EP 187: Stephen Porges PhD | Polyvagal Theory: The Nervous System & Resilience

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Hi. Welcome to the Radical Responsibility podcast. This is Fleet Mall, your host and today I'm really excited to share a conversation with friend and colleague, Dr. Dr. Stephen Porges. We've had the opportunity to have many conversations about his polyvagal theory work which is absolutely fascinating and gives such a powerful window into understanding the dynamics of social engagement, trauma, safety, fear, all of our the neurobiology of fear and survival and how we can transcend that to create the neurobiology of connection and intimacy and relationship. It is such important work across so many dimensions of what we're experiencing in our world today. And it gives us a deep view into how each of us can do our own healing work so that we can have our own social engagement systems online more of the time, which invites others to do the same and so that we're creating relationship and, and connection rather than disconnection and polarization. So really fascinating work. Dr. Stephen Porges, welcome.

Steve.

Well, thank you Fleet, for inviting me. Looking forward to an interesting dialogue.

Yeah, it's great to have the opportunity to have another conversation with you. It's always been a pleasure in the past. So I'm going to share your bio for our audience who, some of whom may not be so familiar with you, and then we'll jump right into the conversation.

Okay, sounds great.

Great. So, Stephen Porges, Ph.D. is a distinguished university scientist at Indiana University where he is the founding director of the Traumatic Stress Research Consortium. He is a Professor of Psychiatry at the University of North Carolina and Professor Emeritus at both the University of Illinois at Chicago and the University of Maryland. He served as president of the Society for Psychophysiological Research and the Federation of Associations in Behavioral and Brain Sciences and is a former recip of the National Institute of Mental Health Research Scientist Development Award. He has published more than 300 peer reviewed papers across numerous disciplines. In 1994 he proposed the Polyvagal theory, a theory that links the evolution of the mammalian autonomic nervous system to social behavior and emphasizes the importance of psychological of psychological state in the expression of behavioral problems and psychiatric disorders. The theory is leading to innovative treatments based on insights into the mechanisms mediating symptoms observed in several behavioral, psychiatric and physical disorders. He is author of the Polyvagal Theory, Neurophysiological Foundations of Emotions, Attachment and Communication and Self Regulation, the Pocket Guide to Polyvagal Theory, the Transformative Power of Feeling Safe and co editor of Clinical Applications of the Polyvagal Theory. The Emergence of Polyvagal Informed Therapies is creator of a music based intervention, the Safe and Sound Protocol, which currently used by more than 1400 therapists to improve spontaneous social engagement, to reduce hearing sensitivities, to improve language processing and state regulation. So clearly a very prolific career in producing that, that sound intervention, that music based intervention. Do you have a musical background yourself or did you collaborate with musicians to do that or.

No, I. I actually have a musical background which I left decades ago. I was a clarinetist, so. But that brought me into questions of listening and breath intonation and facial muscles, all linked to music that later became what I do for a living, the Polyvagal Theory, and became the Social Engage. Yeah, yeah.

And all linked to having our social engagement systems online, which we're going to explore today. Absolutely. Okay, well, let's jump right in. So the overarching inquiry of this summit really has to do with how we can develop deep and sustain the individual, collective and systemic resilience. We need to face the incredible challenges we're facing today as humanity. And, and today's summit has to do with relational and relational resilience and healing trauma. But before we talk about that, I wonder if you could talk about what resilience means to you. What does that mean to you? Or in the context of your work or polyvagal theory, how would you describe resilience even at the individual level to begin with?

First of all, it's a very, very important question. And I was confronted with this question a few months ago when I was asked to be a discussant for a documentary film on resilience. And the film was interviewing people that they had identified as having, you know, great resilience, basically suffering from severe adversary adversities, and then remarkably, being benevolent to others. And so as I listened to these stories, I saw one common theme coming out, and that was the ability of these individuals to stay connected, to stay connected with others. And polyvagal terms, this connectedness is our biological imperative. We as a species, we don't survive unless we have connection with others, meaning that we have trusted, safe relationships. And these people really demonstrated in their own words their connection with other and with community. And for some, it even became a spiritual connection. Was they. They were not alone, they were not isolates. And what you start seeing is that resilience is really the basic building block of society. I call it, use the term sociality. And Connectedness as the building block blocks of society. But you can see that really in terms of function and resilience really is a word that deals with individual function. And so those who function have connectedness. And that connectedness provides the opportunity to co regulate their physiological states, to mitigate their feelings of threat and uncertainty and for them to do the same to others. So you create these reciprocal relationships of connectedness and resiliency is not one dimensional and it's not the individual independent of other people. And I think that's the takeoff point. From my perspective, resilience is a product of how we connect to other people.

So yeah, that's really interesting. And I mean obviously our social connectedness, we're social beings, it's critical to resilience, would you say? I'm just curious though, if there is some sort of internal or individual dimension of resilience as well. I mean even think, I mean for any of us ordinary human beings, I mean some of us are probably genetically predisposed. They used to call that grit which we can't do anything about we're born with or not. But you know, are there other things that we do individually that also enhance our, how we take care of ourselves and so things like that?

Yeah, well, if you get down to the most basic building block in my concept, it's right. Well, I'm now talking about the science of feeling safe. And resilience is really one of the products of feeling safe. Now your, your point that it has a lower foundational.

Basis and that is if our physiology isn't put together, if our autonomic nervous system can't become under any circumstances, then our resilience, our ability to co regulate, interact with others is also disrupted. So but having this ability to have a calm autonomic nervous system is not sufficient is really what I'm saying. We require another level of interaction which I often call neural exercises. So resilience in a, I would say in a physiological demand model is that we challenge ourselves and we recover. So the question is, how do we recover? And what we learn again through the, the case studies of history of individuals is recovery is often related to either a physical CO regulation with another or a mental image of CO regulation that occurred before. So like it's a visualization of a loved one feel safe in the arms of another and not necessarily even requiring the physical connection at that point.

So I, I'm not in any way trying to diminish the incredible importance of the social connectedness part of this and I don't want to Keep beating this up. But just for an example, to the. Let's take for example, the. The advanced yogi in the cave or something. The people who've been able to develop tremendous resilience and strength and so forth in isolation, in a sense now maybe they're connecting in some other way.

Well, actually, we can go back to your earlier point. Is there a genetic component? I'd like to say there's a physiological component that may or may not have genetics because we know that if we have certain illnesses, we lose our resilience. So we know it's not genetic. We know that there is a state component. So if people are under severe threat demands for prolonged periods of time, of time which we often call chronic stress. So it could be a work environment, it could be a time demand, it could be arguments within the home. But our physiology doesn't have the moment to feel safe and calm. And that in a sense we use the term. We might say we have no resource left. And when we use that word, we're saying that we are not resilient at this point in time. So resilience can be dynamic. And I think we want to get to that point point that there's a dynamic component to it and it's based upon a underlying, from my perspective, neurophysiological resource. And that is really in terms that most people can. Is as. Comprehend rather than go into as a deep neurophysiological model. Basically, it's like saying my physiological state is not ruling me. I. I am calm enough to interact. It allows my higher brain structures, my intention self to have some control of my behavior. Those are the. Considered the resilient people, those who no longer have that intentional behavioral regulation but are now so physiologically destabilized by the triggers or the experience. We view those people as not being resilient.

And I, I guess I think it would be safe to assume even if you positive an individual dimension, neurophysiological dimension of resilience, a foundational kind of resilience that gets formed in a social construct from birth forward, right with the, with the mother, with the surrogate parent or the right. That's all it's always developed in relationship. Attachment is at the basis of it.

Now that. That was an earlier discussion I was having with my wife. I was basically saying that, you know, it's taken me decades to start thinking about what my colleagues have been studying and realizing that these early experiences are profound in shaping how we react to the world in a sense, our resilience. But what we can learn from the, literally the very dependent infant. We can see that the very dependent infant is basically sending cues and signals to another for comfort to in a sense down regulate the uncertainty of life experiences with warmth, comfort and the presence of. Of a mother who's not just intellectually caring, but whose body is connected and being present with the infant. And those visualizations and those processes in which that infant basically is going through an experiential learning program, or I would even call that neural exercises. Their body is learning that it can become destabilized. But don't worry, it will become co regulated by a loved one. And then over time, memories or images shift the co regulation into self regulation. And when we have this ability to self regulate, we're really talking about basically super resilient people. They can suffer, they can challenge their bodies and they recover. But one thing we realize as we mature is basically our nervous system seeks predictability. And unpredictability or violation of expectancy is a threat to our nervous system. That's how it evolved. And yet if we are in safe context with safe people we love violation of expectancy, we consider that exciting. And it can even be humor, humorous and playful. But that all requires that enough, we're enveloped in enough. Sufficient cues of safety that our body is not locked into states of threat.

At the risk of oversimplifying, I'd like to talk about your polyvagal theory and invite you to lay that out a little bit for us. At the risk of oversimplifying, I believe it has at least in part to do with the role of the vagus nerve, both the dorsal and ventral branches, in regulating arousal, potentially for both self regulation and co regulation in service of relational safety connection like you've been speaking about. So I know it's a complex subject and you've written several volumes, others have written volumes about it. But I wonder if you could give us a. A sketch of it so we can contextualize our conversation today.

So I want you first not to think of the nerve as having any executive function. You know, the nerve is. Is a conduit. It's a highway. It's a highway of sending information from the brain to organs and from conveying information from the organs to the brain stem. And the interesting part really is what's going on in the brain stem and why is it sending these different set of signals under different conditions. So what the happened through evolution? This, this to me is the, the exciting story, from my perspective at least, is that the transition from asocial reptiles to Social mammals required a repurposing of the autonomic nervous system. Basically, it had to both convey physiological state to those of the conspecifics of the same species. And it had to have the capacity to down regular regulate threat reactions so that we could connect. So it had these unique attributes of connection based into what that autonomic nervous system had to do. It had to broadcast their state to the other. Am I safe to come close to? And if I'm not safe to come close to, how do I down regulate my own system? Or how do you help me down regulate that? And so it became that our nervous system could, for mammals, unlike their ancestral reptiles, who, who like virtually every other living organism, had a capacity to reflexively respond to threat. And I use the term neuroception because it's done without an awareness, without a perception, our bodies just does it. And sometimes we're shocked by what we've done. Our nervous system detects threat. But mammals have this very unique attribute. They could detect cues of safety, they could calm down. This brings us back to that crying baby. What are the cues that the crying baby is extracting from the maternal interaction that down regulates that threat reaction of tantrum or crying? It's facial expressivity, it's intonation of voice, it's the conforming of the bodies, it's the gentleness. We will use words like being present. You know, we have all these fluffy words, but basically intonation or loving sounds of a mother's voice can be quantified. And depending upon how prosodic, how much intonation she has, the baby's behavior and heart rate will calm down, more or less. So if she says the same things, but her voice is not as melodic, it's much less effective. So we're left in the world, which focuses so much on the words we say. But the research is really saying it's not the words, it's how you say them.

Well, I know neuroception is key to this model. I wonder if you could just speak a little bit more about that. And I'm curious about one thing. I don't want to get us outside of the boundaries of evidentiary science, but I imagine where neuroception is happening through our five senses. And at the same time, you know, sometimes you walk in the room, you sense tension. We talk about good vibes, bad vibes. I mean, does the nervous system actually pick up on things apart from through hearing, touch, seeing and so forth?

Let's put it this way, good vibes, bad vibes, that's neuroception we just don't know what the features are that your nervous system is detecting. Your nervous system is detecting patterns and changes. We, you know, the simplest thing is we detect intonation of voice. That's the part that I'm able to quantify and document. Now it can be patterns of touch. You know, people say, oh, that tickles me or that hurts me. So our nervous system is detecting patterns that it interprets as being safe touch or bad touch. And on the negative side, here's where we start learning even more. So like medical trauma to the body can be the same thing as sexual trauma to the body. The body. You know, uninvited intrusion to the body, even with different intentionality, can result in the body reacting and developing trauma symptoms.

You know, I was amazed, just anecdotally. I've had two knee surgeries, knee replacements, and both times I was amazed when I woke up from surgery and they want to get you out of bed, almost immediately. They get you out of bed, going to the bathroom, and then pretty soon they got you doing physical therapy. And I was amazed how just having gone through a three hour surgery on my knee, I felt like.

So vulnerable and so non resilient and like my whole system was just sort of in shock.

Yeah, yeah, well, it was, it was, you know, even though you were under anesthesia, your body, the autonomic nervous system was not what was detecting. Let me put this way, your nervous system detected the intrusion into your body and the treatment of your body and you needed to recover. Surgeries can be extremely disruptive to people and it's not a given rule of how much it's going to be disruptive. Now we, we live in this world which thinks that medicine, like science, is all cause and effect. But even science doesn't account for all the variance of the effect by the causes. And this is again where polyvagal theory comes into the dialogue. Polyvagal theory emphasizes the intervening variable, what is between the cause, what is between and the effect, what's between the stimulus and the response. And it says, look at that autonomic nervous system. So in your situation, you had a surgery and the medical.

Script is for you to get up and move, but the intervening variable was your autonomic nervous system, which was destabilized. And so you're woozy. It's not even that there's pain, is basically you have difficulty recruiting your body to do the behaviors that you requested to do.

I had a different experience with surgery because I kind of went into training for surgery and was Basically, you know, walking around very quickly, but not from. It was a visceral surgery, it was a prostate surgery, it wasn't a skeletal motor surgery like you had. So it was. And, and for the types of surgery I have, the efforts, the sensory aspect of it are different than those that are skeletal motor for good reasons.

So.

I'm wondering, I want to talk about, move on to how from a polyvagal perspective, we can actually deepen our resilience individually and collectively and relationally. But first, we kind of touched this already. But can we look at resilience from a polyvagal perspective.

As a capacity for self regulation and co regulation? Is it can be a stored capacity, is it a learned capacity? Or is it just something that exists as a state in the moment of relationality? Or, or is it a capacity we draw upon?

Well, I would say it's all of them. And that's not merely to get out of your question. The issue is once you start realizing that so much of what you're really, the question you're asking is a state dependency, but that state dependency, everyone doesn't have the same range of states. And part of that's affected by our history. If we're retuned to in a sense be in a state of threat. And this is really part of the world that the pandemic's done this to most of us, it's retuned our nervous system to be in a state of hypervigilance. Hypervigilance of people. And people in the past have been the major ways that we have regulated and now they become threats to our bodies. So rather than being gregarious, we are now withdrawing and our bodies are in alert. And so when you start reading and hearing all the politics and all the reactions to vaccinations and masks, of course that's going to happen when your body is in a state of threat. So in a sense the resilience, the ability to deal with variations or diversity of opinions becomes very narrow. Our body says, I can handle a specific type of predictability and when that's violated, I am going ballistic. And that's really what we're seeing. And so we need to first of all be very conscious and aware of our own bodily state before we make attributions of causality. So going to your basic point about resilience, if we just stop for a moment before we even ask that question and did a little self monitoring of our own physiological states, so we felt that our body was very tense, we would use the word stressed or Reactive, hypervigilant, concerned about uncertainty, forget it. Your resilience is going to be extremely limited. But if we're in a sense in a calmer state and we see others who are not in a calmer state, we take our breath and we try to be helpful to others and we try to help co regulate them. Now, based upon our own history of what we've done, and this is the other part of your question. If we lose our resource so we no longer have this ability to interact, have we developed a toolkit that we can use to re engage our nervous system to calm it down? Are we aware enough of our physiological state that we can navigate, like take ourselves into a quiet room, listen to a little music, do a little breathing, do a little visualization and say, I've got it back now into the world again and I can be your friend or I can be helpful to you because I have my resilience back, my state changed. So I'm saying we have to be very, we have to honor our physiological state as much as we have learned to honor literally our genetics or our phenotype. We tend to, in a sense, honor who we are. And we stand in front of a mirror, we lift weights, we stand on a scale. But we have to really understand that our physiological states, it's dynamic and it changes based upon the demands that were placed on us. And the story of resilience is really this optimistic viewpoint that we can challenge this wonderful nervous system and it will recover. But we all, all of us know that that works some of the time, but doesn't work all the time. We don't, we don't recover like we used to. And you know, even on a personal level, as we mature and for many of us, we traveled a lot and all we needed was a night home to sleep and we're fine for, you know, we're back at the next thing taking another trip. It doesn't work that way. When you get older, the body doesn't rapidly recover. So that level of resilience is changed with maturation. But I think we need to give respect. And again, this is the world of the pandemic. Those who have suffered from, let's say moderate to severe COVID infections, one of the symptoms that has that's residual is the resilience is gone. They're fatigued and they don't know where it came from, from a personal level, because their sense of themselves is, they're robust, they're resilient, and suddenly their body is in a way failing them. And the polyvagal message is honor the body and understand what the body is doing. And the long covet is really about an autonomic nervous system that got retuned to be in a chronic state of defense. And so it's just like what happens with trauma in your autonomic nervous system. How do you resolve that? You basically need cues of safety to permeate your world, so your body gives up its defenses.

Yeah. When you, you mentioned the pandemic, I'll never forget the two moments when the first time I had the experience of walking down a supermarket aisle and also walking down the sidewalk near my home and seeing people approaching and really regarding them as an enemy. I mean.

It was, it was shocking to have that experience. And I'm sure we've all dealt with that to one degree or another.

Yeah, well, you know, so we live oceanfront and we walk on the beach occasionally. And rather than walking towards and saying hello or waving or smiling, you, you move out. So it's about 10ft apart. You know, it's like, it's really asocial behavior and it's becoming the norm. And when we go places and people aren't wearing masks, we, our bodies get really threatened. We don't like that. We want. Because we view it as disrespectful to our vulnerabilities. Yeah, absolutely.

So in terms of how we can.

Deepen our resilience and sustain our resilience. So a lot of that, I would imagine, is learning how to maintain good social networks, good social connectedness. But I'm also wondering about, you know, we talked about state resilience, state dependent resilience. So we know from many disciplines, like meditation or even practicing music for that matter, you know, if you repeat a state again and again and again, it can become a trait. And we know some of the research on mindfulness shows that over time, regular mind training actually changes the brain. So you have neural pathways that are more robust, that support better emotional balance, more cognitive control, and, and thus really resilience in some way. So I'm wondering.

What would. I want to talk about the collective interrelational in a minute. But what might we do to practice becoming more resilient and having better ability to keep our social engagement system online, for example?

Well, in a normal world now, this is pandemic.

For me, my normal way of, of, of thriving and flourishing was to have enough social nourishment. And that has been changed. And this is it. I'm on, on a zoom with you. This is my social nourishment for the day, not bad, but certainly not what face to face would be like. So for me, my body craves going out for coffee or going out for a drink or, you know, doing something with others. Now I am living with my wife and that's wonderful. Occasionally my kids will visit. That's nice. But we're really living in kind of like a bubble. And it's been almost two years for us. It's March, when we basically went into this seclusion way. And so we know, at least I know what my body needs. But the issue is that's with great price because many of my friends have since gone out, even with their three two shots and booster, and they got infected. And their experience, even though they weren't hospitalized, still wasn't positive. And as we get older, and some of us are advanced in years, there's one thing we know about COVID in that age is a risk factor. But we don't know is it a risk factor because of age itself or because of other associated disorders that occur with age.

Here is what we're learning, because I'm actually doing research on the pandemic, that if you go into the pandemic with adversity history.

And what happens is that your mental health outcomes during the pandemic are a lot worse. But virtually all that variance is accounted for for by subjective measures of autonomic state. So our subjective measure of our autonomic state reflects that we're much more in a state of threat. The mental health outcomes are poor. That's the polyvagal hypothesis. Literally, our autonomic state reflects whether or not or it's a mediator of whether or not certain events or experiences are going to be detrimental to our mental health. So carrying adversity history isn't good. But if your autonomic nervous system wasn't retuned by the adversity history, it has little effect on your mental health outcomes during the pandemic.

So it's interesting in terms of a history of adversity and maybe also relationship to.

Experience and belief. So if we have a history of adversity and we've been able to overcome that in the past and thrive, that would probably set us up to have a belief system that I can handle adversity that I suppose would have an impact as well as I know there's some research showing that even around stress, that our belief of whether stress is good, necessary challenge, or whether it's actually harmful actually changes the impact of stress, that it's not harmful. If we don't see it as harmful.

Well, part of the problem is the use of the word stress or the word threat. If we threw out the word stress and asked the simple question, is there a disruption in homeostatic function? Meaning does your autonomic nervous system no longer serve as health growth and restoration? Then you have a nice operational definition. And that essence gets you into concepts like recovery and resilience. Because for most people, yeah, under demands challenges, they disrupt their homeostatic function, but as soon as they complete that task, the system recovers and everyone's fine. And this resulted, if we start using the word stress, we get into trouble because we start talking about good stress and bad stress and we perceive it in different ways. The question is really, does the challenge disrupt our homeostatic functions in a prolonged way, or does it recover when we stop it? And in a sense, it would simplify our understanding of the human experience, in a sense, saying perhaps the challenge or the stressor that we're talking about is really a question of duration, not a question of the quality of the stressor that if it's under shorter duration, we recover. And now this gets to your experiential or learning model. Does our nervous system learn that it will recover or does it learn that it maintains destabilization? And my perspective, at least that I kind of embed within polyvagal theory, is that you can disrupt the system for relatively long periods of time as long as you have opportunities for recovery. And those opportunities for recovery often are characterized by co regulation with others. So this goes back to our earlier point of what is resilience? It's the ability to recover through connection with others, whether it's a visualization or with a real person.

So following that thread, could you say that there could be such a thing as sort of intentional disruption of a homeostatic state or function in service of growth. Which might also connect to the idea of post traumatic growth as well, which wasn't intentional, but nonetheless we experienced it. But there is talk about post traumatic growth as well.

Yeah, I, I think so. I think the disruption basically enables you to honor what the nervous system can do, because you're not really respecting the disruption. You're respecting the fact that it can recover on its own and you're learning. This is where in a sense, an understanding or awareness of what your body does and to honor that is really a good journey to be on. And this means that if your body is fragile or vulnerable to disruption, you honor that and you then craft or navigate a lifestyle that respects that and you don't say, I can do it. And it's like saying that if you're severe diabetic, I don't need the insulin that I can will it. The body is going to tell you what it needs. And part of this is to respect what the body is trying to tell you.

Well, you've already addressed this a little bit, but I'd like to ask a little bit more about from a polyvagal perspective, the impact of trauma. Now you've talked about this disruption of a homeostatic function or state and I suppose is that kind of on us, on a. You've talked about, I think where there's a interruption in what we would normally expect is something unfamiliar or break. So is that on a spectrum from just bad to maybe what we call stress to trauma? And what we call trauma, is that uniquely destabilizing in different ways or.

Well, I think you have, in the package of words you just emitted. The answer is embedded in that, and that is we can't think of trauma as an event. We have to think of it as a response because our body is telling us whether that event is really destabilizing us. And the answer is really we can say that the events are qualitatively not nice, not good. You don't have to have any argument about that. But the impact of those events on our physiology, on our nervous system is really about whether it sticks in our body and creates these prolonged disruptions. Now the question, you have another question embedded that is if we get disrupted by this profound traumatic event and our body recovers, is that post traumatic growth, is that in a sense learning and respecting really the great resilience that our system has and through that a great respect in what we, we make great respect of who we are, not from a intentional or conscious world, but from our own physiological structures. We sit back and say, I feel a great sense of gratitude for the body that I have.

You know, along those lines, I'm doing a lot of work these days with correctional officers, probation and parole officers, law enforcement and other first responders where they have continual exposure to high levels of arousal stress as well as trauma exposure, both primary and secondary trauma, and this question of whether it sticks. So what are the contributing factors to whether trauma sticks and becomes, you know, something that people are then having, that becomes undermining in some continuous way or whether it doesn't stick and people are able to somehow resolve it in the moment?

Well, I think it, a lot has to do with the physiological state you're in so we are already accepting that when we are challenged, it doesn't have to be a traumatic situation, but we can be challenged. And our nervous system loses its resilience, it loses its ballast. Now our system is destabilized and it needs the context and the time to recover. And unless we are aware of that and respect that, we retune to a different nervous system that is now hyper vigilant and hyper defensive and not very social. And then we are really destabilized both with our mental health and also physical health. And we want to join those two together because the trauma world, it is together. So people who have the mental health disruptions of severe traumatic reactions or responses have autonomic destabilizations represented in different, different systems. That could be called dysautonomia, but it could be cardiovascular GI problem, migraines. You start seeing this whole cluster and we don't honor them in the appropriate way. We talk about them as being separate or comorbidities. And for many people who have experienced severe trauma, basically they go to physicians and the physicians can't figure out what causes it. They're viewed as feigning these disorders and told to see a psychiatrist, as opposed to say, when your body is under a state of threat.

You have a dysregulation of autonomic function. So all these systems are not going to work. Right, Even though the end organs are not damaged. And that's what the physicians are looking at looking for, end organ damage. But over time, when the neural systems regulating those end organs aren't appropriately regulating the organ through appropriate feedback methods, organisms, then the end organs start having damage. And remember, one of the symptoms of profound trauma is body numbing. If we translate that into a neurophysiological construct, what it means is that we're not listening to the feedback loops of her body.

I'm wondering if one of the difficult to diagnose kind of mysterious maladies and symptomologies often described as chronic fatigue. And often people struggle getting a real diagnosis. And certainly sometimes there may be cases where it's virally caused, or maybe cases where there's toxins in the air that people develop sensitivities to. But I'm wondering if some cases, it is some kind of trauma related constellation of symptomology.

Yeah, well, this is, it's a wonderful question. And the issue is that we're so attuned to, to a pathogen model of disease that we feel that if we haven't found it, we haven't found it yet. And we're still looking for it, and we're still doing that. And I have a different model. And the model is that our autonomic nervous system reacts to threat. Pathogens are a threat. Other things are a threat. The question is often that threat goes away, but the cue to the nervous system of safety hasn't come back on, so the nervous system has stayed retuned. I think chronic fatigue and many other chronic disorders are really a feature of the nervous system being locked in a state of threat. And that threat can be inflammatory, it can be neural, and it can be. Have other, let's say, molecular attributes to it. But the system is now recalibrated to be in chronic threat when there is no predator. So it's like, what does trauma do to a person's ability to be hugged, to be in close proximity? The body says no. The intentional mind says, I want to have relationships. I want to be safe in the arms of another. But try it and the body will retract. Well, I think many of the chronic disorders are the same way. The body has had a damage. It could be an injury or it could be a pathogen. And when that cue goes to the body, it creates this sense systemic threat reaction. So it has a lot of features of psychological threat, but it's also a physical threat. And now the nervous system retuned. Now it's like when you have chronic pain, often the tissue damage has long been healed and the body just didn't get the message. The nervous system didn't get the message that all things are good. Now with trauma, the person's no longer being injured, but the body didn't get the. The message it's okay now. And that's what trauma therapies are all about.

Well, that's fascinating. So the really, regardless of the precipitating event or factor, pathogen, whatever it might be, experience.

The result is somewhat universal. And therefore the healing modalities may be somewhat universal. We often hear about people having, you know, while science is looking to discover that pathogen that may no longer be there and how to fix it. But people often have the best luck with some of these chronic disorders with alternative therapies that are often about healing the nervous system.

Yeah, well, the. The interesting thing is what I would say contemporary medicine has done with the remarkable power of the placebo effect. You know, the placebo effect is the body convincing itself it's okay and it's not doing nothing. It's really doing all, giving the body the cues, that there's care, there's concern, and the nervous system will attempt to do its own healing. Now this doesn't mean that pharmaceuticals or surgery aren't important, but it means that we should recruit the patient's nervous system as a collaborator on a joint journey to healing. And we tend to mechanize our views of what illness and injury are. We don't treat ourselves as this dynamic, interactive, co regulatory species. We need to feel safe to heal. And this even in terms of pharmaceuticals or surgery. If our bodies are safe, we process the intervention much more effectively.

So let's talk a little bit about relational resilience and how to create greater resilience for ourselves and others and with others. So if we develop self awareness around neuroception and.

What our own system interprets as threat or safety and what others interpret as threat or safety, can we then sort of become better at self regulating through co regulation and helping others self regulate through co regulation? In other words, having more attention to facial expression and posture and vocal tone and things like this. I wonder if you could talk about that.

Well, let's start off with what normally happens in the world. Our detection of threat is literally outside of our conscious awareness.

Like a sound startles us long before we know what the sound is.

Our body reacts to things and then we try to figure out why did we react. That's neuroception. We walk into a room like your earlier examples, and we get good vibes, we feel good. What are the features that our nervous system is? Or we go into another room and we say, we've got to leave this place, this is something good's not going to happen. We're picking up cues that we don't even have, let's say, a good educational template to figure them out. But we have a quote, gut instincts. And those gut instincts tell us how we feel. So the question really is, can we utilize this information to help manage our lives better? And I always like to say we have to start with an awareness of what our body is doing, including like neuroception, before we develop the narrative. So let's assume you're in a room or sitting at a table with an individual. And there are all kinds. The person is a sense low on ballast or low on resource. And there's a lot of activity in the room and the person's physiology is moving into a hypervigilance. And you start looking, you get a ping on your phone and you pick it up and you look at it and you disengage the person. And then something happens. And now that person is yelling at you for not being Engaged or attentiveness. So the issue is we tend to, in a sense, know that our body reacts and we try to make meaning of it, but we often make the wrong interpretation, and we blame others for what's going on inside of us. And so the first step is really this awareness of one's own bodily feeling. So when I developed the safe and sound protocol, to me, the most, I would say interesting phenomenon that I observed was really in the world of trauma, that the music was really the hyper prosodic nature of vocal music. We computer altered it with the expectation that the nervous system could not reject the cues. So music is literally prosodic voice. But we filtered it and amplified the intentional, the intonational changes. And what happened with people with trauma is that they put the headset on, their bodies would relax for a moment, then they would get anxious or, you know, feel vulnerable and get up and become destabilized. And to me, that was really one of the most, I would say, enlightening for me, experiences, because what it meant was that cues of safety were associated with cues of abuse. So if you think about what happens with many of the people who have experienced trauma, it's a violation of trust in someone that they had trusted. And now you're getting distilled. Essence of trust, which is what I would in a sense say the music is, the body now is going to a state of trust, which is vulnerability, which is accessibility to a typical person, but becomes vulnerability to a person carrying trauma. And now they react and they can't handle it. They become destabilized. And to learn through watching this repeatedly with many individuals that cues of safety can be profound triggers of threat.

Really enlightens you to understand that cause and effect relationships are complex. That even though with a person without a severe trauma history, their bodies will just kind of like open up and. And blend. And so, like, if they're in for a somatic therapy type of treatment, their bodies are accessible. But for a person who reacts to that, they're out of the room. And so the enlightened trauma therapists said, aha, this is a gateway. And so they start to use it, but titrated extremely slowly. It could be a few minutes a day, it could be a few minutes every other day. But it was not a strict protocol because the nervous system of the individual had been monitored and respected and honored. And pretty soon, over time, the person could tolerate and experience it and understand that their physiological feelings were feelings that did not have to always have an association with an adverse event.

So as A result of that kind of destabilization that we experience through trauma, we may have to actually, in a very careful, titrated, gentle way, relearn healthy vulnerability or healthy trust or healthy openness.

Healthy having a healthy ability to experience stillness. Because remember, for many people with trauma histories, immobilization without fear doesn't exist in their repertoire. They have to keep moving.

Yeah, absolutely. We've also done a lot of work, continue to do a lot of work bringing mindfulness and mindfulness based programs into prisons for incarcerated persons. And, and literally it can be very destabilized. We have to be very careful and gentle and titrated, give people a lot of space. Because initially just sitting still or quiet room can be very triggering.

Right? Or closing their eyes or having someone sit behind them when their eyes are closed, it's. It's vulnerability. So where it would be viewed for, in a safe context with people who are not challenged under those same circumstances, it would be totally relaxing and they would have this degree of accessibility for the population you were working with, the body says, not a safe place to be vulnerable.

I know in your work you use, I believe, anyway, you've used the term vagal tone. And I'm curious, is that basically a description for a state of homeostasis or good co regulation or does it have something to do with the actual physiology of the vagus nerve or.

Well, you know, in many ways it's not a useful term. So it's like a. Because it's misleading. I realize that people think, is it like muscle tone? How do we increase the vague. The tone of that nerve? It's really telling you how much cardio inhibitory signal, meaning slowing or calming is coming through that vagus. So. So the word vagal tone to me is telling me how much is that brainstem sending a cue to my heart to calm me down? I have come up with another metric that I called vagal efficiency. And it goes one step beyond vagal tone. It's asking the question, how much does the change in vagal tone affect my heart rate? So again, this goes into like a resilient person. You want them to be tightly coupled because the vagal regulation of the heart is through a myelinate nerve. It's. And it's quite manipulatable through either mental effort or physical effort. And so we can see that we can literally lift the brake or the vagal break off the heart if we concentrate or if we breathe different ways or if we run. Now the question is, when we put it back, how does it change? So what I decided to do was literally quantify the dynamics of the two measures, the measure of vagal tone, which was the respiratory rhythm in the heart rate pattern and the heart rate itself. And we found out that virtually everyone who has a feature that could be called dysautonomia, which is, you know, important part of our discussion, has poor vagal efficiency and healthy resilient. Resilient might not. Well resilient in my world, meaning that their heart rates recover rapidly after an exercise. They have, in a sense, how much high level vagal efficiency. So it looks like a easily monitored metric that may link into really the common, the basic theme of what this whole interview is about, resilience. It may, we may be able to measure it. It's like saying, can we recruit this ventral vagal system to calm our heart rate down? And when we need to move, can we retract that system and literally give permission to the sympathetics to mobilize us? So it doesn't mean that we're always quiescent, but when we need to move, we move efficiently because that vagal break is, is a counter to the counter force to the sympathetics. And if we want the sympathetics to be efficient, we better efficiently pull the vagal break away.

And has there, has there been research done on what you're calling bagel efficiency and what a lot of athletes are using as a measure in their conditioning and regimen recover, like heart rate variability? And I think there's another measure that's kind of related to that.

Well, there's about, I think, six studies that we've done, including with premature babies, sleep state, the effect of alcohol.

Even mild adversity. History disrupts vagal efficiency in college students. So you can start seeing these things. And also we look at like children who have severe abdominal cyclic vomiting, dysautonomia in the gut. They have poor vagal efficiency. There's a syndrome called Ehlers Danlos, the hypermobility subtype. They have a lot of emotional and fibromyalgia issue there. We can almost diagnose them from a sample based on vagal efficiency. It's just very poor. So, so it's like saying, if your autonomic nervous system doesn't follow the rules, you probably have poor vagal efficiency. The question really is, can you enhance it? Can you exercise it? And that's, that's what we're working on. We're seeing if we can instance, through quote, neural exercises, including like listening to the prosodic music. Can we get that system back on board in an efficient way. If you think of vagal efficiency as the, the first adaptive reaction of a nervous system under chronic threat, it's to break down the feedback loop that's trying to cut off threat reaction. So you withdraw your vagal activity to enhance threat reactions. And if you need them on all the time, you don't want this limb of the autonomic nervous system to grab control again. And so initially will start deteriorating the efficiency. At least that's hypothetically. And then the next level is if it's deteriorated, what you're getting is the neural feedback to your end, organs are being challenged, and then you should get end organ disease.

Yeah. So I, as well as the sound intervention you've been working with, I would assume breath is another modality for working with this.

Yeah, breath is of course the first go to type of intervention because it's been around for thousands of years. So I wrote it forward to a friend's book on yoga. And to me the remarkable thing is yoga is thousands of years old, yet it has, especially pranayama yoga. It has all the, let's say, neurophysiological attributes that were described in that social engagement system with breath, the muscles of the face, the vocalizations and even pressure points on the face. That's all mapped out in the social engagement system. And that's really the underlying, I would say say neurophysiological mechanisms for pranayama yoga. So I think we can start teaching people or giving them tools to regulate this, the, the eventual vagus or the social engagement system. And so like breath is important. We can think about singing or chanting, we can think about wind instruments. Wind instruments used to be what I would always talk about because I was a wind instrument player. I played the clarinet and that in a sense over when I was much younger, it gave me insights into slow exhalation and the muscles of the face and head, which because of the embouchure and also the listening of intonation. So you get listening, you get breath, you get facial, motor. It's pranayama. So playing the clarinet is pranayama yoga. And I start to get those insights over, I would say the past few decades and, and I think those are tools that people can recruit that perform profound neural exercises that rewire our nervous system. So for me, the fact that I was a musician young, when I was a younger guy, I think it helped create the buffering and resilience for me to live my life, enabled me to be bold and in a sense, one might say courageous. But in a sense, I don't view it as courageous. I view it as one's, you know, I, I living out one's dreams with ideas and my physics. And I had this as a toolkit that could be helpful in regulating my physiological state. So I never, in a sense, swam in a pool of, of cues of threat. I was always able to navigate out of it. And it's only, I would say, during the last 20 years, since I've been, in a sense, associated with many people who work with trauma, that I've been introduced to people who live in a world of threat. And, you know, you start getting tremendous respect for the intent, I would say the, the drive that they have to try to live and try to, in a sense, normalize their lives. Because if you live in a state of chronic threat, your physiology doesn't have that time to calm down.

This has been incredibly fascinating, and you've been very generous with your time. We're kind of near the end of our time. I did have one more question. I'm wondering whether you put thought into this or any research or colleagues are of applying polyvagal theory at the collective or even societal level, like seeing a way forward on how we create a more resilient society or maybe overcome this extreme divisiveness and polarization that we're experiencing today.

Well, I just finished writing a paper called the Science of Safety, and it talks about the building blocks of our society, and it talks about trust. And trust, even in business. Everything is based upon the ability to trust another. So we're connected species. I'm very interested in this. And it's, in a sense, taken decades to be able to, in a sense, be bold enough to say that. That is really where I'm going. But we have to start talking about foundational properties of what it is to be a human. And so when we start talking about society, the foundational property in which a society can emerge is the fact that we can feel safe and trust another. We have to remember that. And that's rooted in our physiology. It's rooted in our heritage as being a social mammal. It's just that we have big brains other than other social mammals, and we can take those foundational principles and expand on them. And that's really what our society is about. So polarization, marginalization, these are all basically creating threats and destabilizing, I would say, the beauty and creativity and genius of what it is to be a human.

Well, I really look forward to your further exploration and writing in that area. I'll be paying close attention because I think that's just so important today and really fascinating that we know a lot today about healthy functioning, about well being, about the constituents of well being and to begin to extrapolate that out into creating a more healthy society, a more resilient society seems to be paramount today.

Well, I think we do know a lot and, and part of where I'm trying to work on actually I think there's the educational system needs to be refrained from a system of chronic evaluation to a shared journey of learning. I think the medical environment needs to be changed from evaluation and tests is the same thing of fear induced and dissociative acts or behaviors treatments to a shared journey of wellness. So I'm on board.

Well, thank you so much Dr. Porges. I encourage everyone to check out Dr. Porges work stephenporges.com I believe and your many books because it's just quite a journey. And I think there's just some basic information that can almost immediately help any of us create more safety and more social engagement and more resilience for ourselves.

So let me also mention that we created a not for profit Polyvagal institute where we're offering educational materials based on the principles of polyvagal theory. And that's polyvagalinstitute.org It's Polyvagal Institute. One word.

Thank you. Wonderful. Thank you so much.

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