What is the Polyvagal Theory?
When we feel threatened, most people are familiar with the idea that our bodies react with a “fight or flight” response; we either get ready to confront the danger or run from it. This happens because of the sympathetic nervous system. We’ve also been told that another system, the parasympathetic nervous system, helps calm us back down afterward when we feel safe.
But Dr. Stephen Porges’s polyvagal theory describes that the parasympathetic nervous system may do more than just calm the body; it may also contribute to a “freeze” response in times of stress. This system is controlled by the vagus nerve which has two branches: the dorsal vagus, which can cause the body to shut down when things feel overwhelming. This might look like zoning out, disconnecting, or even fainting. The other branch, the ventral vagus, helps us feel safe and socially connected. It’s what is activated when we are in a safe state and allows us to engage with others, ask for help, and stay calm around people we trust.
Dr. Porges calls this our social engagement system. When we feel safe, we can use it to connect with others, regulate our emotions, and get support.
How do we know if they are able to access their social engagement system?
It is often clear when a child is able to access their social engagement system because they are calm and participating in activities with you. If you have already established rapport then you will likely know. However, it isn’t always obvious, particularly as you are still getting to know children or if you are unfamiliar with their history or home life. Children who have experienced trauma or who live in ongoing stress may be in a freeze state (dorsal vagus activation). It tends to be more obvious when children are in a fight or flight state because they may have aggressive tendencies or try to hide or run away. Either way, they may not be able to reach out for help or connect with others because their social engagement system isn’t available to them. Even the way they read other people’s faces or actions can get distorted, which can lead to behaviors that seem confusing or out of place to adults.
What are the implications of this in our treatment?
This has implications for what we do in therapy and explains why some of our cognitive behavioral strategies may not be accessible at the moment a child is having a difficult time. We need to ensure that children feel safe with us and in the environment in which we are treating them to activate their social engagement system. This will allow them to learn strategies to manage their anxiety.
This theory can also help us understand some of the behaviors we may find in anxious children, such as active and passive resistance, especially when we can’t see a clear trigger for their behavior. Because they cannot access their social engagement system, they may not be able to tell us what is wrong or why they are resisting. We may need to limit cognitive and social demands at this time and realize that attempted conversations about their behavior will not be very meaningful at that moment.
Children may need to learn to recognize worry signals in their body and scan the environment to see what may be triggering the feelings of not feeling safe. We can also use the Clue Cards to learn more about the things that cause them stress to help them feel safer in their environment. We can also explain this nervous system response in simple terms to children and caregivers so they understand how our therapeutic interventions relate to this theory.
We also need to monitor children for signs of freeze (dorsal vagal) responses, which may be as subtle as a flat affect or a lack of response to a question we ask. If they are not able to access the social engagement system, they will not be in a state to learn cognitive-based treatment strategies. We often tend to assume an ADHD diagnosis in children who appear lost in thought, but they may be in a dorsal vagal state which may require a different kind of support.
Knowing this, should we still teach cognitive behavioral strategies?
Yes, when children are socially engaged they still benefit from learning strategies! It’s just important to keep in mind that feeling safe always comes first. And we should not assume that they feel safe just because they appear calm or we have rapport established.
Understanding this theory will help us understand that big behaviors are often due to a fight or flight reaction in response to feelings of stress. It will also help us focus on a child’s primary need to feel safe before providing cognitive-based strategies. It will help adults understand that reacting with empathy when a child is having a hard time (even if they just threw something in anger) is much more helpful to supporting a child’s mental health than lecturing or punishing them.
Addendum
As I was trying to find a picture for this blog post I found these pictures from the same keyword search and thought they were such good depictions of this theory:
This child is in a ventral vagal state (socially engaged):
This child is in a dorsal vagal state (shut down):
This child is in sympathetic state (fight or flight):
Technically the second and third could be interchangeable, it would depend on other cues we get from the child. I am making the assumption that the child in the second picture is shutting down and unresponsive. But one of the things I think is helpful to understand in this last picture as that his turning away is a "flight" response; we don't necessarily need to see a child hide under a table or run out of the room to assume that they are stressed. These are stock photos, not actual therapy sessions, or I may have more to say on the body language, positioning of the therapists relative to the children, and environment. I'll just leave it at this--they aren't necessarily ideal for fostering a ventral vagal state!