Accessing the Healing Power of the Vagus Nerve: Self-Help Exercises for Anxiety, Depression, Trauma, and Autism

by Stanley D. Rosenberg

In voice training, for example, we did not sing a song with a melody and text written by someone else. We did not try to imitate anything that we heard someone else do, but to explore the world of sounds that we generated in our own imagination—sounds that we had never heard anyone make before. This could take hours, days, or sometimes a week or more before I felt I had succeeded in making the exact sound I had imagined—and there was no one else who could judge whether I had made the “right” sound or not. Once I had made that sound, I never repeated it. I went on to the next sound that appeared in my imagination, and worked toward expressing that.

Could the same be said of physical movement?

“You learn techniques to understand principles. When you understand the principles, you will create your own techniques.”

Oh i hope so

He also continually emphasized one principle: “Test, treat, and then test again.”

However, problems arise when we get stuck in a stress state even when the threat or danger has passed, perhaps because our work or lifestyle is continually stressful. For many decades, chronic stress has been recognized as a health problem, with an enormous amount of scientific research devoted to understanding the harmful effects of long-term stress.

According to the Polyvagal Theory, when a person is feeling safe—not threatened or in danger—and if her body is healthy and functioning well, she can enjoy a physiological state that supports spontaneous social engagement behaviors. Social engagement, neurologically speaking, is a state based on the activity of five cranial nerves: the ventral branch of the vagus nerve (cranial nerve X), and pathways within cranial nerves V, VII, IX, and XI.

The exercises and techniques restore flexibility to the functioning of the autonomic nervous system. They can help eliminate the general adverse conditions of chronic stress, which arises from the overstimul-ation of the spinal sympathetic chain, and depressive behavior and shut-down, which arise from activity in the dorsal vagal circuit. The exercises are noninvasive and do not involve medicine or surgery. The improve-ments in ventral vagus nerve function from doing the exercises help to regulate the visceral organs involved in breathing, digestion, elimination, and sexual function.

However, though it is not usually noted in the study of anatomy, all twelve cranial nerves have one thing in common: they are all involved in helping us to find food; chew, swallow, and digest; and eliminate undigested food as waste.

addition to eating, several other functions are performed by the cranial nerves. The visceral afferent (sensory) branches of cranial nerves V, VII, IX, X, and XI gather information from our visceral organs: Are we safe, threatened, or in mortal danger? Does our body feel healthy, or is there an imbalance, pain, dysfunction, or illness? If we are safe and healthy, these nerves facilitate the desirable state of social engagement.

By reducing the volume of sounds above and below the frequency of the human female voice, the stapedius muscle allows a baby to more clearly hear her mother’s voice. If you are easily disturbed by background noises, your stapedius muscle might not be doing its job of reducing the volume of the low-frequency sounds, making it hard for you to hear what someone else is saying in a noisy room.

The Polyvagal Theory begins by recognizing that the vagus nerve has two separate branches—two separate, distinct vagal nerves that originate in two different locations. We get a more accurate representation of the workings of the autonomic nervous system if we consider that the auto-nomic nervous system consists of three neural circuits: the ventral branch of the vagus nerve (positive states of relaxation and social engagement), the spinal sympathetic chain (fight or flight), and the dorsal branch of the vagus nerve (slowdown, shutdown, and depressive behavior). These three circuits regulate our bodily functions in order to help us maintain homeostasis.

The way to move people out of both states—stress with accompanying fight-or-flight behaviors (mobilization with fear) and depressive feelings behaviors with shutdown (immobilization with fear)—is to activate the ventral branch of their vagus nerve.

“But you’re not a doctor!” some people may say. No, I am not. In my clinic, I do not make any form of medical diagnosis, or treat disease. Giving a diagnosis and treating disease with prescription drugs fall solely within the responsibility of a well-trained medical doctor. All I can do in this context is evaluate and address the function/dysfunction of the ventral branch of the client’s vagus nerve and the other four cranial nerves necessary for social engagement. Many people who come to me have already been diagnosed by a medi-cal doctor. I do treat people who have been given a medical diagnosis, primarily to improve the function of their nervous system. It has been my experience that bringing their autonomic nervous system into a state of social engagement and moving them toward optimal health has a positive effect and helps many of them with various medical issues.

Today there are many systems, including Pilates, yoga, martial arts, and mindfulness meditations, that help restore people to their sense of their body. If my clients have such a way of sensing their body, I ask them to use that. If not, I teach them an approach to help them do this. The skin of the face is innervated by cranial nerve V, and the muscles of the face are innervated by CN VII. Light stroking of the face often calms us and helps us out of a state of stress. People very often unconsciously do this for themselves.

It is enough for me as the therapist to simply place my hands on the client’s body, lightly touching the skin. Then I ask the client to “come to my hands with your awareness.” At first, it can take some time for clients to clear their mind sufficiently of mental or emotional clutter in order to sim-ply sense where their body is and what is going on in it. Therefore, I repeat the process several times. This is a simple way of helping clients to use their own sensing as a resource to get them grounded in their own body.

Sensing our own bodies and staying grounded helps us to remain in a ventral vagal state. Awareness of our body can help us avoid getting carried away by emotions that can lead to faulty neuroception.

When you make eye contact with another person, look for spontane-ous facial expression in the middle third of her face (between the bottom of her eyes and the top of her mouth). The small movements here are an indication of social engagement (or lack of it) and the flexibility of her emotional responses.

When they came for their next appointment, they sometimes told me that they were so relaxed after their last session that they had to pull off to the side of the road and shut their eyes to nap for a few minutes. Sometimes they even pulled over two or three times. They enthusiastically commented that this was great because they had been “so relaxed.” Even on the next day, they often did not want to get out of bed and go to work. Today, looking back, I realize that my sessions had left them in a dor-sal vagal state. They were not relaxed, but instead were dissociated and exhibiting depressive behavior. Nowadays, I am careful to address ventral vagal function

The method I used involved observation of the breath and pulse. If our pulse is faster on the inbreath and slower on the outbreath, this indi-cates good ventral vagal function. The greater the difference, the better the ventral vagal function. I monitored this by putting a finger over an artery in the client’s wrist while at the same time observing the pattern of her breathing. The idea behind this method goes back to studies on the autonomic nervous system from the 1890s, with the discovery of variability in blood pressure described as Traube-Hering-Mayer waves.

“The Listening Project Protocol”43 (further described in Chapter

A Simple Test of the Pharyngeal Vagus Branch

In order to test vagal function, I ask the other person to say, “ah-ah-ah-ah-ah” while I observe the arches on either side of the uvula. These sounds should be percussive and staccato—short, distinct bursts of sound in quick succession, and not a long, drawn-out “aaaaaaaaahhhh,” which does not create the desired effect. If there is good function in the pharyngeal branch of the ventral vagus nerve on both the right and left sides, these muscles tighten symmetrically with a clear impulse when the person makes the sounds “ah-ah-ah-ah-ah,” lifting the arches of the soft palate equally on both sides. If, on the other hand, there is dysfunction of the pharyngeal branch of the ventral branch of the vagus nerve on one side, the nerve impulses do not innervate the levator veli palatini muscle on that side, and the arch in the soft palate on that side does not lift when the person says “ah.”

Treating a Hiatal Hernia

The stomach is on the left side of the abdomen, just under the rib cage. Place the fingertips of one hand lightly on the top of where you imagine you can find the stomach. The stomach is soft but palpable. You should be able to feel the stomach if you slowly and gently extend your fingertips into the abdominal muscles. You only want to feel the top surface of the stomach. Under no circumstances should your move be painful. If the person experiences pain, you should stop immediately. Gently pull it downward toward the feet until you sense the first sign of resistance—usually after pulling it only about one half-inch to one inch (Figure 1). Hold it at that point of slight resistance until the esophagus relaxes. Although you might be tempted to push the stomach down in order to stretch the esophagus, it in not necessary to exert any force. If you have your fingers on the top of the stomach, you will signal the nerves for the esophagus to lengthen, and the stomach will descend in the abdomen, making room for the respiratory diaphragm to descend on the inbreath.

Diaphragmatic Breathing

Normal breathing should involve up-and-down movement of the diaphragm. In order to evaluate whether this is happening, I place my hands lightly on the sides of the chest at the level of the last two ribs. If there is diaphragmatic breathing, I can detect a lateral movement of the lower two ribs on both sides. However, if there is a hiatal hernia, I can feel lateral movement on the right side but almost none on the left.

When we cannot inhale with a normal lowering of their respiratory diaphragm, we find alternative ways to make space for the expanding lungs. One very common way is to lift the shoulders and upper ribs. This is called high costal breathing (“costal” refers to ribs). This breathing pattern is associated with the emotions of fear, anxiety, and panic.

Another common pattern in non-diaphragmatic breathing is to inhale using the abdominal muscles. Sometimes, when we are typically short of breath, the belly is distended, soft, and flabby. The belly muscles are too soft, and when they go slack the intestines descend, pulling the lungs down. Sometimes people call this “belly breathing” and interpret it as a good sign because they can see that the breath is going down into the abdomen. However, it does not actively involve tightening the respiratory diaphragm. People breathing this way ofte...

The trapezius and SCM are also determining factors in the shape and health of the spine. Furthermore, a chronic tension in the sternocleido-mastoid muscles on one side can actually change the shape of the back of the head, leaving it flat on one side because of the constant pull of the muscle on the temporal bones (the skull plates behind the ears). In every child I’ve treated on the autism spectrum, I have observed this distortion in the shape of the back of their head.51 (See Part Two for a technique to round the back of the head.)

For this test, we only have to squeeze the muscles on the top of the shoulder. The Trap Squeeze Test takes only a few seconds, and is well suited for use on children and people on the autism spectrum, with whom we might otherwise encounter difficulties in getting their cooperation for the usual technique. To use this form of testing, you first need to practice on several people in order to develop the necessary kinesthetic skills. It is normal to feel uncertain the first few times that you try testing the trapezius muscles. However, you will likely find that you can get the feel of it after a few attempts. CN XI can be tested by sliding, lifting, and rolling the top of the trapezius muscles (on the tops of the shoulders, halfway to the neck), and comparing them on the left and right sides. Although the trapezius muscle covers a large area, it is very thin. Take hold of the trapezius muscle on each side, squeezing it lightly between your thumb and your first finger (Figure 2). Whereas most novices simply grab the muscle, the lighter you squeeze, the better. If you squeeze lightly and slowly, you should be able to lift the muscle slightly away from the underlying muscles. Figure 2. Trap squeeze test Compare the tonus of the trapezius muscle on one side with the tonus of the trapezius muscle on the other side. Do the two sides feel the same to you, or is one side harder than the other? Ideally, both sides should be soft and elastic. However, one side is often soft and elastic...

time goes on and FHP gets worse, we lose an increasing portion of our breathing capacity. FHP is often found in people with breathing problems such as asthma and COPD.55 It is no wonder that they experi-ence general fatigue and low levels of energy. Research published in the Journal of the American Geriatric Society also reports that they also have shorter life expectancy—shorter even than people who smoke a pack of cigarettes a day—and that older patients with FHP have a significantly higher mortality rate.56

In addition to reducing breathing capacity, the loss of internal chest space puts pressure on the heart and crowds the blood vessels that go to and from the heart. FHP also compresses the spaces between the vertebrae of the neck and upper thorax, putting pressure on the spinal nerves of the neck and the upper thoracic spine. Furthermore, forward head posture compresses the vertebral arter-ies that carry blood up to the head, diminishing blood supply to the face, parts of the brain, and the brainstem, where the social-engagement cranial nerves V, VII, IX, X, and XI originate. When this occurs, as we might expect, we look pale, lack spontaneous facial expression, and are not socially engaged. If these five cranial nerves do not receive adequate blood circulation, they can fail to function properly, and we are likely to be in a state of chronic stress or dorsal vagal activity. Many aches, pains, and stiffnesses develop over time due to deterio-rating posture. According to a Mayo Clinic newsletter, “Forward head posture leads to long-term muscle strain, herniated discs, arthritis, and pinched nerves.”57

According to Dr. Roger Sperry, Nobel Prize recipient for brain research, “Ninety percent of the stimulation and nutrition to the brain is generated by the movement of the spine.”

I tried to verify this claim but my research fell flat and seems to not be accurate

I certainly could have used my hands for this treatment, but I wanted her to do it herself so that, if she experienced migraines in the future, she could come back to her own muscle memory of how to achieve positive results on her own. Although it is nice when people come back to me because they remember that I helped them in the past, I think it is better for them to help themselves rather than depending on me or any other therapist.

Another way to self-regulate our autonomic nervous system is to do the exercises in this book. A host of other practices from cultures and traditions around the world have been used for centuries with good effect: meditation, tai chi, and yogic breathing (pranayama), to name a few. When we meditate, we sit still, overcoming any impulse to fight or run. We also learn to keep awake, avoiding the tendency to withdraw and dissociate. When we do tai chi, we move slowly, simulating the movements of a very relaxed state. Moving slowly also makes it easier to sense our body and to be present in it.

I believe that there is an interrelationship between the mind, body, and emotions. Issues as different as post-traumatic stress, anxiety, phobias, and autism spectrum disorders have a somatic component, and almost all cases of so-called psychological problems include a lack of flexibility and resilience in the autonomic nervous system. I have found it both interesting and efficacious to consider the somatic component of what we generally term “psychological issues.” A great deal of healing potential becomes available when we consider the possibility of identifying and treating the physical manifestations of the autonomic nervous system at the outset of psychiatric and psychological treatments. If there is indeed a unity of mind-body-emotion, it follows that we might be able to help people with psychological diagnoses by starting their treatment with body-therapy techniques, especially if these can bring them out of a state of chronic stress or dorsal vagal activity and toward greater flexibility of autonomic response.

If we feel that our social network is inadequate, we may also experience helpful and positive interactions by turning to health professionals such as massage therapists, counselors, coaches, psychologists, or psychiatrists. We may choose to consult a religious or spiritual teacher or leader. We may also find solace in prayer, or read religious and spiritual texts to help put things in perspective.

Psychologists and therapists often focus on the object of fear, such as heights (acrophobia), not having enough space (claustrophobia), or spiders (arachnophobia). Their diagnoses focus on the triggers, which may or may not be easily linked to specific biographical events. A phobia might be caused by experiences from the past—for example, when someone encountered a threatening person or a life-threatening situation. A phobia can just as easily come from a virtual experience, in which the person suffering the phobia did not actually experience the event—for example, it might have come from someone else telling a story, or from watching a scene in a movie.

In order to better understand something, we tend to classify it and give it a name. But rather than considering ablutophobia (fear of washing) as basically different from acousticophobia (fear of noise), for example, it may be more useful to move our focus away from the triggers and toward an understanding of the physiological activity in the autonomic nervous system in all cases of phobia.

When treating post-traumatic stress, therapists tend to focus on the trauma itself rather than the psychophysiological fixation that followed the event. Recalling the experience and telling someone else about it is certainly one way to ease post-traumatic stress, but it is not the only way, and it can often backfire, as the person can become re-traumatized by recounting it. In many cases, it is easier and more effective for a therapist to bypass recall of the event, and work with exercises or hands-on trea-tments to restore a state of social engagement.

A project in Denmark involved a group of therapists who treated vic-tims of trauma from the wars in Afghanistan and Iraq. The therapists included traditional psychologists, a craniosacral therapist, and body therapists using various modalities. All of the subjects received the same number of sessions, which included both verbal and nonverbal therapies. Some started with craniosacral therapy, followed by other body therapies, and others started with more traditional, verbal forms of therapy. Looking back on the results, the therapists noticed that the subjects who started with the nonverbal craniosacral therapy had better results than the subjects who started by talking about what they had experienced. One of the psychologists in the group, Marc Levin, speculated that when people felt safe and relaxed after the body therapy, they felt more robust and therefore more open when they started to talk about what they had experienced. By contrast, when people talked about their experiences first, it seemed harder for them to let go of it; some of them may have actually restimulated the trauma.73

While the footnote says there was no formal study for this it is presented as though it was. I recognize that in alternative treatments there is more space for this sort of claim but I also feel compelled to work in evidence based ways so this is disappointing. It does not help with confidence for the masses

When an autistic, Asperger’s, or otherwise challenging child comes to my clinic, I ask the parents about their child’s hearing. Invariably, they say that their child’s hearing was tested by an ear specialist who reported that it was normal. Most autistic children have their hearing tested in the usual way: they wear headphones, and respond when they hear the varied volumes and frequencies of sound from the headphones. The parents are almost always told that their child has good hearing, but this misses the core of the autistic child’s hearing problem. It is not a question of the child hearing single tones in a test, without background noises. The question should be: can the child hear the human voice in the presence of background noise? Does the child have the ability to filter out background sounds, especially low-frequency sounds?

Several of my patients who originally came to me with an autism diagnosis were evaluated again after I treated them and were found to be no longer autistic.

Ummmmm

Technique for Rounding a Flat Back of the Head

You can see Thor tell William’s story on YouTube (Search “autism, William, Stanley”).

The Basic Exercise

Basic Exercise instructions

I waited this whole book to learn the basic exercise only to find it is a technique i already am aware of and even teach. I havent seen the results thatbare described in thr book thiugh

Why would a trauma, the memory of a trauma, or even just a negative thought lead to a structural change such as a rotation of C1 and C2? Ten small muscles connect the occipital bone at the base of the skull with C1 and C2. Eight of these muscles are called the suboccipital muscles, and lie on the posterior (back) surface of the vertebrae. Two other muscles, the rectus capitis lateralis and the rectus capitis anterior, lie on the anterior (front) surface of these same two vertebrae. They are innervated by the occipital nerve, located on the scalp at the back of the head. (See “Suboc-cipital muscles,” “Vertebral arteries,” “Suboccipital muscles with vertebra,” and “Suboccipital nerve” in the Appendix.) Inappropriate tensions in any of these ten muscles are enough to shift and hold C1 and C2 out of joint.

The transverse processes of each cervical vertebra have openings (called foramens, or foramina) to accommodate passage of the vertebral arteries. Rotation or tipping of the vertebrae can twist or put pressure on these arteries, reducing the flow of blood, as in a plastic garden hose; if you put a bend in it, you reduce or shut off the flow of water. The amount of blood passing through these vertebral arteries depends on the position of the upper cervical vertebrae in the neck.

When we do the Basic Exercise, we lie with the weight of our head on our fingers. This pressure is enough to stimulate the occipital nerve, causing these muscles to relax and to come into balance with each other. When we do the Basic Exercise, the first two cervical vertebrae move into a better position relative to each other. When C1 and C2 come back into place, it relieves tension on the ver-tebral arteries, providing better blood flow to the brain and brainstem, and allows us to return to social engagement. Adequate blood supply to the cranial nerves, brainstem, and brain is necessary for proper function of the social nervous system as well as other bodily functions. Concurrently, therefore, with realignment of C1 and C2, there is relief of many of the symptoms that we earlier described as the “Heads of the Hydra.”

Why do we move our eyes in the Basic Exercise? The Basic Exercise involves movement of the eyes because there is a direct neurological connection between the eight suboccipital...