Eye Contact with baby

Polyvagel Theory

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Polyvagel Theory By Mark Rains, Ph.D.

How can parents help soothe stress in infants and build their capacity for attachment, self-regulation, social engagement, and resilience? Of all the many ways to understand this, one article that transforms how we look at relationships and stress response systems is “Neuroception” by Stephen Porges1. Published in Zero to Three in 2004, it remains timely; applicable to current problems with traumatic or “toxic” stress, childhood protective factors, and prenatal substance exposure, as well as classic infant mental health challenges with temperament, attachment, parenting, etc. It also introduces concepts of personal and social stress management that support coping with the psychosocial and professional challenges of COVID care.

Neuroception involves how the brain senses safety or threat through (primarily) visual, auditory, and tactile cues in the social environment and organizes responding. A complementary article by Porges, also in Zero to Three [1993], focuses on Interoception2, a “sixth sense” response to internal physiological cues. Both social and internal inputs are linked via the vagus nerve to multiple response systems. The multiple roles of this nerve and its contribution to Social Engagement Systems of parents and infants are elaborated within a Polyvagal Theory of stress response3.

Basically, polyvagal theory refers to (1-6):

  1. the general variety of inputs and outputs of the ventral (front) and dorsal (back) branches of the vagus nerve in the parasympathetic Autonomic Nervous System (ANS),
  2. the involvement of the ventral branch of the vagus in communicating (receiving and expressing) cues of safety and threat within interactions in the Social Engagement (i.e. Safe to Friend 4) System.
    In conditions of safety, the ventral vagus regulates the ups and downs of:
  3. mobilization without fear for action (waking, food gathering, defense, etc) by inhibiting and disinhibiting the sympathetic arousal branch of the ANS, especially heart function, and
  4. immobilization without fear for physical maintenance (sleeping, digesting, lactation, intimacy, illness recovery, etc.) by dorsal branch of the vagus and release of oxytocin.
    In conditions of significant or life-threatening stress:
  5. mobilization with anger/fear leading to dominance of ventral vagus by sympathetic arousal and limbic system overriding cortex (“losing your head”), i.e. Fight/Flight systems OR
  6. immobilization with fear involving physical shutdown by dorsal branch of vagus nerve, i.e. Freeze/Faint systems, going into shock, loss of blood pressure, etc.

In other words, with safety the parasympathetic ventral vagus nerve regulates both the sympathetic ANS and the parasympathetic dorsal vagus, as it balances waking and sleeping, gathering food and digesting it, engaging socially and withdrawing for reflection, energetic sexual activity and safe intimacy, child protection and lactation, etc. When this homeostatic balance is overwhelmed and sympathetic ANS or dorsal vagus is unregulated, an individual is vulnerable to physical and/or mental health problems.

Health and resilience involve accurate sensitivity to threat cues and flexibility in response. Problems result when persons see threat in safe situations and miss threat in stressful situations and/or when their mobilization or immobilization with anger or fear is chronic and less flexible. Polyvagal theory adds another lens to viewing current problems in self- and social-regulation: the importance of safety, the role of social engagement system in communicating and managing safety, and dysregulation that follows lack of safety.

The Social Engagement System develops within the attachment relationship between infant and parent and continues through adult interactions. Social engagement involves muscles of face and head, available in infancy, before development of extremities.

Following are some of the highlights:

Social Engagement

with Safety

(higher vagal tone, more flexibility)
• Make eye contact
• Display contingent facial expressions
• Vocalize with appealing inflection and rhythm
• Modulate middle-ear muscles to distinguish human voice more efficiently
• Problem solve
• Safe Touch, Massage
• All the above contribute to Attachment and to Soothing stress before it becomes toxic

Disengagement

with Danger

(lower vagal tone, less variability)
• Eyelids droop
• Positive facial expressions dwindle
• Voice loses inflection
• Awareness of human voice is less acute
• Sensitivity to others’ social engagement behaviors decreases
• Chest (crisis) breathing

Porges (2004)

There is a YouTube video that depicts the role of social engagement system in soothing stress and relationship development https://www.youtube.com/watch? v=zcz2Towvf8A. Spoiler alert: It portrays a father attempting to comfort the cries of his infant daughter. Their facial expressions mirror as he becomes stressed and she continues to fuss. He contacts her mother by cellphone where she is shopping in a grocery store and mother tries a variety of attempts to connect with and entertain her daughter via the cellphone screen, unsuccessfully. A grandmotherly figure in the grocery store appears to wonder, “What is going on here? How ridiculous to think technology could replace human interaction.” Nothing works.

The father then picks up his daughter with safe touch, brings her up to make eye contact with his safe face; all of which soothes her upset and catches her interest, and they eventually calm and connect. Its poignancy brings tears to mother’s eyes, perhaps gratified to see father and daughter’s capacity to join her in parenting. Both father and daughter were able to utilize their social engagement systems. Although it’s not clear that the producers of the video clip were thinking beyond “Technology will never replace love”, it seemed to me to illustrate social engagement well.

Polyvagal theory adds another lens to viewing current problems in self- and social-regulation. Heart Rate Variability (HRV) is a measurable biomarker of flexibility in ventral vagal regulation of heart function. Heart rate rises and falls with respiration. I won’t attempt to go into detail about this, beyond noting that it is one of the ways of studying the tone (high or low flexibility) of the ventral vagus in a variety of physical and mental health problems. Porges (2004) proposes that faulty neuroception (ability to switch effectively from defensive to social engagement strategies) may contribute to autism, schizophrenia, anxiety disorders, depression, and Reactive Attachment Disorder. Infants may learn defensive behaviors with frightened or frightening caregivers, which may then be ineffective or costly within safe environments.

For example, in infants exposed prenatally to substances and experiencing withdrawal symptoms as neonates, sympathetic arousal may be dominant, resulting in difficulty with parasympathetic functions of eating and sleeping and being comforted.5 Caregiving within the Eat, Sleep, Console program6assists in regaining sympathetic/parasympathetic balance, supported by medication to manage sympathetic arousal. Massage has been helpful in vagal tone of premature infants, enabling better weight gain. 7

The social interaction and communication challenges associated with autism spectrum difficulties8 are another area of research on polyvagal theory where intervention increases eye contact, vocalization, and anxiety; sensitivity to stimulation, etc. It doesn’t cure autism, but addresses some of the challenges, which might lead to a vicious cycle of withdrawal, behavioral difficulties, etc.

Turning to the parental role in the social engagement system involves parents being able to regulate their own emotional state and sense of safety, in order to be a safe partner interacting with their child. After ensuring that the child’s “alert system” is not hyper- (“wired”) or hypo- (“tired”) aroused and that the child’s “alarm system” is not activated by internal (interoception) or psychosocial (neuroception) threats, a parent can communicate safety within the parent-child social engagement relationship by providing nonverbal (right brain) relationship cues and utilizing developmentally appropriate language (left brain).9 Synchrony in the parent and child social engagement systems supports resilience. As the child develops beyond infancy, neuroception of safety is needed for verbal communication or executive functioning to be successful. Infant mental health interventions can model and provide safe social engagement by therapists to support safe parent and child interaction.

Parallel to the experience of parents, providers of healthcare and social services experience both vulnerability and opportunities for resilience, managing exposure to stress, utilizing professional coping strategies, practicing personal self-care, and experiencing organizational support. In particular, social engagement through teamwork and mutual support can help maintain resilience and reduce feelings of unmanageable threat. Unfortunately, this has been limited during COVID, in which distancing and masking undermine social engagement opportunities. When such social connection is not available, individual practices can help ‘jump start’ vagal tone through a variety of portals to the ventral vagus nerve. These include:

  1. Confident (diaphragmatic) “belly-button-breathing” (e.g. four count inhalation and six count exhalation), which is an alternative to crisis (chest, up-and-down) breathing.
  2. Massage, safe touch, which renews vagal tone.
  3. Vocalization (e.g. singing, chanting), which can engage the cranial nerve regulating the trachea and, together with diaphragmatic breathing, stimulate the ventral vagus nerve.
  4. Auditory stimulation which renews the balance in sensitivity to voice frequencies that can be dysregulated after exposure to danger frequencies, e.g. with soothing music in the range of voice frequencies (e.g. classical stringed instruments) or specially programmed music (Safe and Sound Protocol10) to stimulate middle ear functioning and flexibility.

Using such vagal stimulation strategies to achieve or renew a parasympathetic state of Safe to Friend provides a foundation for confidence and other cognitive coping strategies. This is built into a series of “Resilience Stretches”, which help recover from, manage, and prepare for psychosocial stress; like physical stretches prepare for physical activity.11

Research into these areas is still at early stages in many respects, at promising to evidence-based levels. As polyvagal theory has gained popularity12 , interpreters (myself included) may stray from science or evidence base, promoting short cuts to social engagement with oxytocin, vagus nerve stimulation, quick fixes, etc. I recommend sticking close to the source and staying up to date with the evidence base.

Take Home / Take to Work points:

  • In addition to Fight/Flight and Freeze/Faint responses to
  • Adverse Experiences, there is a Safe To Friend system of social engagement to manage stress with resilience.
  • This system is ready to begin from birth and is developed within safe, stable, supportive attachment interactions and relationships.
  • Vulnerabilities in the Social Engagement System may contribute to a variety of physical and psychosocial health problems.
  • There are multiple portals to renew safety at a personal level of neuroception and interoception and at a social level of protective factors for parents and professionals
  • With professional/personal/organizational resources, Infant mental health specialists can bring their own social engagement systems to safe, healing, growthful, interactions with parents and children.
  • Ongoing research will contribute to better understanding of the potential and limits of the preceding points
  1.  Porges, SW. (2004) Neuroception: A Subconscious System for Detecting Threats and Safety.  Zero to Three, 24:5,19-24.  (Downloadable from www.stephenporges.com )
  2.  Porges, SW. (1993) The Infant’s Sixth Sense: Consciousness and Regulation of Bodily Processes. Zero to Three 14(2), 12-16. (Downloadable from www.stephenporges.com )
  3.  Porges SW (2017). The Pocket Guide to the Polyvagal Theory: The Transformative Power of Feeling Safe. New York: WW Norton.
  4.  There are a variety of abbreviations for describing the Social Engagement System in contrast to “Fight/Flight, Freeze/Faint” systems, e.g. Tend and Befriend, Rest and Refresh, Friend, etc.  I am proposing “Safe to Friend” as a psychophysiological state, which an individual may reach through social interaction or personal activities.
  5.  Jansson, LM, DiPiero, JA, Elko, A and Velez, M. (2010) Infant Autonomic Functioning and Neonatal Abstinence Syndrome. Drug Alcohol Depend. 109(1-3): 198-204.
  6.  Grisham, L. et al. Eat, Sleep, Console Approach: A Family-Centered Model for the Treatment of Neonatal Abstinence Syndrome. Adv Neonatal Care. 19(2):138-144.
  7.  Field, T. (2019). Pediatric Massage Therapy Research: A Narrative Review. Children (Basel), 6(6): 78.
  8.  Porges SW, Bazhenova OV, Bal E, Carlson N, Sorokin Y, Heilman KJ, Cook KH, Lewis GF. (2014). Reducing Auditory Hypersensitivities in Autistic Spectrum Disorder: Preliminary Findings Evaluating the Listening Project Protocol. Frontiers in Pediatrics. Doi:10.3389/fped.2014.00080
  9.  Rains, M. Contact mainerains@gmail.com for handout. Brief video illustrating Brain in Palm of Hand    https://www.youtube.com/watch?v=evikiqovSVw
  10. https://integratedlistening.com/ssp-safe-sound-protocol/
  11.  Rains, M. 2022. “Resilience Stretches” Contact mainerains@gmail.com for copy.
  12.  Porges SW & Dana D (2018).  Clinical Applications of the Polyvagal Theory: The Emergence of Polyvagal-Informed Therapies. New York: WW Norton.
  13.  See also a wide variety of YouTube videos featuring Stephen Porges.