La teoría polivagal en terapia: Cómo unirse al ritmo de la regulación

by Deb Dana, Stephen W. Porges (Foreword)

Aprender sobre la teoría polivagal es aprender acerca de la ciencia de la seguridad, la ciencia de sentirse lo suficientemente seguros como para enamorarse de la vida y correr el riesgo de vivir. La teoría polivagal proporciona una comprensión fisiológica y psicológica de cómo y por qué los pacientes se mueven a través de un ciclo continuo de movilización, desconexión y compromiso. A través de la lente de la teoría polivagal, vemos el papel del sistema nervioso autónomo a medida que moldea las experiencias de seguridad de los pacientes e influye en su capacidad de conexión. El sistema nervioso autónomo no responde a los desafíos de la vida cotidiana diciéndonos lo que somos o quiénes somos, sino diciéndonos cómo somos. Este sistema gestiona el riesgo y crea patrones de conexión cambiando nuestro estado fisiológico. El trauma interrumpe el proceso de construcción del circuito autónomo de conexión segura y desvía el desarrollo de la regulación y la resiliencia. Los pacientes con un historial traumático suelen experimentar respuestas autónomas más intensas y extremas, lo que afecta a su capacidad para regular y sentirse seguros en las relaciones. La teoría polivagal ayuda a los terapeutas a comprender que los comportamientos de sus pacientes son acciones autónomas al servicio de la supervivencia, respuestas adaptativas arraigadas en una historia de supervivencia a la que se accede automáticamente. El trauma amenaza nuestra capacidad de relacionarnos con los demás al reemplazar los patrones de conexión con los patrones de protección . Si no se resuelven, estas respuestas tempranas de supervivencia adaptativa se convierten en patrones autónomos habituales. La terapia a través de una lente polivagal ayuda a los pacientes a reformular las formas en que funcionan sus sistemas nerviosos autónomos cuando el impulso de sobrevivir compite con el anhelo de conectar con los demás. Este libro está diseñado para ayudar a los terapeutas a incorporar la teoría polivagal a la práctica terapéutica. Proporciona un enfoque integral de la intervención al presentar formas de mapear la respuesta autónoma y configurar el sistema nervioso autónomo para la seguridad. Con este libro, se aprende la teoría polivagal y se utilizan fichas y ejercicios empíricos para aplicar ese conocimiento a los aspectos básicos de la práctica. «A través de las ideas presentadas en este libro, descubrirás cómo el uso de la teoría polivagal en terapia aumenta la efectividad de tu trabajo clínico con supervivientes a los traumas. Este proceso no solo cambiará tu práctica terapéutica, sino también tu forma de ver el mundo y de estar en él. Mi experiencia, tanto personal como al enseñar la teoría polivagal a terapeutas y pacientes, es que hay un antes y un después del aprendizaje de esta teoría. Una vez que comprendas el papel del sistema nervioso autónomo en la configuración de nuestras vidas, ya no podrás dejar de ver el mundo a través de esa lente». —Deb Dana «En La teoría polivagal en terapia, Deb Dana transforma con brillantez una teoría basada en la neurobiología en una práctica clínica y hace que la teoría polivagal cobre vida». —Stephen W. Porges «La teoría polivagal ha sido una bendición tanto para los terapeutas de trauma como para los supervivientes, ayudándoles a entender los misteriosos e incontrolables síntomas y reacciones. Hasta ahora, sin embargo, los terapeutas carecían de un método para poner en la teoría en práctica. Con este libro bien escrito, Deb Dana no sólo explica la teoría con claridad, sino que también ofrece a los terapeutas pasos prácticos para ayudar a los supervivientes de trauma a seguir regulados». —Richard C. Schwartz, PhD, Creador del Modelo de psicoterapia IFS

Genres: Psychology, Nonfiction, Mental Health, Counselling, Self Help, Health, Social Work

320 pages, Paperback

First published January 1, 2018

About the author

Deb Dana is a clinician and consultant specializing in working with complex trauma and Coordinator of the Traumatic Stress Research Consortium at the Kinsey Institute, Indiana University. She developed the Rhythm of Regulation clinical training series and lectures internationally on ways in which polyvagal theory informs work with trauma survivors.

Reviews

[Antigone · Rating 4 out of 5]

Polyvagal Theory is a product of brain science. Developed during laboratory research by Stephen W. Porges, the core of the theory was published in a book that turned out to be a fairly difficult read. Deb Dana, a clinician and subsequent collaborator with Porges, simplifies the material with an eye toward application in therapeutic treatment. I am about to simplify the matter even further (and thus sacrifice a good chunk of nuance) in an effort to assist anyone wondering whether or not such reading might be of interest to them.

The essence of the theory is this: The internal mechanisms of the body and brain register three types of encounter - the safe experience, the dangerous experience, and the life-threatening experience. These judgements are made, to large extent, on the basis of an individual's personal history. If, say, someone smiling at you is remembered as a portent of praise and affection then such a smile would register as a safe experience. If someone smiling at you is, instead, remembered as a precursor to criticism then such a smile would register as the portent of a dangerous experience. If a smile is recalled as the signal of an impending blow, then such a smile would register as a life-threatening experience. A person who has been severely traumatized will spend more time than is healthy in the dangerous/life-threatening end of the experiential spectrum. While these internal judgements are often deeply entrenched, the states themselves are fluid and capable of being maneuvered through. The psychological application involves retraining that registering system so that a mind spends more of its time in the safe (ventral vagal) experience.

The theory is, as I've mentioned, more nuanced than this and Deb Dana does a wonderful job explaining it. That explanation constitutes approximately one-third of this book. The rest is devoted to clinical exercises designed to be used by therapists during treatment sessions. Those exercises make sense in the context of the theory, and offer another avenue to take in the difficult journey toward recovering from trauma.

I've done a lot of reading on this subject, enough to know that neuroscience is bringing fresh strategies into a field that really needs them. Trauma is complicated. Should you find a methodology that speaks to you, it might be worth exploring.

[Morgan Blackledge · Rating 4 out of 5]

Polyvagal Theory (PT) is an evolutionarily grounded, neuroscientific and psychological construct that explains the role of the vagus nerve in mammalian threat response and emotion regulation via social connection (co-regulation) initially introduced by Stephen Porges in 1994.

For a good introduction to PT, read The Pocket Guide to the Polyvagal Theory by Stephen W. Porges.

Read my review if it here: https://www.goodreads.com/review/show...

This book is author Deb Dana’s practical application of PT to psychotherapy.

And while there’s much more to be said on the subject.

Deb Dana is great.

And this is a nice place to start with her work.

I have it 4/5 stars because the book does not rise to the level of greatness.

But it is still really good.

And really useful.

So go ahead and get it 😜

[Michael Maloney · Rating 5 out of 5]

I can’t recommend this book enough for therapist that work with trauma But even for therapists who don’t this is a great addition to build your skills and bring some of the research of some of the experiential practices in therapy. Deb Dana brings a theory that was very jargon heavy in Stephen Prorges great works work and makes it client friendly and interactive. She goes into play, bodywork, processing different emotions, emotion tracking and so many other skills that will be helpful to any therapy practice.

[Sharon]

I read about polyvagal theory because it seemed to be somewhat commonly cited by current trauma therapies. This book is largely about clinical practice, but does talk about the scientific basis.

I also read some criticisms online that said that the science is not well-founded, specifically that certain nervous system structures don't work the way that Porges says they do, and that nervous systems of mammals and reptiles aren't divided up the way that Porges describes.

I don't have any background in neuroscience myself, and very limited education in natural sciences in general (some college coursework). I didn't understand those criticisms well enough to evaluate them and decide whether I agreed with them.

What I can say is that most of the practice exercises in this book seem relevant regardless of the theory behind them. Naming the ventral vagal, sympathetic, and dorsal vagal pathways / systems helps a person sort their experiences based on how they physically feel.

One takeaway that's repeated over and over: patients who are introduced to polyvagal theory often feel relieved by the idea. Conceptualizing their trauma response as an overactive surveillance system that can be modified helps them shed the shame that society places. In other words: "I thought I was defective, but now I appreciate that my body was reacting in ways that kept me safe before. Now that I'm safe, I can learn to react in different ways."

[Lance Hill · Rating 5 out of 5]

This book has changed the way I help my clients. It’s a must read if you’re in the counseling field.

[Michelle Curie · Rating 3 out of 5]

I think of the Polyvagal Theory as a compelling concept for understanding your own emotional landscape better. It might not be the one-to-end-all-theories in solving emotional imbalances, but humans are far too complex for something like this to ever exist in the first place.


The Polyvagal Theory in Therapy is a book about exactly what it implies: written by a Clinical Social Worker and addressed mainly to psychological therapists, it shows them ways to implement the Polyvagal Theory in their sessions with clients/patients.

So first of all, what is the Polyvagal Theory? Developed by the American psychologist Stephen Porges, it centres around the idea that the autonomic nervous system regulates stress and social behaviour through three pathways: the ventral vagal, sympathetic, and dorsal vagal. The book at hand reinforces the idea of viewing these pathways as a ladder, on which we constantly move up and down. If we're in a ventral vagal state of mind, we feel social, open to the world, relaxed and peaceful. The sympathetic mode triggers our fight-or-flight instinct; we're hyperaware and alert — often what we perceive as feeling stressed. If we reach the dorsal vagal state, we've come to a point where we basically shut down. As a survival mechanism, we disconnect mentally, feel numb, and collapse in reaction to extreme stress.

Why is this knowledge useful? People who aren't in touch with their emotions and responses can find themselves in the sympathetic or dorsal vagal state without realising how they got there. Their feelings might seem overwhelming, sudden, and irrational — but if we listen closely, our bodies actually provide all the information we need in order to anticipate where we're heading emotionally. This book provides worksheets, methods, and ideas for how to convey the theory to patients. It makes something that might feel abstract to people who haven't dabbled in psychology before easier to grasp and relate to their own life.

It's an accessible book that doesn't oversell itself. I appreciate how Deb Dana doesn't pretend that the cure for all evil has been magically found. The theory is presented as a helpful tool, supported by case studies, which I found interesting to read. It's a fairly clear and easy read, considering how complex the subject matter is, and it definitely helps with building awareness. It should be noted that this shouldn't be viewed as settled science: while there's clinical utility, especially in trauma work, it's still a hypothesis. While there's supporting evidence, some aspects of the theory remain unproven. The book doesn't speak much about this, so it should really be seen more as a practical guide and supporting material, rather than something aimed at those specifically wanting to learn more about the theory itself.

[Montana · Rating 5 out of 5]

A must read for all clinicians, especially those working with clients with trauma!

Deb Dana provides an incredibly detailed and comprehensive guide to Polyvagal Theory. The exercises are wonderful and helpful. I will definitely have to get the physical book to refer back to them for future use!

[Lucia Gannon · Rating 3 out of 5]

A clear, well-researched and useful guide to Stephen Porges “polyvagal theory.” An expert translation of the theory into practice for both personal and professional use. Some prior knowledge of the theory is probably necessary as this book simplifies it so well that some of the complexity may be lost and some of the relevance of the proposed exercises missed. Very useful for therapists or anyone in the caring profession.

[Nathan · Rating 3 out of 5]

I'm not really the perfect audience for this book so don't take my 3 star rating as a major critique. I liked the book, but didn't find it life changing or so incredible to warrant a 5 star review the way some therapists may find this completely changing their practice. Disclaimer over.

This was a really cool book. For someone interested in neuroscience, emotions, how we act etc it is very approachable yet deep. It outlines the work of Dr. Porges on the Polyvagel theory then offers a lot of ways to integrate the theory into clinical practice. I was able to get a ton of value out of it in a 2 hour reading session.

My mom suggested I read this book after I mentioned am interest in decision science. While I don't know how to qualify or quantify the accuracy of the science other than it is from a respected researcher who worked on it for decades, I did enjoy some interesting learnings about emotions and emotional regulation concepts.

#1: Ventral vagal nerves
Polyvagel theory is about the anatomy of survival, Deb claims. The two vagal nervous systems and the sympathetic nervous system all work to help us survive. There's a hierarchy of these systems, she claims. We apply a "vagal brake" slowing down the heart when in a connected state. This is activation of the ventral vagal nervous bundle, a series of nerves connecting your lungs, heart, and face. The bundle has about 80% of its connections sending information to the brain and 20% from the brain to your motor system. This is evolutionary the most recent development and essential to mammalian abilities to connect. From this state you're most able to calmly react to whatever happens.

#2: Sympathetic nervous system:
When you feel a sense of danger this system kicks in (and in other situations). The "vagal" brake is released and your heart rate can climb. You take action often with this system activated. This is the 2nd most recent evolutionary system of the 3, Deb claims. One question I have is what system works when you're excited. For example, in taking these notes I feel my heart beating faster than when reading Deb's book. Is my sympathetic nervous system in action? In many ways I feel it is, but I don't feel fear. I'm excited to capture and digest the ideas and science I'm reading about. That part wasn't clear to me in this book.

In any case, Deb claims this is a lower system. From here you can return to the ventral vagal system and apply the "vagal brake" or go to the lowest/oldest system, the dorsal vagal bundle.

#3: Dorsal vagal nerves:
This system is the immobilization system, Deb claims. She uses the metaphor/phrases of "playing possum/dead" to explain it. These are the nerves that connect your gut to your brain via a vagal connection. When active you freeze and this can be a place/system to avoid. You'll go here sometimes but in trauma you get stuck here instead of regulating your way out. I can relate to this in jobs Ive felt stuck in. I've given up trying and in retrospect maybe immobilized myself in some ways. To get out she describes your sympathetic nervous system energy moving you to action and then out of immobilization.

#4: Therapeutic exercises:
Deb describes many exercises to build awareness of these 3 systems and eventually rewire/reshape them to enhance regulation. Breath is a key, connection is key, touch can help, she has many ideas. There's a lot of exercises in this book to work with Porges' Polyvagal theory and Deb describes many of them in the context of trauma work.

#5: Societal survival/power seeking vs. connection seeking
Conceptually it is interesting to see connection at the top of a hierarchy of this sort. We often seek control, power, autonomy as peak states, feelings and perspectives. Personally, as I age I do see the value in trust, connection and its intimate vulnerability as higher states than the ones that lead you to seek control, power or autonomy.

I can also understand many people's (and often my own) desires to seek the effects of the sympathetic nervous system as the goal/peak. When our heart rates and our body produces lots of adrenaline, cortisol, and the hormone cocktail we call flow, it feels great. Like an orgasm at times. I and others can seek that pleasure as superior to connection and its associations. There's a sense of power which can feel good.

Conclusion:
The Polyvagel neurobiological theory of our nervous system's functions, regulations and strategies is an interesting lens to look at society and decision science. As a techie it makes me want to experiment with measurements as teaching tools. If I ran a decision science lab I'd be interested in connecting Polyvagal theory to results on hunger's impact (e.g. judge's granting parole significantly less before lunch). As a data scientist working on behavior change it suggests an experiment with content and coaching to drive awareness and reshaping of the nervous system to avoid chronic health issues. Check out this book if you're interested in learning about our nervous system through a Polyvagal lens and consider how it could drive your work.

[Quin Rich · Rating 4 out of 5]

Really good as a practical guide to how to implement polyvagal theory in your therapy practice.

As a social work student, I found this quite clear and helpful to understand and practice polyvagal awareness. I am not yet a therapist, but this theory makes a lot of sense for understanding clients and myself.

As a neurodivergent person, I find polyvagal theory more helpful and accessible than mindfulness based on cognitive labeling of emotional states. Because of my alexithymia, I find it easier to notice and name my polyvagal state than my current emotion. This guide offers a practical method for those of us who have trouble with mindfulness-based emotional awareness to more easily tune into our current state of dys/regulation.

As always, it loses a star for not having an explicitly feminist and anti-oppressive lens. You have to do some translating work to connect this theory to the experiences of clients for whom “safety” is not a given experience because of oppression.

[Beth · Rating 5 out of 5]

I'm a psychologist, and I received this book as part of a webinar training with the author, Deb Dana. Polyvagal theory is a relatively new clinical approach, one that is an embodied mind-body intervention. This speaks to me as both a psychologist and a yoga teacher. The book is very well-written, with easy to understand examples and information. There are plenty of handouts/worksheets to use with clients. I wish there had been more about the specific language of introducing this theory to clients, particularly to ones who are more concrete. It also would have been nice to have different perspectives of the theory, like how to utilize it within a short-term framework. My actual rating would be about 4 1/2 stars, but I do definitely recommend the book.

[Francescajemm · Rating 5 out of 5]

Although I’m not a therapist, I read this one bc my library didn’t have Anchored. In spite of that, this book landed w me exactly how The Body Keeps the Score did when I first read it. All of a sudden, I have language for so many of my lives experiences, regardless of the story/ies I have developed around my experiences. Highly recommend!

[Jen · Rating 5 out of 5]

Love this book and it’s practical applications of a complex theory. Helps lay the foundation for therapy work and easily integrates into practice. Use of the maps is bringing another dimension of healing to my clients. Deb Dana is brilliant!

[De Bruyn · Rating 3 out of 5]

De theorie wordt goed uitgelegd, daarna staan er veel oefeningen in.

[Randi · Rating 4 out of 5]

This book was full of great information and completely changed how I think about our nervous system and its regulation. It is definitely written for therapists not parents of children who are dysregulated, but provides lots of good background. I have since found other resources for parents that build upon the polyvagal theory and I now have a strong foundation to fully understand them.

[Yao MacLean · Rating 3 out of 5]

The next time someone asks me about the secret to happiness, I'll take great delight in saying (only half tongue-in-cheek) that it's about finding joy in "co-regulation," an activity which appears to activate most expediously the ventral vagus system (that hallowed bit of nervous machinery which allows us to feel safe in connection with others)

[B · Rating 4 out of 5]

Read for a class.
This book does a great job of explaining Polyvagal Theory in a way that’s easy to understand and actually useful. This is the third time I've read about this and the first time I've really understood it!

[Emma Sells · Rating 5 out of 5]

Changed my life actually

[Shelley · Rating 4 out of 5]

Excellent resource for therapists on how to use polyvagal theory in treating clients.

[Sarah Beth · Rating 5 out of 5]

This book is changing my life and my therapeutic practice. I have already started reflecting on how the three vagal states show up in my life, and using the frameworks, interventions, and worksheets with my clients. I know I will come back to this book again and again

[Grace · Rating 5 out of 5]

“With nervous systems toned through experience, our trauma survivor clients are sensitive to the most subtle shaking. Therapy is a process of building the new, deep autonomically supported foundation of safety through attending to environmental, embodied and relational cues”
3:27:51

[Max Booher · Rating 5 out of 5]

Polyvagal Theory MAKES SO MUCH SENSE. What we call “personality” is really just a pattern of how one does or doesn’t regulate their autonomic nervous system. Not only does this theory explain “personality”, it also explains behavior in general — how and why people resort to unhealthy choices.

[Muhamed · Rating 5 out of 5]

Great practical tips for a therapy based on the poly-vagal theory. The book first explains the theory and then mentions the different ways this theory can be used to facilitate the therapy process. Really practical and insightful.

[Maryam · Rating 5 out of 5]

So good for trauma and offers a more science based working with the autonomic nervous system.
I really like one of the last sentences, “yet is a harbinger of change”

[Barbara S. · Rating 5 out of 5]

Informative, easy-t0-understand, practical takeaways and worksheets that help the mental health clinician help their clients understand the autonomic nervous systems actions and reactions to the environment. Gives hope that while our nervous systems are wired to survive, with effort and compassion, we can rewire default responses to live more fully today.

[Jack · Rating 4 out of 5]

I originally bought Stephen Porges' book, but it was way too scientifically technical for me. At that point I could've bought his pocket guide, but this book appealed to me because I care more about the application of the theory than the theory itself. And oh boy is that application fantastic!

This review is going to be a long one, so let me tell you what to expect. I'm going to outline five things that I noticed as cool/helpful or that changed in me from having read about polyvagal theory. I'm not going to explain what the theory actually is though (you can Google for that or checkout Instagram). I'm also not going to spend a lot of time talking about the book itself. My short take away is that it was a relatively easy read, explained concepts clearly, and offered a lot of exercises and concrete application.

So! On to the things that interested me..

1. It's actually pretty important to feel safe. Within this framework, it is physiologically difficult if not impossible to have genuine social connection or a feeling of security while the body is feeling unsafe. This is sort of obvious in retrospect, but I guess I thought that I could think myself calm, or that the feelings of anxiety were aiding me in the moment.

I decided to experiment with this by implementing a small habit: when I notice that I'm feeling unsafe/anxious/wanting to run away/wanting to fight, then I pause what I'm doing. Take deep and slow breaths. Bring as much gentle curiosity as I can. When I did this during solo moments of worry, I found myself feeling less urgent and closed in afterward. When I tried this during interpersonal conflict, both of us were able to settle and have difficult conversations while maintaining connection. Frankly, they were the best, hard conversations I've had.

2. The body/mind connection. Within this framework, your body is tracking the environment around you and it's responding as it believes is correct. My body senses danger? I feel tense and activated. My body senses safety? I feel relaxed and comfortable. How I feel comes after my body taking in information. The stories that I tell myself about a situation are irrevocably linked up to what I'm physically experiencing.

The example from the book about this is how when someone is feeling unsafe, a neutral face is read as angry. That same neutral face will be read accurately as neutral or even positive by someone who's physiologically feeling safe.
There's an example from my life where this clicks and it brought a significant, "ah ha!" moment. When I'm feeling stressed and low energy and I think about my life, it feels like everything is terrible and without meaning. Then I go to bed, wake up feeling rested, and I think about the same things that had been on my mind the night before, and things no longer feel terrible and without meaning. And this has been incredibly confusing for me, because what's the truth? How do I actually feel? How is it that I can think about the very same events in one state and have one interpretation, but when I think about the same things in a different state, I have a different interpretation? Polyvagal theory offers a fairly complete answer to these previously impossible questions.

3. This re-contextualized a lot of my past experiences. I don't want to go into a lot of detail about this one, but the short version is that it was extremely validating to see my past in this light and it allowed for some releasing of tension.

4. This removes any need for internal adversarial orientation. My body is doing its best for me. My body has been conditioned from the experiences that I've had. All of the behaviors that are causing me difficulties now, were at one point mechanisms that served to protect me. This removes a huge chunk of shame and blame.

5. The framework and language itself. The way it structures experience in a way that can be easily mapped onto. The way it provides keywords both for internal use and for communicating to others. Simply having named concepts is useful for understanding.

Anywhoo, would definitely recommend. Only 4/5 because while it was absolutely useful, it's being dissolved into my broader body of knowledge instead of living on as a tool I repeatedly go to use.

[TJ · Rating 4 out of 5]

Did not finish past 50% cause the audiobook version of this just doesn't work for me. I need to highlight and annotate a paperback copy 😭

[Jules Morgan · Rating 4 out of 5]

This book is fantastic. Polyvagal theory is hereby my new therapy baby. I love finding new language to describe internal processes and this book gave me a lot of it. I only wish she had gone into more detail about feelings that require overlapping polyvagal states! It’s absolutely fascinating to me. I also appreciate how I can weave this theory with Pat Ogden’s sensorimotor psychotherapy and Richard Schwartz’s internal family systems theory. I love it when all the pieces fit together. Would highly recommend to anyone dealing with c-ptsd.

[Kharina Kharran · Rating 5 out of 5]

First came accross the polyvagal theory (poly=many, vagel=wandering) while researching complex cptsd.

A well written book that looks at vagel nerve the circuits that are regulated in the brain stem and how this is regulated when in different states (fight/flight) so over sees the functions of
parasympathetic nervous system
and sympathetic nervous system.
Unfolded are their functions in the bodys reaction /social interactional behaviour and pick of of cues.

The book keeps it simple enabling you to really understand the evolution of the theory.

[Katie · Rating 5 out of 5]

My therapist recommended this book for me to help me work through some stuff. It’s a relatively short read and fantastic for working through trauma and the polyvagal response to perceived threats, real or not. This book opened my eyes to a lot of my behaviors that have been “protecting me” but also hindering my relationships and everyday life. I will definitely re-read this one before the end of the year, to pick up on things I may have missed on my first pass.