Bob Dylan’s song ‘One more cup of coffee for the road……..’ sung by Frazey Ford (part of the trio ‘The Be Good Tanyas’ Enjoy: https://www.youtube.com/watch?v=3oMb06O2wXo&index=3&list=PLvH6172Mu-twN_wa2X9VA80Vbl1YnkvS7

Continued from previous post…

 ‘Trauma has an impact on all aspects of our human civilization and individual lives. Yet, the reality of trauma is often overlooked in societal approaches to public policy, education, and the resources offered for mental health. How can the pain of trauma be so often missed?’ Pat Ogden

Sources:

Reframe Your Thinking Around Autism: How the Polyvagal Theory and Brain Plasticity Help Us Make Sense of Autism (2015) by Holly Bridges, which contains a foreword by Stephen Porges

Brief information on the polyvagal theory from Kathy Brous’s website http://attachmentdisorderhealing.com/

Trauma and the Body: A Sensorimotor Approach to Psychotherapy (2006) by Pat Ogden, Kekuni Minton and Clare Pain with foreword by B. Van der Kolk and Dan Siegel

Beyond the Brain: How the Vagal System Holds the Secret to Treating Trauma by Stephen Porges and Ruth Buczynski (Retrieved from http://stephenporges.com/images/nicabm2.pdf)

Mindsight: The New Science of Personal Transformation (2010) by Dan J. Siegel

Dan J. Siegel’s Mindsight Journal, Issue No. 1, March 2015

Brief notes on polyvagal theory and trauma responses

Significant advances in neuroscience have taken place, which have shown that humans like other animals respond to incoming stimuli with relatively predictable behaviours and responses, and that under stress or threat, people will resort to more primitive defences. During trauma, attack or threat the natural interaction and flow of the body is disrupted because the system initially gets into a survival mode ready for fight or flight. When there is no possibility for fight or flight, people freeze, like an animal caught in the headlights. Finally, our fourth survival mechanism is to faint and go to a partial paralysis. Unfortunately, prolonged trauma or stress can turn these responses on all the time or way too often, with detrimental effects for our bodies and lives. Trauma is about past learning and top-down processes hijacking our bottom-up processes. It is about past experiences colouring our evaluation and understanding of new incoming stimuli. And unfortunately, it is often about ongoing violations of interpersonal boundaries, harassment and lack of safety in the present, which severely undermine healing and empowerment. People who have suffered trauma often automatically respond to trigger-situations that remind them of past events with responses they had engaged in during trauma, which may often be inappropriate and self-sabotaging. Pat Ogden writes ‘survivors may be competent and focused most of the time, but they may suddenly collapse into primitive and inflexible states of immobilization when confronted with situations that remind them of the past. Some may remain aware of what they are feeling, what is going on around them, about potential escape routes, and physical impulses to protect themselves, whereas others space out and lose contact with both their internal sensations and what is going on around in their environment’. Finally, trauma is all about our physiology for as Pat Ogden writes survivors’ symptoms tell their story. Trauma impacts health tremendously and victims of trauma are vulnerable to physiological dysregulation. Many post-traumatic symptoms are somatically driven and these bodily symptoms tell the story.

Stephen Porges’ polyvagal theory changes our understanding of how our nervous system responds to threat and trauma and explains physiological behaviours as a result of trauma. It also stresses the importance of physiological states in understanding the mind. The polyvagal theory and exciting new findings about our brain plasticity can also open doors to new understandings of autism and other conditions. Holly Bridges writes ‘this theory is beautiful and allows for the possibility of real change’. She adds that ‘polyvagal theory suggests that autism may not be a neurological disorder but a learnt response of the body to early stressors’. In her book she mentions that ‘many people do change on the autistic spectrum. Some people are not verbal, only to find that they later find their voice. Others can become much more proficient and comfortable in company as they mature. Some parents have described their child as neurotypical only to find after some event that they were not, and some document that the symptoms of autism in their child have been completely reversed’. Several years ago while I was studying for a degree I did a course on the autistic spectrum experience and I realise now that polyvagal theory and more recent findings by neuroscientists, as well as books  like Holly Bridges’, which I had no access to at the time, would have greatly enriched my learning process and allowed for deeper understanding.

Stephen Porges found that there are actually three autonomic nervous systems or circuits –not two as previously believed. The autonomic nervous system mostly works without our control and it regulates functions, such as breathing, digesting food, heart rate. It also responds to trauma and threat. At this point it is necessary to expand a bit on the term autonomic. Stephen Porges writes that the term autonomic dates back to the 1900s, but ‘our new mammalian autonomic nervous system has a whole new component of voluntary input’. He claims ‘it’s not simply autonomic meaning automatic – it’s really a hybrid system that as we get more mammalian, we’re using more voluntary or higher brain structures to choreograph how our visceral systems work’ . What this practically means is that we can change our breathing, control what is coming out of the mouth or in it, turn on our cortex and calm the limbic area of the brain, diffuse pain, soothe our digestive system, etc. Porges further states that the acoustic environment, what we listen to, can impact and alter our physiological state through neural regulation of the middle-ear muscles. He refers to the findings that trauma survivors describe hypersensitivities to sounds and vibrations that others do not feel. They also avoid crowded places like malls or supermarkets, etc. He explains that our nervous system has evolved to pick up and interpret certain features in the environment like acoustic features or gestures in order to evaluate risk. However, a great part of this interpretation is not on the level of cognitive awareness. So, Porges and many other neuroscientists, physicians and therapists believe that when people become aware that the body reacts and colours their perception of the world, this knowledge will inform their life narrative, and can potentially allow change to take place. He goes on to provide a personal example of how his decision to have an fMRI brought on a panic attack making him aware of a vulnerability he was not previously aware of and how understanding this resulted in his not subjecting himself to a state of immobilized fear, but finding a way to deal with the situation constructively. So for instance, having a stomach ache may not be the result of gastric distention, but might be triggered by context and environment. Past trauma and learning may be triggering physiological reactivity that we are unaware of.

Therefore, Porges believes that if people become knowledgeable about the features of their body’s responses, which involves their being aware of their subcortical reactivity then the higher cortical areas of their brain can start inhibiting them at a natural level. Knowledge of how our body works and of our mental beliefs can shape our physiological responses. Dan Siegel writes that reframing stress alone ‘can alter the biological effects of stress by harnessing more flexible neural circuitry than reactive brainstem systems utilized to deal with threat, which means the ability to know one’s own mind – to have mindsight abilities – can help us change the physiology of taxing experiences. I will very briefly quote Dan Siegel’s understanding of mindsight and hope to return to this subject in future posts. He claims that mindsight has three components a) insight, which involves reflecting with awareness by focusing our attention on the internal, subjective world of our mind b) empathy, which is feeling the inner experience of another person within one’s mind, feeling felt by someone else is the foundation of a supportive relationship and c) integration, the differentiation or specialization and linkage of systems, including the brain and interpersonal relationships. Furthermore, Dan Siegel writes that through interoception, which means perceiving within, we can gain access to our body’s wisdom. By doing a body scan we can become aware of the interior of our body. I will very briefly here refer to a vignette in Dan Siegel’s book that demonstrates ways interoception can be developed. While working with a client he asked her to look inward and focus her awareness on different parts of her body. One intervention that he used to facilitate this process after his client experienced a panic attack while focusing on her chest was an exercise involving colour that evokes different feeling states in order to awaken her shifts in physical sensations. He uses eyeglasses that have lens made of various colours because colour seems to be a powerful emotional cue for many people and each person seems to have a unique response to certain colours (Dan Siegel, Mindsight, Chapter 7).

So as mentioned above, the ANS has in the past been conceptualized as consisting of two branches the sympathetic that activates fight-flight responses during threat and the parasympathetic nervous system, which refers to a calm state. However, Porges views the ANS as three hierarchically organized subsystems that determine our responses to environmental stimuli. Polyvagal theory consists of the word ‘poly’ that means many and vagal, which refers to the vagus nerve, a big cranial nerve that exits from the brainstem (information on the brainstem in the previous post) and sends information about the organs in the body to the central nervous system. The vagus nerve is part of the parasympathetic nervous system, but it can also shape the sympathetic and it regulates inner body feelings, pain thresholds, cortisol level secretion, the heart, face, lungs and abdominal viscera. Stephen Porges writes that ‘the vagus nerve directly supports the behaviours needed to engage or disengage with the environment’ (cited in Bridges, 2015) and if it is left on too long it can potentially lead to anxiety, discomfort and pain, insomnia, digestive problems, and many other health issues.

The three circuits/ subsystems of the ANS are the a) ventral parasympathetic branch of the vagus nerve (social engagement), which corresponds to optimal arousal b) the sympathetic system (mobilization), which corresponds to hyperarousal, and the c) dorsal parasympathetic branch of the vagus nerve (immobilization), which corresponds to hypoarousal. The most recent uniquely mammalian subsystem is the ventral vagus, which originates in the brainstem and determines the person’s consciousness. Porges calls this system the socialengagement system, because it provides us with the capacity to communicate more flexibly and it regulates areas in the body, like the heart and the muscles in our face and head that are used in social interaction, without mobilizing our more primitive defensive responses. Other scientists and researchers have referred to our capacity to tend and befriend, in times of stress, which elicits oxytocin release and activates the social engagement system that is embedded in our mammalian brain. This circuit has the capacity to down regulate stress responses. ‘The social engagement features, such as, prosody, facial expressivity, gesture within a quiet safe environment provide opportunities to help soothe…… and downregulate sympathetic activity, adrenal activity’ (Porges).

However, when we are threatened or stressed out and the social engagement system proves ineffective it is overridden by the sympathetic system, which activates fight-flight responses. We experience symptoms like shallow breathing, dry mouth, and our hypothalamus causes the secretion of increased levels of hormones like adrenaline and cortisol that increase arousal and facilitate mobilization. If we manage to fight or run from our predators or danger, hyperarousal may return to an optimal level once the danger has passed. But, ‘mobilization is not always possible and trauma is all about unsuccessful attempts to flea or fight’ (Stephen Porges). However, if both social engagement and fight-flight responses fail then the other branch of the parasympathetic nervous system, the dorsal branch of the vagus nerve is triggered into action by hypoxia, lack of oxygen in the body tissues, which causes immobilization, such as feigning death, behavioural shutdown and even syncope. This mode is regulated by the oldest branch of the vagus nerve, which we share with reptiles. Immobilization, bradycardia and apnoea are parts of this older reptilian defence system. For instance, in reptiles like lizards and snakes, immobilization is the primary fear defence strategy. In this state of immobilization our body becomes slower, our digestion, bladder, bowel control, sight and vision go offline, our heart rate decreases, and we feel numb and separated from our sense of self. Reduced blood flow to the brain causes dissociative features. So, ‘what we want is a state of homeostatic balance between our older sympathetic system, which gets our cardiovascular system working and ready for fight or flight, and our new social engagement system’ (S. Porges), which inhibits more primitive defensive responses and allows us to soothe our physiology and navigate ourselves out of potentially unsafe situations without shutting down and becoming immobilised.

 ‘We can create environmental or social structures that mimic a mammalian idealized model versus mimicking a reptilian model because a reptilian model is going to create isolation; it’s not going to foster boldness. A mammalian environment will be empowering of others, more of a shared environment, and have more empathy and care for others’ http://stephenporges.com/images/nicabm2.pdf

Dr Stephen Porges’ BODY PERCEPTION QUESTIONNAIRE  (1993 –  in English and several other languages), which has five sub-tests: a) Awareness b) Stress Response  c) Autonomic Nervous System Reactivity d) Stress Style and e) Health History Inventory, can be retrieved from his website http://stephenporges.com/index.php/publicationss/21-body-perception-questionnaires