyke, Dumitrescu, & Zeanah, 2002) illustrates
the usefulness of the construct of neuroception in
understanding the development of normal and atypical
attachment behaviors. Researchers evaluated two groups of
institutionalized children and compared them to children
who had never been institutionalized. One group of institutionalized
children (the standard unit) was cared for
according to prevailing standards: Twenty different caregivers
worked rotating shifts, with approximately 3 caregivers
for 30 children on each shift. A second group of
children, the pilot unit, consisted of 10 children with 4
caregivers. If we apply our concept of neuroception to this
study, we would hypothesize that familiar caregivers would
be essential to children’s neuroception of safety—which, in
turn, would be essential for the promotion of appropriate
social behavior. Specifically, a child’s ability to recognize a
caregiver’s face, voice, and movements (the features that
define a safe and trustworthy person) should set in motion
the process of subduing the limbic system and allowing the
social engagement system to function.
The data from the Smyke et al. (2002) study supports
our hypothesis. The higher the number of caregivers children
had contact with, the higher the incidence of Reactive
Attachment Disorder among these children. The standard-unit children were more likely than the other
two groups to have Reactive Attachment Disorder. On
some indices of Reactive Attachment Disorder, the pilotgroup
children did not differ from the children who had
never been institutionalized. These findings suggest that
once we understand the contextual and social features
that inhibit the neural circuits which mediate defensive
behavioral strategies, we can “optimize” the development
of prosocial behavior.
At the University of Illinois at Chicago, we are using a
newly developed biologically based behavioral intervention
based on principles derived from the Polyvagal Theory.
We are testing this approach with children with
autism and individuals with language and social communication
problems. Our model assumes that for many children
with social communication deficits, including those
diagnosed with autism, the social engagement system is
neuroanatomically and neurophysiologically intact. Yet
these children do not engage in voluntary prosocial
behaviors. To improve spontaneous social behavior, we
have reasoned, an intervention must stimulate the neural
circuits that regulate the muscles of the face and head.
The Polyvagal Theory predicts that once the cortical regulation
of the brain-stem structures involved in the social
engagement are activated, social behavior and communication
will spontaneously occur as the natural emergent
properties of this biological system. The intervention
“stimulates” and “exercises” the neural pathways involved
in listening and simultaneously stimulates the function of
other aspects of the social engagement system. The intervention
provides acoustic stimulation that has been computer
altered to systematically modulate the neural
regulation of the middle-ear muscles. Theoretically, the
middle-ear muscles need to be regulated during listening,
and the nerves that regulate these muscles are linked to
the nerves that regulate the other muscles of the face and
head involved in social engagement. Preliminary results
are promising. They suggest that interventions designed to
improve spontaneous social behavior should: (1) ensure
that the context elicits in participants a neuroception of
safety that will allow the social engagement system to
function; and (2) exercise the neural regulation of the
social engagement system.
Conclusions
According to the Polyvagal Theory (including the concept
of neuroception), our range of social behavior is limited
by our human physiology, which has evolved from that
of more primitive vertebrates. When we are frightened, we
are dependent upon the neural circuits that evolved to provide
adaptive defensive behaviors for more primitive
vertebrates. These neural circuits provide physiological
mechanisms that reflexively organize mobilization or immobilization
behaviors before we are consciously aware of what
is happening. When, on the other hand, neuroception tells
us that an environment is safe and that the people in this
environment are trustworthy, our mechanisms of defense
are disenabled. We can then behave in ways that encourage
social engagement and positive attachment.
Focusing on biologically based behaviors common to all
humans allows practitioners to imagine new intervention
paradigms to help children whose social behavior and
attachment are compromised. We can alter the caregiving
environment so that it will appear—and be—safer for children
and less likely to evoke mobilization or immobilization
responses. We can also intervene directly with children,
exercising the neural regulation of brain stem structures,
stimulating the neural regulation of the social engagement
system, and encouraging positive social behavior.

The Autonomic Nervous System- Dancing with ying and yang

A true revolution is unfolding in health care with the
rise of a more accurate understanding of the autonomic
nervous system (ANS) and comprehension of its significance.
The ANS was under-appreciated in psychology’s early
history.154 Now we can say with certainty that most health
problems, including psychological conditions, arise from
ANS functions. Understanding the ANS is crucial to clinical
effectiveness because the ANS and its “survival imperative”
form the substrate for most behaviors and responses,
including the immune system. According to Franklyn Sills,
The autonomic nervous system is pivotal in the
regulation of survival functions. Its importance
cannot be overstated. The entire field of
post-traumatic stress disorder certainly falls in its
scope, along with most degenerative diseases, all
stress-related situations, autoimmune diseases, and
many others.155
Randolph Stone anticipated the revolution, describing
the difference between voluntary and involuntary function
and giving specific, effective methods for ANS support.
118
154 Roy Porter, ed., Medicine: A History of Healing. Ivy Press, 1997.
Chapter 6, “Healing and the Mind,” gives a concise history of
psychology, and the autonomic nervous system is never mentioned.
155 Franklyn Sills, Foundations of Craniosacral Biodynamics, Vol. 2.
North Atlantic, 2012. p. 527.
No relaxation of the voluntary nervous system and
muscles can take place as long as the involuntary
ones are locked and tense… Merely telling the
patient to relax is useless. Tension usually goes
much deeper than the voluntary muscular control.156
The ANS controls most of the body’s involuntary
activity, including the essential survival functions including
circulation, respiration, digestion, metabolism, daytime
alertness and mobilization, nighttime sleep and regeneration,
and more. In addition, the ANS operates our stress responses,
such as ”fight-or-flight” as well as “freeze.” The ANS has the
goal of assuring survival, achieved through constant
adaptation to changing conditions. This biological imperative
is too important to be left to chance or voluntary control; the
ANS is the hard-wired, fail-safe mechanism to avoid disaster.
Most health care professionals will answer the question,
“What is the ANS?” by saying it is the reciprocal action of sympathetic and parasympathetic branches, particularly
fight/flight for the sympathetic nervous system and
rest/rebuild for the parasympathetic nervous system. They
may also add that a goal of therapy is to reestablish a
parasympathetic state and reduce the over-expression of a
sympathetic state, which is corrosive for the body if sustained
for too long. This description has been around so long that it
is accepted without question and recycled in textbooks and
classrooms. However new information shows that the
familiar explanation is only partly true.
Stephen Porges and his Polyvagal Theory
The “Polyvagal Theory” is a new understanding of the
ANS, arising from the research and writings of psychiatry
professor Stephen Porges. He conducted research that
changes the standard view, with huge implications for
psychotherapies and health care in general. Based on Porges’
findings, the ANS has three branches, not two, and they are
sequential, not purely reciprocal.
“Polyvagal” derives from Porges’ observation that one
branch of the vagus nerve (Cranial Nerve X) does not fully
conform to the expected standard classification as
parasympathetic like the rest of the vagus. Porges sought an
understanding of the true function of this branch, known as
the “ventral vagus.” He found that it is still autonomic in that it regulates involuntary survival functions, including a
previously under-appreciated role in heart regulation, but
that it has other functions as well.
Exploring further, he found that the ventral vagus
branch was interconnected with involuntary facial gestures,
listening, vocalizing and other faculties. Considered in
combination with other involuntary nerves in the face, throat
and neck (Cranial Nerves V, VII, IX, X and XI), the ventral
vagus participates in a unified complex that has a critical but
previously unrecognized survival function in mammals and
especially in primates. Together these nerves provide
mission-critical functions for infants (securing maternal
bonding), and later for adults (enabling speech and social
communication).
Primates need maternal bonding more than other
animals because their much more complex cortex needs time
to mature. A bird or fish newborn is relatively functional soon
after birth, but mammals need more time and humans need
literally years before their survival capabilities are fully
available. The ventral vagus nerve group secures the
mother’s loyalty and nurturance to make sure that the
vulnerable new baby is able to survive, and then throughout
later life it enables communication functions that are key to
our astounding biological success. New infants need no
coaching to orient toward their mothers and engage in loving
interchanges through voice, listening and facial gestures.
Their mothers are just as involuntarily captivated and
expressive.
A great chain of benefits ensues from our unique
polyvagal anatomical design: maternal bonding enables the
maturation of our large cortex and development of language.
These facilitate the transfer of knowledge, which, in turn,
enables the efficient development of social structures and
Chapter 6: Autonomic Nervous System
121
technology, leading to ever-increasing security ascending the
ladder of needs to richer access to the purpose in life.
Embryological and anatomical evidence strongly
supports the theory that the Social Nervous System is the
ultimate development in regulatory design. A Social ANS
function, communications (especially speech), has been
convincingly discussed as being the supreme functional
purpose of the numerous anatomical specializations that are
uniquely human, bestowing major survival advantages such
as transfer of knowledge.157 The design works: humans are
the ultimate biological success story, even to the point of
threatening ourselves through overpopulation.158 Our success
is due to our brainpower, thanks significantly to this third
branch of the ANS.
Phylogeny and the ANS
Porges’ inquiry led to an examination of phylogeny.
Phylogeny refers to the study of the development of functions
across different life forms. For example, all animals have
some form of digestion and circulation; even a single-celled
organism floating in a liquid medium has some way to take
in nourishment and discharge waste. As creatures progressed
through evolutionary stages, these systems became more
sophisticated, all in the service of enhanced survival. What is
true for the digestion is also true for the nervous system;
greatly increased complexity has led to enormous
improvements in adaptability and biological success.
Dancing with Yin and Yang
122
157 Jos Verhulst, Developmental Dynamics in Humans and Other
Primates: Discovering Evolutionary Principles through Comparative
Morphology. Adonis, 2003. Page 348 contains an intriguing diagram
showing that human morphology seems to have speech as its ultimate
functional goal.
158 The situation poses an unanswered question in the evolutionary
story: can our expanded cortex capabilities, which brought us such
success, solve the overpopulation problem? Porges found that the phylogeny of heart regulation in
vertebrates showed this kind of increasingly sophisticated
progression, and that the ventral vagus appeared only in the
most recent creatures in the evolutionary chain: mammals,
primates and especially humans. The resulting picture of
heart regulation, shown above, shows alternating
mechanisms for increasing and decreasing heart rate, each
new layer adding greater resiliency and range of motion.
Three Branches of the ANS
The parasympathetic system is the oldest part of the
ANS, reflecting the survival needs of a primitive passive
feeder. It innervates essential baseline metabolic functions,
delivering nutrient-rich, oxygenated blood to the system,
particularly the brain, and its components regulate heart,
lungs and viscera. Normal parasympathetic functions are
relatively limited, such as waiting for food and opportunities
to mate. Parasympathetic stress responses are limited to adjusting the metabolic rate within a fairly narrow range,
such as in “death feigning” survival tactics. In mammals the
parasympathetic stress response appears as “playing
possum” behaviors; in extreme cases it is known as
parasympathetic shock.
The sympathetic nervous system is a later development
of the ANS, adding mobilization and a wider range of
possible responses. More sophisticated animals gained more
survival options in essential feeding, protective and mating
behaviors. With a sympathetic ANS branch, creatures can
pursue food and mates, evade predators and adjust to
environmental conditions with greater adaptation and
success. The capacity for movement and increased sensory
awareness developed, and muscular/structural tissues
became more sophisticated. The sympathetic system acts as a
controller on the primitive parasympathetic to give a wider
range of metabolic responses, a faster heart rate for higher
exertion, and the ability to shift resources to muscular,
visceral or other systems as needed in response to survival
challenges.
“Social nervous system” is a prospective term for the
third branch of the ANS. This most modern branch confers
supreme survival advantages. The social nervous system is a
controller over the sympathetic to greatly expand the
functions of the more crude “fight/flight” responses and
fulfill the purposes described above.
Hierarchical Interactions of the Social Nervous System
The anatomy of the social nervous system consists of
mechanisms that create the all-important protective bond
between newborns and their mothers. These include
vocalization, hearing, visual contact and facial expression,
which are each capable of triggering hormones inducing
pleasurable sensations in both infant and caregiver. These are
hardwired, involuntary, precognitive functions that exist in newborns and have a compelling power to engender
biochemical changes that create emotional bonding during
the vulnerable period. Healthy babies exhibit these
capabilities instantly at the time of birth. Infants experience
compromise or failure of these strategies (such as betrayal by
or alienation from the caregiver) as life threatening, and
justifiably so. Drawing on the “Theory of Dissolution” (developed by
British neurology pioneer John Hughlings Jackson, ca. 1910),
Porges also explains a sequence of operation. Under stress,
we involuntarily try our newest, most sophisticated and
efficient equipment first. If that doesn’t work, older strategies
are attempted, and if they don’t work, the oldest resources are
employed. Therefore, under stress, humans first use our
social/relational tactics, then fight/flight, then immobility, as
survival strategies. Each of these stages has characteristic
indicators for accurate identification.
The sequence bears repeating and elaboration because it
is so important in therapy. The hierarchical scheme is
undermined by traumatic experiences. If social engagement
did not work in the past, we are less likely to try it again in
the present. Instead, we go to the next, older strategy,
sympathetic’s fight/flight neurochemistry and anatomy.
Furthermore, if these did not work earlier in life, we may skip
the sympathetic stage and simply go to the last ANS level,
parasympathetic. Parasympathetic stress responses (freeze,
immobilize, dissociate) are the final functioning points in the
model. If these kinds of responses are also overwhelmed, the
situation can be fatal, as in parasympathetic shock. Averting
parasympathetic shock is justifiably well known as a top
priority for emergency response personnel, because shock can
be fatal.
Robert Scaer, neurologist and trauma expert, has
identified dissociative, depressed states as the fullest
expression of post-traumatic stress disorder and the proper
primary target of PTSD therapies.159 Among many studies
described by Scaer , two stand out: • The phenomenon of “voodoo death,” in which a tribe
member would receive a curse from a shaman and just lie
down and die, was investigated by physiologist Walter
Cannon in the 1930s. Cannon, who coined the phrase “fight
or flight,” wondered what could be the mechanism of such a
sequence; the hierarchical arrangement of the ANS explains
the mystery. At the low end of the sequence, there is no
further ANS option and the system shuts down.
• In autonomic experiments, lab rats put in a deep
basin of water swam indefinitely because they knew the
routine of being subjected to experimentation during the day
and cared for at night; in contrast, wild rats swam once
around the edge to determine that there was no escape, and
simply gave up and sank to the bottom. They had no
expectation of a survival alternative.
The whole sequence is played out in a sub-optimum
hospital birth. Newborn babies come out pre-programmed
for maternal bonding including skin-to-skin contact and
nursing. Instead they are often separated from their mothers
(“infant quarantine”) and subjected to painful unnatural
procedures, facilitated by medicine’s obsolete belief that
babies are insentient. Since the social engagement system
impulses are thwarted, babies then try the older strategy, the
sympathetic ANS in the form of angry-sounding crying.
When that doesn’t work, and it cannot work unless the adults
are sensitive and discerning about such sounds, all they have
left is the parasympathetic freeze/immobilization response.
The misunderstanding caregivers may interpret this
seemingly quiet state as being “good babies,” when actually
they are seriously compromised. Potential long-term
implications include reduced immune system, limited heart
rate variability and loss of other ANS functions. Many
research studies have confirmed the reality and value of a
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functional social engagement system: patients with strong
and active social connections recover faster and live longer.160
A beautiful case study was accidentally created by “The
Rescuing Hug.” 161 Twin newborn girls were in their hospital
bassinets after a difficult birth, and one was not flourishing. A
nurse intuitively had the insight to put them together in one
bassinet instead of being separated. The stronger one flopped
an arm over the weaker one in a heart-touching embrace.
With the social engagement system stimulation stimulated by
her sister’s touch, the weaker sister’s heart rate stabilized and
her temperature returned to normal. These are remedial
effects beyond the capability of modern medicine, a perfect
example of a Yin approach being able to solve a situation that
a Yang approach cannot. Seventeen years later, journalists
tracked down the sisters and reported the story again with a
fascinating video interview. Porges, with an expert eye for
micro-cues given during the interview, readily identified
which girl had been the weaker one at birth.
In another compelling example, the famous baby doctor
Benjamin Spock (1903-1998) actually filmed a close-up view
of the three-step sequence of ANS progressive degradation
during a circumcision surgery.162 The steps are clearly visible
exactly as described by Porges. In his late eighties at the time,
Spock commented poignantly about its effects, expressing
extreme remorse for some of his earlier beliefs about babies.
At the time of the movie filming he did not have a context to
really explain what was happening, but it is excruciatingly
obvious after learning about Porges’ work. I am unable to
show this video clip in class because the students become too
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160 Dean Ornish, Love & Survival. William Morrow, 1999. pp. 34-51.
161 To follow up, use The Rescuing Hug as internet search terms.
162 Benjamin Spock, The Circumcision Question (VHS). Wilbert
Productions, 1994.
distressed for any further learning and we have to spend the
rest of the day restoring their ANS range of motion.
Implications of the New ANS Understanding
The new ANS understanding firms up a field that was
previously considered to be “soft science.” Science seeks
precision, in the form of measurable results, isolated variables
and double-blind methodology. Human behavior does not
readily fit in with such constraints, due to having too many
variables. As a result, the fields of psychology, sociology and
related topics have suffered from second-class status in the
science community. With a fuller understanding of the ANS, a
door is opened for more measurement and credibility and
perhaps real progress in changing destructive practices. The
ANS is not hard to measure: even a saliva sample shows
instant changes, and biofeedback methods for measuring
ANS activity are being constantly improved.163
Counselors have known for years that creating rapport
and supporting safety were important for clients; now they
gain credibility with a physiological explanation and a precise
way to identify and measure the effects.
As new ANS theories are confirmed and applied, major
changes can be expected. The first applications would be in
health care, particularly with young children and post-trauma
treatment, but further applications are also easily envisioned.
Basically, there is now a compelling reason to treat babies
with much more attention to maternal bonding and avoiding
painful interactions, so that the “trump card” of the
all-important ANS will thereby be preserved. This is a
revelation in health care: it was not until 1998 that the
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163 Minimally invasive ANS measurement methods include heart rate
variability (HRV), galvanic skin response (GSR), muscle activation
(sEMG), body temperature, brain wave (EEG), cortisol levels in saliva
and carbon dioxide measurement. Dark field microscopy of fresh blood
samples is a more high-tech method.
American Medical Association even agreed that babies could
feel pain, and the medical profession is still not unified about
such ANS-damaging practices as infant quarantine, umbilical
cord cutting and circumcision.
In the future, a newborn baby could be tested for
autonomic markers from the first moment (using a
non-invasive saliva swab test), and biofeedback could give
caregivers instant ANS status reports to guide optimum
handling. Procedures would be applied more gently, and
some procedures would be stopped altogether if the actual
autonomic effects were made visible.
Similarly, environments of the future for young children
and emergency medicine are likely to be re-designed to
optimize for the social nervous system, in the knowledge that
if this part is highly functional, the older sympathetic and
parasympathetic systems will work better. The effect has been
demonstrated very effectively by the “Roots of Empathy”
program in which new mothers bring their young babies into K-12 classrooms.164 The mere presence of a baby triggers
involuntary neurochemical changes throughout the whole
classroom, with enormous benefits in learning and behavior
that have been repeatedly confirmed in scientific studies. This
program is another example of conscious actions (bringing a
baby into the room) being able to reach into subconscious
processes and definitely change ANS states and behaviors.
Uplifting the social engagement system is the new
“holy grail” of therapy, health care and child care. When the
highest resource of the whole ANS is fully operative, the
immune system, neurological function, self-empowerment
and related indicators all improve. These new methods have
even worked with autism, using specific sounds to induce
nerve signaling along the social group anatomy.165
To illustrate the significance of this new understanding,
a male client in his mid-60s came for sessions complaining of
heart problems, particularly irregular heartbeat and episodes
of not feeling well, including fatigue and mild depression.
His family history featured an abusive, alcoholic father, so
there was plenty of material for traditional psychotherapy
and the trauma history was acknowledged but it was not the
first emphasis of inquiry.
Instead of trying to resolve the past, we inquired into
the surrounding context of his current life, focusing on the
hierarchy of action fields and the ANS. He told a story of
multiple disappointments in intimate relationships, including
a marriage that “lost its spark” and ended in a disappointing
divorce, followed by a more recent breakup of a subsequent
relationship. Through a two-chair Yin and Yang counseling
process, he gained insights into why these relationship
patterns had developed in the past, and how to recognize
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164 http://www.rootsofempathy.org
165 http://www.education.umd.edu/EDHD/faculty2/Porges/tlp/tlp.html
them in the present. He became more self-aware about the
complexity of relationships and observed that his own social
engagement system was under-nourished and under-utilized,
especially since he was retired and living alone.
The deficiency of social stimulation was understandable
in light of his history of disappointments, but once he became
aware of the situation he resolved to consciously undertake
remedial actions, such as going out into social situations more
frequently. Over time he was able to make major changes,
including creating a new relationship with a much stronger
sense of purpose and an intentional basis informed by
understanding Yin and Yang archetypes. Within a year his
heart symptoms faded and then disappeared altogether.
In another example, a female client in her 30s sought
help with severe depression. The initial sessions went fairly
well, leading to resolving binds with her highly-inappropriate
boyfriend as well as her parents who had been through a
divorce a few years earlier. She was beginning to exercise
more and get out in nature; these are signs of re-establishing
sympathetic autonomic fulfillment, one step up the ladder
from parasympathetic’s bottom rung. She was improving but
progress was slow. Then one week she arrived for her session
and was visibly much better. When I asked what had
happened, she reported that her sister and her best friend had
both given birth that weekend, and she had spent the entire
week holding newborn babies. In holding the babies, she was
inadvertently stimulating her own ANS via the
neurochemistry of the social nervous system, and her
depression lifted. She did not have a relapse and
discontinued the sessions to focus on her career.
Differentiating Normal Function from Stress Responses
The new ANS understanding also remedies a common
error, confusing “normal functions” with “stress responses.”
This is an example of familiarity and habit obscuring critical
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thinking. For decades the characterization of the ANS has
been mixing apples (sympathetic’s fight/flight, a stress
response) with oranges (parasympathetic’s rest/rebuild, a
normal function).
Another effect of the new ANS understanding is to put
the sympathetic branch in a new light. Previously,
sympathetic was primarily known for its stress response, and
its normal function was under-appreciated. Meanwhile
parasympathetic’s stress response, the freeze/dissociation
response, was under-recognized as a more serious survival
problem, the last resort for the ANS survival sequence.
Resolving this error overturns a popular therapy model
misconception about the ANS, that the sympathetic,
fight/flight autonomic response is worse for health than the
parasympathetic. In fact, therapists of the future will try to
re-establish the sympathetic through enabling thwarted
defensive responses. The whole ANS can be seen as a
three-step ladder, with parasympathetic being the lowest and
last rung. The parasympathetic can appear to be calm and
placid and thereby possibly “better” but in fact if the state is
involuntary, such as in depression, it is far worse biologically
and more challenging therapeutically.
The diagrams below summarize ANS functioning. For
efficient ANS therapeutic support, I suggest that the
information in these charts be memorized in its entirety, so
that ANS clients are correctly identified and appropriate
therapeutic strategies can be deployed. I have made these
into a poster (see the back of this book) so that they can be
viewed repeatedly until they become second nature.
Reviewing the Stress Response Sequence
Because of its importance in health care, the sequential
operation of the ANS deserves repetition and embellishment.
Again, the ANS stress responses are organized in involuntary
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sequences. At the first moment of perception of novelty or
threat in the environment, a precise set of step-by-step actions
will ensue.
This can be readily experienced in everyday life by
making a loud noise in a room of people, whether or not they
are primed to study the topic. The fact that the responses are
the same with or without prior warning shows that the
sequence is involuntary and therefore autonomic; the same
sequence appears because cognitive control does not reach
deeply enough to manage the reactions. I first instruct the •A high percentage of health conditions are Autonomic Nervous System events, including immune system
disorders, attention deficit conditions, psychosomatic issues, post-traumatic stress effects and others.
•Normally, ANS stages flow and interchange rhythmically based on routine stimuli and biological sequences such
as circadian rhythm, digestion and sexual processes. ANS fixation or loss of flow is a sign of PTSD.
•Voluntary and Involuntary functions overlap significantly, and most of the functions listed here could be either.
But voluntary and involuntary can be distinguished by close observation. Involuntary (autonomic) responses
are immediate and universal across differences of age, gender, education and culture. The conscious mind
cannot fully control face and body expressions. The ANS seems to be mainly incapable of inauthenticity or
deception (Paul Ekman (2009).
•In the presence of novelty or threat, we try our phylogenically newest, best strategy (Social) first. If that does not
work, or has not worked in the past, we try our older, second strategy (Sympathetic). If that does not work, we
try our most primitive, last strategy (Parasympathetic). If that does not work, we are in great danger and we
experience Immobilization, deep depression or parasympathetic shock.
•“The higher nervous system arrangements inhibit (or control) the lower, and thus, when the higher are rendered
functionless, the lower rise in activity.” –John Hughlings Jackson (1835-1911), Neurology Pioneer.
group to take an internal inventory of sensations and
self-awareness, to get a baseline state. Then I make a loud
noise, and each person closely observes what happens next.
Regardless of education, age, gender, religion, culture, belief
system or any other demographic variable, everyone will
have similar physiological involuntary responses.
First is an instantaneous elevation of the head, neck and
shoulders (the “alarm” phase), quickly followed by a
sharpening of the senses, especially eyes and ears, with a
turning of the head to locate the sound (the “orient” phase).
Less frequently, the head and neck may quickly contract
downward, in a “duck and cover” gesture; the simultaneous
up and down impulses may be a key to neck tension, because
realistically the muscles can only do one at a time. Next
appears one of two possibilities: a turning toward
relationship, such as eye contact with other people and some
form of the question, “What was that?” or a turning toward
the disturbance, beginning a mobilization for action. The
sequence continues with a sense of muscular engagement for
fight or flight, whichever the ANS determines has the best
chance of survival based on each individual’s prior history. In
a real emergency there may be a quick deployment of
teamwork strategies at this time, an expression of the social engagement system: one person is designated to telephone
for help while another runs for the fire extinguisher.
If neither fight nor flight is effective, next there will be a
“playing possum” state, in which the system suddenly “puts
the brakes on” all the mobilization that was present an instant
before. This is the moment of stepping down to a lower, less
functional, more dangerous state, the parasympathetic stress
response. It can be effective in dealing with a threat, because a
frozen, dissociative “duck and cover” strategy can constitute
a form of “death feigning,” making some predators lose
interest. Unfortunately the dissociative state can become
habitual, with severe health consequences. The analogy is a
car with both accelerator and brakes both pressed to the floor:
something has to give.
After the crisis has passed, the threat has been
identified and removed, and the ANS perceives a return to
safe conditions, shaking or micro-fibrillations in the tissues
will begin. This movement discharges the intense ANS
energy that was mobilized. Ideally the system will later
experience a deep restorative sleep.
If every step is deployed, including subtle or obvious
shaking and discharge moving to rest, the system is likely to
re-set back to normal, ready for the next challenge. Problems
arise when there is not enough time or capability to go
through the whole sequence. Then the system will seem to
get stuck at one point. For example, in a car accident, the
person may have just noticed the impending problem and not
have had time to swerve with the steering wheel or stab at the
brakes; the ANS system tries to fulfill its program with
defensive responses by the hands, shoulders and legs, but it
cannot. Months or years later these parts of the body may be
still trying to do what was intended before the response was
interrupted. Physical problems may appear in the exact
places, such as arthritis in the hands that gripped the wheel
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and circulatory or structural problems in the leg that stabbed
for the brakes.
Peter Levine has discussed the effects of “thwarted
defensive responses.” The phrase refers to how there is a
great value in helping clients experience fulfillment of
defensive responses so that those impulses can be “retired”
from continual effort. This can be done any number of ways;
authors such as Levine and Diane Heller have given excellent
descriptions, which will be explored later.
ANS portals
Another new concept for therapy arising from Porges’
work is the concept of “portals” for affecting the ANS
branches. “Portals” refers to anatomical components of the
ANS that can be physically stimulated to support a particular
layer. By stimulating specific locations in specific ways, ANS
changes can be created. Creating signaling along a portal
pathway is very useful therapeutically because it is effective
without cost or risk; methods for this are discussed in the
following chapter.
For example, in The Listening Project research at the
University of Maryland, Porges found that stimulating nerves
of the social nervous system through specific muscular
activation created profound improvement in the relational
behaviors of autistic patients.166 The effect is also seen in the
use of vagus nerve stimulation, in which a pacemaker-like
device is implanted adjoining the vagus nerve in the neck to
relieve neurological and behavioral symptoms.167
The portals for the parasympathetic system, based on
anatomy, are the vagus nerve, accessible on both sides of the
neck, and the sacral plexus. For the sympathetic ANS branch,the muscles of the limbs, and the sympathetic chain along the
spine are highlighted; the superior cervical ganglion in the
side of the neck provides access. For the social ANS branch,
Cranial Nerves V, VII, IX, X and XI, observable as a group in
the embryological “pharyngeal arches” structure, can be used
by gently stimulating their sensory and motor components in
the face and throat/neck areas.
The method for using these portals varies with different
modalities. In massage, manual contact with the relevant
areas, particularly the sides of the neck and the face, such as
in a facial massage or lymphatic therapy, might be used. In
Polarity Therapy, energy balancing and reflexology contacts
could be employed. In Franklyn Sills’ Craniosacral
Biodynamics, the “motility of the central nervous system”
and “Becker’s Three-Stage Process” concepts are useful. In all
cases, accurate knowledge of the anatomy is important.
Having clients participate in ANS stimulation has also
proven to be supportive. For the parasympathetic nervous
system, paying conscious attention to the breath and its
involuntary movement of the belly is helpful. For the
sympathetic system, engaging the muscles of the whole body,
or, more specifically, the arms and legs for fight/flight
defensive response fulfillment, followed by relaxation of the
muscles and being conscious of subsequent sensation, can be
effective. For the social nervous system, the approach can
include recalling a favorite person or pet and using the
imagination to induce the warm feelings and neurochemistry
of being lovingly recognized. By stimulating the various
nerve pathways of the ANS, old thwarted impulses can be
fulfilled safely.
Recognition of the client’s ANS state provides a
blueprint for therapeutic strategy. Identifying the currently
active layer, we can use the portals to guide clients in
fulfilling the impulses of that layer, and support them in
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naturally moving through the three-part sequence. The
therapeutic goal is to restore capacity to function at all three
layers, but the third, the social, is the key because it is the
most sophisticated tool in the stress-response repair kit.
Applications in Pre- and Perinatal Therapy
Pre- and perinatal psychology is a rich field for
application of the new ANS understanding.168 Before birth,
babies are immersed in their mother’s experience yet also
super-sentient on their own. The fetus definitely responds to
the environment. The goal is to minimize feelings of threat
and disturbance for as long as possible so a new baby has
maximum time to experience security and trust, building a
strong base that will serve throughout life as the ANS
foundation for resiliency.
The Polyvagal Theory can transform treatment of
infants as well. Among other benefits, there is now a
measurable scientific basis for emphasis on ANS support as
described above. Prior to Porges’ work, modern anti-bonding
medical practices often felt wrong to parents, observers and
some primary care professionals, but clear information about
the nature of the damage was lacking. Babies cannot report
their experiences in normal language and the prevailing
attitude was that babies are insentient and have no memory.
Now we know that newborn quarantine, anesthesia,
cord cutting and circumcision affect the ANS of babies, their
most important lifelong anatomical group. The practices
defeat a baby’s best (social) stress-response resources and
force the baby to a sympathetic (fight-or-flight stress
response) or, worse, to a parasympathetic (immobilization) strategy. The baby’s subconscious brain169 is imprinted with
an expectation of betrayal in intimacy that may endure long
into adulthood. The impact is high because of the social
nervous system’s top-rung place in the ANS hierarchy.
Trauma experts such as Bessel van der Kolk have noted
that the two greatest determinants of “recoverability” from
trauma are how early the incident occurred and whether
betrayal was involved.170 Flawed birthing beliefs create stress
on both ways. An optimum birth is an excellent preventive
strategy for lifelong ANS and immune system resiliency.
The discovery of the social nervous system also makes
sense of the observation that humans are especially prone to
post-trauma dysfunction. In the wild, other animals do not
show PTSD symptoms with any frequency. There is
something in human processing that engenders PTSD, and
the answer is likely about our emotions. Levine and others
have noted that the emotional component of a trauma, such
as rage or terror, is often more overwhelmingly painful than
the physical experience. In Stone’s words, “A mental pain can
be far more devastating than a mere physical pain.”171 The
problem is particularly true in the case of betrayal trauma.172
The experience of emotions and thoughts may be what makes
humans so susceptible to being traumatized. The discussion
of emotions will be continued further in Chapter 12.
Another explanation for humanity’s PTSD tendencies
may be modern life itself. Human biology evolved over eons of time spent in hunter-gatherer and agrarian lifestyles. In
just the last century, the challenges have changed
significantly. As writer Nathan Seppa observed, “Human
biology is ill-prepared for this lifestyle.”173 Some PTSD
reflects a mismatch between ANS biological design and
modern life’s inevitable alienation, pace and pressure. This
also applies to technology: humans were not constructed to
experience many commonplace events of modern life. For
example just one century ago the ANS dealt with a different
environment. The night was dark instead of being in constant
illumination. The seasons were a primary feature of
experience instead of controlled central heating/cooling. The
social fabric was a direct daily interpersonal process instead
of through modern isolation and technological media. One
century is far too short a time for evolutionary adaptation,
and ANS symptoms are epidemic.
The ANS in Large-Scale Popular Culture
Given that the large majority of human behavior is
ANS-driven, any enormously popular phenomenon,
including religion, entertainment and politics, must have an
ANS basis or it would not become large-scale. The logic is
circular but compelling. Cognitive processes alone do not
explain the size of major events. Most obvious are movies and
television involving ANS-centered fear (action thrillers,
fright-inducing movies) or sex (romantic love stories,
pornography, onscreen nudity) because these functions are at
the very foundation of biological design and most fully in the
domain of the ANS. The ANS is in the driver’s seat of
behavior: if something happens in social groups, there is
likely to be an ANS explanation for who, when, where and
how it manifests. An entertainment experience that has not received
much commentary is the phenomenon of children’s cartoons.
Since television first arrived, Saturday mornings have been
filled with children hypnotically watching all kinds of
mayhem; “Roadrunner and Coyote” is an example. These
show exaggerated crashes, collisions and falls, in the
expectation that these are funny. The movie Who Framed Roger
Rabbit (1988) addressed the topic directly and skillfully. Any
laughter that appears in such a context is the ANS releasing
stress, as health visionary Moshe Feldenkrais observed:
“[ANS] Laughter is when we realize the danger is to someone
else, not us.”174 Again, we are so surrounded and immersed
in all this that we do not notice the phenomenon, an ANS
disturbance hiding in plain sight.
My earliest memory of film is Dumbo (1941); I mainly
remember the heart-wrenching separation of baby from
mother. With the new understanding of the ANS, I realize
how the movie had such a big impact.
Along with entertainment, advertising is the
preeminent ANS pop culture application. Long ago,
especially since the advent of television, commercial artists
and producers figured out how to influence buyers by using
subliminal messages. The craft of ANS manipulation has only
become more sophisticated through the years. If there is any
doubt about the supremacy of the ANS in determining
behavior, commercial activity is conclusive proof. There is a
wealth of information published in this topic area, so I will
not dwell on it here.Major holidays reveal ANS behaviors, if we look
beneath their formal titles. Pay “ANS attention” the next time
you are attending a large-scale celebration, and you are likely
to see subliminal processes at work, including ritualistic
restoration of social engagement bonds, discharge of pent-up
stress, increased financial activity and related possibilities.
The time of the winter solstice is celebrated in most cultures,
as is the springtime equinox with its theme of rebirth, fertility
and renewal; Mardi Gras comes to mind as an ANS spectacle.
At the harvest time we seem to have ancient echoes of famine
during the long winter that is approaching. Perhaps most
amusing from an ANS perspective is Halloween, a day given
over to alter egos and frightful archetypes, ritually instilled in
very young children with the odd twist of saturation
bombing with sugar, a well-known hormonal toxin linked
with mood changes, attention deficit disorder, diabetes and
obesity. We might ask, “What are we thinking?” but there is
no answer because the ANS is not about thinking.
Sports are of special interest for me, not least because I
enjoy them so much. Huge crowds gather, at great expense, to
don the tribal colors and join in boisterous, rhythmic Yang
rituals. The spectacle comes complete with patriotic
ceremonies and displays and sexually provocative sideline
“entertainment,” super-charged subliminal ANS practices
that have no rational link to the game itself. I invite you to go
to any large sporting event and watch the crowd as much as
the game, viewing through ANS-colored glasses.
An ANS explanation is that modern sports, both as
participatory and as spectacle, fill an important role in
subconscious experience. For millennia the human ANS has
evolved, and been molded by circumstances, to perform as
hunter-gatherer-protector. The sympathetic branch of the
ANS, the Yang Principle, has existed to mobilize with
daytime alertness, to solve complex threatening situations with skillful mental and physical skills, and to experience the
satisfaction of victory by hard-fought struggle.
Now, in just the last century, the human system finds
itself in a far different world, in which the challenges are
muted at best. At worst, a creature who is biologically
designed for active engagement lives a life confined to traffic
jams, office cubicles, medications and nighttime TV. The
situation has been depicted frequently, making comedy or
tragedy out of the futility and alienation of modern existence.
Falling Down (1993), with Michael Douglas, and Office Space
(1999) with Peter Gibbons, depict the situation brilliantly.
Sports give us an outlet for our ancient ANS impulses.
Each sport has some quality of sympathetic ANS fulfillment,
and each can be analyzed as such, with great insight. Some
are about the territorial imperative, some are more about
aiming a projectile toward a target, some involve sexual
symbolism (sexual processes being primarily ANS events).
Many create fields of action for tribal instincts that engage
and exercise the social branch of the ANS.
Participants and spectators experience a momentary
deployment of biologically programed physical, emotional
and mental skills that otherwise would be mostly dormant in
a modern life. We join with our tribe in mirror neuron
gratification of super-skill performance, including dressing in
the regalia of “our people,” and feeling fulfillment when
“our” team wins. If the team wins the top place, mob
psychology can occasionally be observed, as predicted by
Levine and others. The neurochemistry of these experiences is
no doubt deeply nourishing for the sympathetic ANS
fulfillment-starved modern participants. This is a beneficial
process, an under-appreciated form of therapeutic release.
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An additional level of subconscious understanding is
inspired by the book Initis.176 The author makes reference to a
distinction between “Contraries” and “Contradictories.”
Contraries are the norm in daily experience, defined as
anything that happens in relative “shades of gray,” such as
light and dark, young and old, hot and cold. Contraries can
be usefully modified by “somewhat” or “relatively.”
Contradictories are very rare, being phenomena that are
absolutely different from their complementary conditions.
“Living” and “Dead” are the ultimate examples that meet the
Contradictories criteria, and these are universally fascinating.
The precision of science and mathematics, the celebrated
winning of the big deal in commerce and the satisfaction felt
by compulsive shoppers when they score a good bargain are
other examples of much-enjoyed absolutist ANS satisfaction
rarely available in normal daily life.
Everyone is fascinated by Contradictories, because they
are a hint of the great mysteries and the infinite invisible
world, which are so instinctually compelling. It seems that
sports create an artificial experience of the Contradictory
state, in that, unlike most of “real” life, each event has a
definite outcome. The goal is scored, or not; the shot beats the
clock, or not; the player is in bounds, or out; the putt is in, or
out. Enormous technological sophistication is deployed to
give super-slow-motion replays from every angle, with “life”
and “death” hanging in metaphorical balance. Large masses
of people attend these events with religious fervor, to catch a
whiff of the infinite and have momentary relief from their
daily grind of “maybe” relativistic experience.
In sum, sports can be seen as a much-needed field of
action in a modern context, keeping the age-old sympathetic becomes “Yang-deficient” rather quickly.
The ANS in Medication
The enormous popularity of intoxicants can be seen as
an ANS phenomenon. Each substance has a particular
neurochemical effect, either excitation or soothing, and an
ANS interpretation can help make sense of otherwise
inexplicable behaviors. Intoxicants of all kinds can be
interpreted as form of ANS self-medication. Although these
are often sub-optimum in their effects, in fact many lives are
ruined in the process, the usage is still arising from an
intelligent ANS intention to re-establish equilibrium in
response to extremely difficult circumstances.
Selective Serotonin Re-uptake Inhibitors (SSRI-class
drugs, the Prozac family) deserve more attention than they
have received. Numerous experts have pointed out that these
are ANS-changing, and more risky than acknowledged.177
About five percent of users have reactions, including suicidal
or homicidal ideation. Unexpected domestic violence and
mass killings (such as Columbine and Virginia Tech) often
coincide with SSRI usage, but news reports rarely include
such information. A review of the data reveals the enormous
extent of the problem.178 In the future, investigations of these
horrific events will include the question, “What medications
was the perpetrator on, if any?” Patients will be much more
supervised including inquiry about problematic ideation and
access to weapons. ANS-distressed teenagers are a recipe for
disaster if they have a set of very commonly-intersecting
circumstances: a disabled social ANS, immature risk assessment brain areas, SSRI medications, a devotion to
hypnotic “shooter” video games and access to their parents’
military-grade weapons.
Additionally, the ANS effects partially account for the
popularity of lotteries and gambling. The odds of winning are
very low, but the players experience a temporary “what-if”
euphoria before the selection of a winner. The neurochemistry
of optimism surges for a time, making a lottery ticket a
relatively inexpensive self-medication for anxiety or
depression, with few side effects and some voluntary taxation
benefits. The tax is regressive, since the buyers often are not
affluent, and should be spending scarce resources on
something tangible, but the analgesic effect is also significant.
The ANS in politics
Understanding the ANS also sheds light on politics. The
notion that elections are decided by thoughtful people
analyzing issues and positions has been thoroughly
disproven.179 While a fraction of our mental processing does
pay some attention to issues, the real action is behind the
curtain, where feelings call the shots. Political persuasions
generally follow ANS criteria.180 Candidates’ electability
closely follows people’s quick subjective impression of
images of their faces.181
Marshall McLuhan anticipated the effect of the internet
when he described how subconscious processes influenced behavior as new media were introduced, with print, radio
and television all having specific effects.182 Now the whole
phenomenon is being magnified by the emergence of the
internet, and a new science specialty is arising to interpret
trends in social media traffic. Political strategists are
increasingly seeking to strike the ideal emotional tone to gain
advantage for their candidates, and attempting to use
emotional responses to control behavior; politicians now need
to be effective actors as much or more than policy visionaries.
Politics are also a playground for Yin and Yang. The
modern continuum ranges between sympathy or antipathy
for the poor, freedom or structure, liberty or protection,
opportunity or security. All these and more can be interpreted
as dualistic processes. Governments, just like families, tribes
and organizations, always deal with the universal question: is
it better to have a more democratic system (Yin, the
periphery), which tends to be less decisive and more chaotic,
or a more authoritarian system (Yang, the core), which is
extremely efficient but prone to injustice and exploitation?
Political parties can be characterized along these lines, and
voters will align for ANS reasons more than actual policies.
This can get a little strange, as some people, in acts of
cognitive dissonance, may actually vote against their own
best interests. The ANS perspective explains why maps of
voting patterns so often resemble maps of ANS phenomena
such as obesity, diabetes, poverty and education level. Even
the USA political parties’ blue and red color schemes match
the traditional colors for Yin and Yang.
From a Yin and Yang perspective, the answer to the
age-old political question, “Freedom or control?” lies in
finding balance, with a gentle flow back and forth between
core and periphery, and a highly functional neutral to avoid tendencies for fixation. The designers of the American
system, with its three-part structure, were brilliant in trying to
design a sustainable system for balancing between the two
great polarities.183 In the three governmental branches,
Executive represents Yang principles, Legislative represents
Yin and Judicial represents Neutral. Where are Goethe and
Franklin (philosopher-scientist-politician-artists of their era),
now that we need them?
Applications in Groups
Because groups automatically invoke the social ANS,
Porges’ work has profound implications for group
dynamics.184 In a sense, the whole multi-person group is
functioning as what therapist and teacher Mukara Meredith
calls “one living system,” with many individual cells.
In a group setting, each person’s relational experience
becomes expressed in a collective form. Some participants’
higher faculties, namely the social nervous system layer, will
be operational, but some will have experienced defeat on that
level and habitually respond in older sympathetic autonomic
ways (conflict or flight); more severely damaged group
member s wi l l tend to use thei r mos t pr imi t ive
parasympathetic responses (withdrawal).
When a group attempts to accomplish a task together,
especially in a difficult or seemingly threatening context, all
three layers of autonomic function will be discernible. At first,
relational (social) strategies will be exhibited, except under
severe conditions. These will be successful or gradually yield
to sympathetic (fight/flight) tactics, and ultimately to isolation and immobility within individuals and the group.
For individuals in the group, there will be a “bell curve”
effect with some people exhibiting behaviors in advance of or
trailing the majority. For example, as a group under stress
shifts from relational to fight/flight behaviors, some
participants will already be showing immobility while others
will be continuing to try social engagement. This sequence
sheds light on the perplexing phenomena of mob psychology,
and guides us toward optimum group management.
Groups can be facilitated to “evolve” up the three-part
ANS chain, using awareness and careful management. The
key is to gently re-establish full range of motion in the ANS,
by intentionally invoking the highest function, the social
nervous system, while also acknowledging, de-pathologizing
and safely fulfilling the impulses of the older ANS branches.
For example in a classroom dealing with challenging
material, teachers can splice in social nervous system
activities (having students interact with allies), encourage
movement (sympathetic ANS fulfillment) and provide snacks
(parasympathetic fulfillment). Similar to the effects of the
“Roots of Empathy” program, such strategies can be expected
to lead to enhanced learning, less anxiety, more creativity and
higher and more integrated functionality.
Similarly, groups can be managed to maintain
functionality in the collective social nervous system layer by
carefully noting when individuals, or the group as a whole,
start to slip down to a lower base. For optimum functionality,
the critical mass majority should be maintained at the social
ANS level. Group participation can help individuals by
pulling them up to function at a social level, even though
their individual systems may be habitually more inclined to
lower levels. Properly conducted, a group experience can be
healing for an individual with an ANS problem, rather than
making it worse, as is often the case.

How your nervous system sabotages you

What if many of your troubles could be explained by an automatic reaction in your body to what’s happing around you? What if the cure for mental and emotional disorders ranging from autism to panic attacks lay in a new understanding and approach to the way the nervous system operates? searching for clues to the way the brain operates, and has developed what he has termed polyvagal theory. It is a study of the evolution of the human nervous system and the origins of brain structures, and it assumes that more of our social behaviors and emotional disorders are biological – that is, they are “hard wired” into us – than we usually think. Based on the theory, Porges and his colleagues have developed treatment techniques that can help people communicate better and relate better to others.

The term “polyvagal” combines “poly,” meaning “many,” and “vagal,” which refers to the important nerve called the “vagus.” To understand the theory, let’s look at the vagus nerve, a primary component of the autonomic nervous system. This is the nervous system that you don’t control, that causes you to do things automatically, like digest your food. The vagus nerve exits the brain stem and has branches that regulate structures in the head and in several organs, including the heart. The theory proposes that the vagus nerve’s two different branches are related to the unique ways we react to situations we perceive as safe or unsafe. It also outlines three evolutionary stages that took place over millions of years in the development of our autonomic nervous system. They study models of social behavior and develop treatments for disorders such as autism and anxiety. Porges’ polyvagal theory is becoming part of the training of bodyworkers, therapists and educators.  Dr. Porges was the keynote speaker. (Hakomi is both a system of bodywork and a system of body-centered psychotherapy.) Here, Porges speaks about the polyvagal theory and its significance with Nexus publisher Ravi Dykema.

RD: Please tell me about polyvagal theory. Isn’t it an innovation on the theory of the two nervous systems?

Let me clarify. Historically, the autonomic system has been broken into two branches, one called the sympathetic, and the other parasympathetic. It is an organizational model that came into place in the late 1800s and the early 1900s. Over the years, this model has taken on a life of its own, although we know more now. Essentially, it linked the sympathetic system with the “fight or flight” response, and the parasympathetic system with ordinary functioning, when one is calm and collected.

This model of the autonomic nervous system has evolved into various “balance theories,” because most organs of the body, such as the heart, the lungs and the gut, have both sympathetic and parasympathetic innervation.

Most of the parasympathetic innervation (nerve energy) comes from one nerve, called the vagus, which exits the brain and innervates the gastrointestinal tract, respiratory tract, heart and abdominal viscera. However, the easiest way to conceptualize the neural pathways that go through the vagus is to think of the vagus as a tube or conduit. Conceptualizing the vagus this way forced the scientist to notice that various fibers in the nerve originated from different areas of the brainstem. For example, the neural pathways that go through the vagus to the lower gut come from one area of the brain, while the neural pathways that go to the heart and to the lungs come from another area.

the theory is that the system reacts to real world challenges in a hierarchical manner, and not in a balanced manner. In other words, if we study the evolutionary path of how the autonomic nervous system unfolded in vertebrates – from ancient, jawless fish to bony fish to mammals to human beings – we find that not only is there a complexity in the growth of the cortex, (the outer layer of the cerebrum, which is the largest portion of the brain), there’s also a change in how the autonomic nervous system works. It is no longer just a sympathetic/parasympathetic system in balance. It’s actually a hierarchical system.

So one thing happens then another thing happens then another thing?

RightThis influences how we react to the world. The hierarchy is composed of three neural circuits. One circuit may override another. We usually react with our newest system, and if that doesn’t work, we try an older one, then the oldest. We start with our most modern systems, and work our way backward.

So polyvagal theory considers the evolution of the autonomic nervous system and its organization; but it also emphasizes that the vagal system is not a single unit, as we have long thought. There are actually two vagal systems, an old one and a new one. That’s where the name polyvagal comes from.

The final, or newest stage, which is unique to mammals, is characterized by a vagus having myelinated pathways. The vagus is the major nerve of the parasympathetic nervous system. There are two major branches. The most recent is myelinated and is linked to the cranial nerves that control facial expression and vocalization.

Which are virtually all for the benefit of someone looking at us, right?

Right, or for us looking at them or communicating or signaling–or even listening. We forget that listening is actually a “motor” act and involves tensing muscles in the middle ear. The middle ear muscles are regulated by the facial nerve, a nerve that also regulates eyelid lifting. When you are interested in what someone is saying, you lift your eyelids and simultaneously your middle ear muscles tense. Now you are prepared to hear their voice, even in noisy environments.

How would you apply these principals or findings in a treatment setting?

Let’s say you’re a therapist or a parent or a teacher, and one of your clients, students or children’s faces is flat, with no facial expression. The face has no muscle tone, the eyelids droop and gaze averts. It is highly likely that individual will also have auditory hypersensitivities and difficulty regulating his or her bodily state. These are common features of several psychiatric disorders, including anxiety disorders, borderline personality, bipolar, autism and hyperactivity. The neural system that regulates both bodily state and the muscles of the face goes off-line. Thus, people with these disorders often lack affect in their faces and are jittery, because their nervous system is not providing information to calm them down.

How will polyvagal theory change treatment options for people with these disorders?

Once we understand the mechanisms mediating the disorder, there will be ways to treat it. For example, you would no longer say “sit still” or punish a person because they can’t sit still. You would never say, “Why aren’t you smiling?” or “Try to listen better” or “Look in my eyes,” when these behaviors are absent. Often treatment programs attempt to teach clients to make eye contact. But teaching someone to make eye contact is often virtually impossible when the individual has a disorder, such as autism or bipolar disorder, because the neural system controlling spontaneous eye gaze is turned off. This newer, social engagement system can only be expressed when the nervous system detects the environment as safe.

 

The concept of safety is relative. You and I are sitting in this room together and nothing appears to threaten us. We feel safe here, but it may not feel safe to a young woman with panic disorder. Something in this environment, which is safe for us, might trigger in her a physiological response to mobilize and defend.

So if she gets a flat affect or is fidgety and nervous in this situation, she may not have a choice. It’s a neurological phenomenon, right?It is actually an unconscious or subconscious neurobiological motivational system. She’s not doing it on purpose. It’s an adaptation to a situation that her nervous system has evaluated as dangerous. The question is, how do we get her out of feeling threatened? Traditional strategies would be to reason with her, to tell her she’s not in a dangerous situation, to negotiate with her, to reinforce her, to punish her if she doesn’t respond as directed. In other words, we try to get the behavior under control. But this approach doesn’t work very well with social engagement behaviors, because they appear to be driven by the body’s visceral state. Our current knowledge based on the polyvagal theory leads us to a better approach. Thus, to make people calmer, we talk to them softly, modulate our voices and tones to trigger listening behaviors, and ensure that the individual is in a quieter environment in which there are no loud background noises.

 

RD: Because it’s hard for them to hear a human voice with background noises?

SP:  those systems aren’t working and because loud background noises will trigger physiological states and defensive behaviors.

RD: So if someone’s in a severe reactive state, he or she may not able to pick up a human voice against background noise?

 

SP: Exactly. People in these states are often brought in for hearing tests, and they test perfectly in a soundproof room. People whose nervous systems function properly have certain neural mechanisms for hearing beyond background noise. Those mechanisms attenuate low-frequency background sounds, which enables them to hear human voices more clearly even in environments with noisy background sounds.

These mechanisms aren’t available to people with certain disorders. For example, a young boy with autism will have difficulty differentiating voices from background noise; human voices will wax and wane based upon the background sound. The voice will start “disappearing.” That’s why people with autism and several psychiatric disorders generally don’t want to go to shopping malls, or don’t want to be where there are loud ventilation systems. For them, the background noise distorts the human voice.

RD: What about the normal neurotic, those of us who don’t have an identifiable or diagnosable disorder, but have periods where we’re stressed or anxious? How would polyvagal theory suggest that we be treated?

SP: In much the same way that we’d treat someone with a more severe disorder. For example, when we’re stressed, we may engage in high-intensity exercise. But this actually creates a greater retraction of the social engagement system; it puts us in a state of analgesia, so we no longer feel the stress, as opposed to stimulating a sense of safety and security. Polyvagal theory would suggest strategies to create that sense of safety, like retreating to a quiet environment, playing musical instruments, singing, talking softly, or even listening to music. Think about what we do when we’re stressed; we take ourselves out of interpersonal relationships, as opposed to moving into them. But it’s natural for human beings to use other people to help regulate our own mental and emotional states. So when you ask, “How can we use this knowledge,” the answer is that we have to re-understand what it is to be a human being.

Part of being a human is to be dependent upon another human. Not all the time, of course. Similar to most mammals, we come into the world with great dependence on our caregivers, and that need to connect and be connected to others remains throughout our lives. As we mature, we need to find safe environments so that we can sleep, eat, defecate and reproduce. We create the safe environments by building walls to create boundaries and privacy. Or, we may get a dog, which will guard us, so we can sleep. The point of these strategies is to create an environment in which we no longer need to be hypervigilant, and to allow us to participate in the life processes that require “safe” environments. Social engagement behaviors – making eye contact, listening to people – require that we give up our hypervigilance.

Back to the issue of clinical applications: when we see people with flat affect, flat muscle tone, drooping eyelids, people who are talking without intonation in their voice or having difficulty hearing what people are saying, people who are in states that are kind of jittery and non-relaxed, we can see how these physiological states might have adaptive functions related to protection. But these adaptive functions will not mesh well with the social context in which an individual is living.

RD: You mean they think it’s an unsafe world?

SP: It’s not related to a cognitive process. It’s a physiological reaction that involves the nervous system. It’s not a conscious reaction; most people who feel that way would rather not feel that way. They just can’t turn it off. We have to understand that these feelings are physiological events, triggered by specific neural circuits, and we need to figure out how to recruit the neural circuits that promote social behavior. That’s the important part of the research–we can actually recruit these neural circuits through a variety of techniques: intonation, reducing the amount of stimulation in the environment, listening, and presenting familiar faces and familiar people.

 

What we often do when we’re stressed or anxious is to distract ourselves or create novelty. We’ll say, “Let’s go to the park! Let’s do something different!” But what we need to understand is that the nervous system is really requesting familiarity and predictability, which is a metaphor for safety.

 

RD: It might explain why some New Yorkers wouldn’t leave Manhattan after 9/11.

SP: Right. It’s familiar. It’s home. And “home” is a powerful metaphor for safety.

RD: I’ve heard the human mind described as a paranoid instrument. The premise is that when we are living in our senses, in the here and now, we usually feel safe, but our thinking mind often throws scary impressions in front of us, as if it’s anticipating some threat.

SP: I’ll address that by describing to you a part of our nervous system that is entirely focused on responding to other people, even other mammals like dogs and cats. This is not the same part of the nervous system that can put us into states of enlightenment or ecstasy. In a sense, this is a very grounded component of our nervous system. It engages contact with certain levels of senses that are not the ones that you’re describing. It’s where we are feeling our bodily information from inside our organs. This information from the body actually travels through nerves up through the brain stem and radiates upward to our cortex. This part of the nervous system provides a contact with reality; it regulates our bodily state, so we become alert and engaged. That does not include all of human experience, but it does include most of what we call social interactions. We can say that the social interactions are a very important component of our psychological experience as human beings. And this system, the social engagement system, is what determines the quality of those interactions – the features that we show other people, the facial expression, the intonation of our voice, the head nods, even the hand movements, are part of this. And if I turn my head away while I’m talking to you, if I talk in a monotone without any intonation, or if I drop my eyes, will you have a visceral response? How do you feel when I do that?

RD: It feels like you’re not very present, like you’re withdrawing or you’re disconnected.

SP: Disconnected, which may be interpreted by the other person as evaluative, not liking, not being motivated to engage, condescending or suspicious. So these facial gestures, which for some people are purely physiological responses, are now interpreted with a moral or, at least, a motivational overlay. This may or may not be true. Social engagement is a unique and very powerful component of our interactions.

Now, how valuable is this knowledge? Let’s take three different types of clinical populations. One, fussy or colicky babies who cry excessively. Two, kids with attention deficit disorder. Three, individuals along the spectrum of autism. How do the parents of these three types of children feel? Do they feel that their children love them? Is it easy for them to love their children? Or, do they feel duped and disliked by their kids? How do they feel? With the fussy baby, parents often feel that their overtures of love and caring are being rejected. With the hyperactive kid, they feel their overtures of engagement are being rejected. They feel the same way with the autistic kids. So they are responding to a common feature expressed in these three types of children, and their nervous system interprets their child’s features as if the child is motivated not to like them.

Where’s the power of knowledge and science in helping these families? Where and how can this knowledge be used? We can teach these parents to understand that the child’s behaviors are not motivated by or directed at them. We can teach the parents that they need to help soothe and calm their children. What generally happens in all three conditions? The parents are feeling very upset and these feelings increase the intensity of their interactions with the child and makes the child’s behavior worse.

RD: They can’t help but reveal their anxiety about the child’s behavior?

SP: Yes, and that anxiety gives more cues to the child, and often is translated to the child as anger. The parent may feel justified, because they think that the child does not love him or her. It’s tragic.

RD: Have you used these principles to treat autism?

SP: Yes, but I have approached it at a very different level. I’ve actually tried to trigger the neural mechanisms in the autistic child that enable him or her to make better eye contact and facial cues. I went through the portal of how they listen to acoustic information, and actually created an intervention program that stimulates active listening to modulated sounds. This system of intervention works very well, and very rapidly – within a few hours. As many as 60 to 80 percent of the children treated demonstrate changes in eye gaze, heart rate activity, visceral state and ability to process language. The changing of eye gaze and facial expressivity of a child who is autistic changes the whole interaction with the parent. It’s quite amazing. What’s perhaps the most interesting is that many parents don’t even know it’s happening, because it’s such a natural process.

If I am looking at you, and our contact feels safe and appropriate, and your nervous system is in tune, you’ll feel uncomfortable if I turn away. But then, if I turn back, you’re back on target and you forget about the fact that I turned away. The same thing happens with parents of autistic kids. Once the child is engaged, they forget the child ever had a problem on those levels. Our nervous system expects this facial expressivity and dialogue. When that expectation isn’t met, we feel bad. When it comes back into play, it’s natural.

RD: Can you talk about polyvagal theory as it relates to our need for safety and our reaction when we don’t think it’s there?

SP: If we start thinking in terms of what happened through the stages of evolution, when mammals evolved they required lots of nurturing. When they were born, they were not able to take care of themselves. Unlike reptiles that hatch and scamper off to the water, mammals need to be suckled. So with this physiological evolution, there also evolved social cueing – facial expressivity, crying, vocalizations, sucking movements; all these types of behaviors of the neural regulation of the face provide poignant cues and are part of the mammal’s repertoire for behavioral and state regulation.

We still use the same “cueing” communication system to test social interactions. The neural regulation of the facial muscles provides a way to reduce psychological distance before we deal with the inherent risk of moving physically closer. This social engagement system enables people to touch each other. We don’t just walk up and touch someone; there’s a whole interaction between the face, vocalizations, other bodily cues, to see if we feel safe with each other. Then we can touch. Thus, social engagement behaviors precede the development of social bonds. Social engagement behaviors provide an option to test interactions in “psychological space” with very low risk, prior to the test in “physical” proximity. Polyvagal theory shows that as reptiles evolved into mammals, the neural regulation of the heart and lungs changed. It came to be regulated by an area of the brain that also controlled the facial muscles. After that, emotional expressivity, ingestion of food, listening and social interactions were all related to how we regulated our bodies. Those components calmed us down. Thus, social behavior could be used to calm people down and to support health, growth and restoration.

Everyone knows that social support is good. But what are the features of social support and why does it work? Generally, it operates through the mechanisms that we’re talking about; it triggers the social engagement system, which is linked to the myelinated vagus that calms us and turns off our stress responses. It’s self-soothing and calming, and makes us much more metabolically efficient. The theory involves the complex linking of systems: how the nerves that regulate the heart and lungs are linked to the nerves that regulate the striate muscles of the face and head and how the cortical regulation of brain stem areas that do this regulation enable us to turn off defensive strategies. Here’s one thing I didn’t discuss: how do we distinguish between friend or foe? There’s an area in the brain that picks up biological movement and intentions. That area detects familiar faces, familiar voices and familiar movements. So hand gestures, facial expressions and vocalizations that appear “safe” turn off the brain stem and the limbic areas that include fight, flight and freeze responses.

RD: The sympathetic nervous system?

SP: It’s actually even more than that. The limbic system “grabs” the sympathetic nervous system (as well as what’s called the hypothalamic- pituitary-adrenal-axis) to turn on defense systems including the fight-or-flight mobilization system and the freeze immobilize system.

RD: Where’s the “freeze” response in all this?

SP: Fight and flight are actually programmed in different areas in the brain. Even though they generate the same autonomic responses, like sweaty hands and increased heart rate, they are actually different programs of movement, and they’re programmed in different areas of the brain. But the freeze response is totally different; where fight and flight are mobilization, freeze is immobilization, and immobilization is potentially lethal for mammals.

RD: It’s like being scared to death?

 

SP: Exactly. The metaphor would be the cat-and-mouse game. When a mouse is confronted by a cat, it may freeze into a death-like faint, where it will be floppy and unresponsive. Actually, about 20 percent of the small mammals who use this death-feigning strategy will die, just by going into that state. It is not a voluntary behavior, in which they are pretending to die. It is a reflexive, adaptive response. They’re literally in a dissociative state. Their pain thresholds are raised.

RD: Does this happen in humans?

SP: Well, this may be part of the post-traumatic stress disorder (PTSD) syndrome. PTSD may be about raising pain thresholds; it may be a preparation to be killed. Many mammals have this mechanism. In a sense, it’s a beautiful strategy; if you’re going to die, raise your pain thresholds and just say goodbye. There’s another kind of immobilization, an immobilization without fear that is positive and enjoyable. Often immobilization without fear is required to enjoy sex. This state of immobilization without fear is common for female mammals. Actually, men may immobilize after sexual activity as well. There is an important link between immobilization without fear and being in a safe environment. What’s the saying? If you want to steal something from a man, do it right after sex. They’re just totally helpless. And to really enjoy sex, women, in a sense, have to feel safe with the man and to immobilize without fear.

RD: How does polyvagal theory relate to all this?

SP: The theory has two important parts. The first is the link between the nerves of the face and the nerves that regulate the heart and the lungs. The second is the phylogenetic hierarchy that describes the evolutionary sequence from a primitive, unmyelinated vagus related to conservation of metabolic resources, to a sympathetic-adrenal system involved in mobilization strategies, to a myelinated vagus related to modulating calm bodily states and social engagement behaviors. The hierarchy emphasizes that the newer “circuits” inhibit the older ones. We use the newest circuit to promote calm states, to self-soothe and to engage. When this doesn’t work, we use the sympathetic-adrenal system to mobilize for fight and flight behaviors. And when that doesn’t work, we use a very old vagal system, the freeze or shutdown system. So the theory states that our physiological responses are hierarchically organized in the way we react to challenge, and the hierarchy of reactions follows the sequence in which the systems evolved. Additionally, the linkage between the nerves that regulate the face and the nerves that regulate the heart and lungs implies that we can use the facial muscles to calm us down. Think about it: when we’re stressed or anxious, we use our facial muscles, which include the ears. We eat or drink, we listen to music, and we talk to people to calm down.

RD: So we could use dramatic facial expressions to calm down?

SP: Absolutely. Think about how pranayama (a yogic breathing technique) works. When you do these breathing exercises, you’re actually “exercising” both the sensory and motor nerves regulating the facial muscles; you are controlling breath and maneuvering the oral motor cavity. It’s a very efficient way of working on the system. A lot of people don’t like to teach pranayama because they think it’s too powerful. Polyvagal theory explains how pranayama might work and how other methods of stimulating the same system, including social interactions, can result in similar benefits to our health and mental state. The social engagement system includes the nerves regulating the face and the myelinated vagus regulating the heart and bronchi. The power of the social engagement system is amazing both in terms of its effects on behavior and mental state, but also in terms of the speed with which it works.

 

RD: So do humans have the ability to consciously access our more recently developed neurological systems, instead of reverting automatically to our reactive systems? If so, can we use them to override the vague anxiety with which many of us live?

 

SP: Let’s take a very optimistic viewpoint. Let’s say that some of these behaviors – at least the shutting down of social engagement to facilitate defensive behaviors – are not voluntary choices. However, often when this occurs, it is as if the nervous system has betrayed us.

 

To cope with these apparent betrayals, we need to recognize when our nervous system is failing us and to learn to compensate with voluntary behaviors. What does that mean? It means that if I’m in this state of activation and arousal, when my nervous system detects that I am in danger, I can use voluntary behavior – I’ll move myself into a quiet room or go to what I perceive as a safe environment.

Some people believe that you don’t have that option; if you have a job, you have to perform even at times when your nervous system wants out. For example, you have to lecture, teach or see clients. You can’t remove yourself from the situation, because you have responsibilities that define you as a professional. What are your alternatives?

First, listen to your body. Your body is telling you that it’s in an unhealthy state. Your body is not well adapted for prolonged periods of stress and anxiety. And while you can’t control all of your surroundings, you can control some of them. We also need to recognize and honor our individual differences. Just because our significant other enjoys a noisy party, doesn’t mean that our nervous system can handle it. So with this understanding, we can arrange our lives so that our surroundings are more harmonious and peaceful, so that our neural circuits aren’t being triggered.

 

RD: So let’s say I’ve just arrived at a party where I don’t know anybody, and I realize I’m underdressed for the occasion. I’m embarrassed, but it’s an important business function and I can’t leave. How would I use the listening-to-my-body approach to calm myself and feel safe?

SP: I think the essence of what you’re describing is the feeling of being trapped. You can’t leave. It’s like being in a situation where there’s too much noise, it’s too hot, there’s an abusive conversation going and, for whatever reason, you can’t leave. That’s very difficult. But, in general, we have to learn to navigate situations and find ways to make ourselves feel safe.

In this case, you have to do something; your visceral state has shifted because of something that cognitively is not very important–your clothing–but your body may have reacted in the way that destabilizes your ability to be social. What I’m saying is we have to respect that. We can’t minimize that because to us it appears to be inconsequential.

RD: So staying at the party – pushing through the situation – is not the solution.

 

SP: Absolutely not. The solution is in respecting and honoring the body’s responses. When this feeling of being trapped comes up, we have to deal with it by saying, “How can I modulate that?” Children like autistic kids are feeling trapped all the time, because their physiology is saying, “Get the hell out of here.” And they’re being forced to sit, to make eye contact, to do things that are terrifying to them. To treat them, we must first respect what their bodies are saying.

The bottom line is that our nervous system is evaluating risk and safety in the environment. It’s automatically doing that all the time. It’s like a radar system, constantly sensing whether we’re safe or not. We can use many metaphors. For example, someone may say, “I don’t like the energy in this room.” Let’s investigate what that means. It may be that people are not making eye contact, they’re not inviting, and there may be a lot of background noise. There are many features that we can now decode.

RD: But in the sequential order, if we’re feeling that the environment is unsafe, then social interaction could either make us feel safe, or make us feel threatened, right?

 

SP: Right. But we don’t make the determination. The person engaging us is actually triggering our system, one way or another. So let’s say you go into this strange room. You don’t know anyone. You’re hypervigilant. Your body is saying to you, “I’m not comfortable here, because I don’t know anyone.” There’s no familiar face, there’s no familiar voice, so you’re unable to turn off the brain structures that regulate defense strategies. Then someone comes up and makes eye contact with you and says, “Oh, I’ve heard so much about you. I get your magazine.” And he says, “Can we sit down and talk, because I have some ideas.” And then you go into a quieter place, you have a drink, and suddenly you feel fine. Now if someone doesn’t engage you, and you stand there in the periphery, the way you were feeling continues to radiate and you formulate a strategy to get the hell out of there as soon as you can.

RD: That’s exactly how I feel when I go into a business setting, and I don’t know anybody. And then as soon as someone I do know arrives, everybody else seems to be friendlier.

 

SP: Ah. Now you’ve brought up a very interesting feature, because when you’re in a state of this arousal or this danger evaluation…

RD: …everyone seems to be judging me.

SP: Oh, but not necessarily. You are misreading their cues.

RD: But that’s what I’m feeling.

SP: Absolutely, because what happens is when you’re in that physiological state, neutral faces appear to be angry, so you misread everything on a conservative level related to survival. In this conservative state, your nervous system evaluates anything that may be neutral as dangerous, rather than pleasant. But once you become calm and engaged, you see neutral as being neutral, and then you engage people and they start reacting back to you.

RD: It seems counter-adaptive. If I go into an environment like that and my well-being depends on my making a good impression, I could blow it.

SP: No, because you’re too smart to go that direction. You’ve been in similar situations and know what to expect and how to regulate through appropriate behaviors. What we’re really talking is how the mammalian system evolved to maximize survival. We really only want to be in groups with people we know. But you’re not considering your behavior from a motivational model in which your success and professional survival is dependent on you making connections. This motivational model involves much higher brain structures that can modulate the more “primitive” defense strategies.

RD: Maybe, but it’s the people who are willing and able to go into those threatening environments over and over again who are leading corporations and governments.

SP: Maybe, but those people may also have some features that would not result in strong interpersonal relations. They may start veering toward what we might call sociopathy. They may not discriminate among whom they like or interact with, since they are always socially engaging. It is possible that these people don’t develop very good close relationships.

RD: Any closing words?

SP: Yes, I think it is important to remember that we can use our higher cognitive processes to help maintain important and positive connections with people, even during stressing situations. When we are in a mobilized anxious state and want to communicate or relate on a calmer personal level, we need to put the brake on our sympathetic-adrenal system and recruit the neural circuit that promotes social behaviors. We can do this by using our facial muscles, making eye contact, modulating our voice, and listening to others. The process of using the muscles in our face and head to modulate our social engagement will actively change our physiological state by increasing vagal influences on the heart and actively blunt the sympathetic-adrenal system. Then we can be more in contact with reality, more alert and engaged. The social neural circuit also supports our health.