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Therapynotes is the highest rated EHR practice management and billing software for mental health professionals. Its all in one platform is designed to streamline all aspects of your practice from connecting with clients via secure messages to scheduling, notes, billing and more. You can trust TherapyNotes has you covered and one of the best parts 24. 7 customer service with a live person, it's beyond easy to get help over the phone or by email at any time of day from their knowledgeable and friendly representatives. The best time to give TherapyNotes a try is now. Sign up for your free trial by going to therapynotes.com, clicking Start My Free Trial and accessing your first two months free with the promo code. Chat See why TherapyNotes is the most trusted EHR for behavioral health professionals today. Therapy chat podcast episode 472 this is the therapy chat podcast with Laura Reagan, LCSWC. The information shared in this podcast is not a substitute for seeking help from a licensed mental health professional. And now here's your host, Laura Reagan, lcswc. Hey friends, I don't know what may have happened since last week as I'm recording this because I'm recording these introductions on the same day, but I'm sure there will be much more to ponder by the time you're hearing this. I hope you are doing well, hanging on to your goodness, staying connected to the people you trust, remembering that fear is not the place to make your decisions from taking action from your center, trying to find grounding, taking action where you have control, including focusing on tending to your own inner resilience and building resource in the meantime. This week's episode is like last week. It's in the vein of hoping to inspire and encourage you. If we look at what's happening right now through the lens of polyvagal theory. This interview that I'm replaying this week is my interview with Dr. Stephen Porges, who introduced the polyvagal theory and has studied it for decades. We recorded this interview back in October of 2023. That was a time when many people were reeling about some violence that had been horrifying and shocking to so many and which contributed to where we are now in the division and I think also played a major role in our political situation right now because the way that those events were used in social media to influence people's decisions about voting and I believe many people were misled into voting for someone they thought would benefit peace and that didn't turn out to be the case. So I hope this interview with Dr. Porges will remind you that we humans are all trying to find safety in the way that we know to. And when our nervous systems are in sympathetic activation, when it's in defense of our own safety, truly our bodies, our nervous systems know what to do. But sometimes when our systems are stuck in sympathetic activation and sensing threat, where there really is no threat, we do violence and harm to others. And the importance for all of us of finding safe enough energy in our nervous systems to bring about a more peaceful world, honestly, for the sake of our whole planet. Hi. Welcome back to Therapy Chat. I'm your host, Laura Reagan. And today I'm so honored and excited to be here with Dr. Stephen Porges. Steve, thank you so much for being my guest today on Therapy Chat.
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B
Hi, Laura. And thank you very much for inviting me. Nice to see you again.
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A
Yes, thank you. You too. And I met you briefly at the Master Series in Oxford, and I'm very excited to speak with you. Of course, Polyvagal theory is something that as a trauma therapist, you know, I've been hearing about for a long time and I use in my work through sort of Deb Dana's translation of it. And. But getting to speak with you is very special, especially after hearing you at the Master Series and seeing just how the way you speak about this, I'm really, really pleased. So let's just start off though by you telling our audience just a little more about who you are and what you do for those who aren't familiar.
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B
Okay. Well, you know, I have a long background, as I mentioned before, longevity is very helpful. I have been a faculty member. I got my PhD in 1970 and I was a 25 year old assistant professor. And when the world invited young people to sit in front of classrooms and graduate for graduate work, I was already had my PhD. And so it's a long journey. I started out really looking at this emerging new discipline, which was called psychophysiology. I was very interested in physiological reactions that people had that were not in the realm of overt behavior, meaning words. It was when things were going on in their body. Could we detect what was going on by literally putting electrodes on them? It wasn't like eavesdropping, but I was more concerned about processes like mental effort, sustained attention, stress, those types of variables. So I was measuring physiology and I observed that heart rate variability. I actually was the first one to quantify this as an individual difference and also as a response variable. I noticed that when people got engaged and started to attend and process information, their heart rate stabilized. And also the people who had more variable Baseline heart rates tend to be more resilient, more physiologically. They could react and recover more rapidly. And this led me on a journey to initially, what was this heart rate variability? And this led into the world of the vagus. So when I started in my research, no one talked about the vagus, especially in psychophysiology. They talked about sympathetic nervous system fight, flight reactivity, activation was a popular word, arousal. But no one talked about the vagus. In a sense, it was out of their scope. They didn't learn about it, they didn't talk about it, and they didn't even think about measuring it. But I started go on this journey of quantifying heart rate variability and then trying to understand its underlying neural mechanisms. And that moved me into signal processing, mathematics. It moved me into neurophysiology, neuroanatomy, animal research, baby research. And you know, this was really the dream type of job for a young scientist who had an idea and just really wanted to figure out what was going on. And I was really fortunate because by the time I was 21 time I was 30, I was a tenured associate professor and had received an award from the National Institutes of Mental Health that took me off of teaching for 10 years. I could do anything I wanted to do. It was called a Research Development Scientist Award. And at that time I was associate professor at the University of Illinois in Champaign, Urbana. But you have to put it into context. So if you ever were to say to someone, you're 30, you're not tenured yet, what's going on? It was a different world. Departments were expanding, young people were being hired, and the training, or I would say the knowledge base from which we learned was much smaller than what it is now. So that put me on this journey of looking at heart rate patterns and it led me into intensive care units in newborn nurseries. So this is this interesting journey because not only did I was. I studied as an experimental psychology and a physiological psychology, but I had a developmental interest. So I was studying basically preterm babies and I noticed something very interesting. If they had heart rate variability, this respiratory rhythm and heart rate, the babies did real well. But if it was, if they didn't, they really had issues, including something that was called bradycardia. Heart rate got too low and they stopped breathing. And I wrote a paper on this about the protective effect of the vagus on preterm babies. And I got a letter from a neonatologist who said to me, that's very interesting paper. But when I was in medical school, I learned that the vagus could kill you. Perhaps too much of a good thing is bad. Well, I had to think, and then I had to literally morph into. What did a neonatologist learn in medical school? Well, they were looking at these bradycardias and they were vagal. And so they were the indicators of potential morbidity. But in my world, I didn't look at that as vagal. I looked at the oscillations. And the explanation that too much of a good thing is bad just didn't make any sense to me. And that led me in this journey. And the journey was that there really were two vagal pathways coming from different areas of the brain. One created these rhythms and one created the bradycardia. And the interesting part is, when you start putting it all together, and that's how polyvagal theory emerged, is that you're really describing an evolutionary migration of cells that control the heart from the brains, that move from the back of the brain to the front of the brain. But this is the interesting part. When they move to the front of the brain, where are they going? They're going to an area that controls the muscles of the face and head, so that our voice and our face now are literally co regulated with the nerve, the vagus, that regulates our heart. So we literally are wearing our heart on our face and broadcasting it in our voice. And even the laryngeal and pharyngeal, which creates intonation, they're vagal nerves. So the part was, you now have this very interesting story of this journey of a vertebrate species that became social, was enabled, are allowed to become social. The way we define it. And that is we use face to face interaction. And the other important aspect is the system that is social for us starts off with newborns as a suck, swallow, breathe and vocalize circuit. It's ingestion. And guess what? How do we calm our bodies? We ingest. But ingestion, if you work with people with eating disorders, doesn't work really work that well. And in fact, with babies, when they're very young, ingestion is great, but then they want the social interaction with the mother or someone else. So we want social nourishment. And social nourishment triggers the same system that our initial ingestive system does. So that was really my journey. And the journey did not start in areas of psychiatry or areas of mental health. The journey started in terms of questions regarding mechanisms and the to kind of end this narrative part. In 1995, when I published the theory, I started to get invited to clinical conferences like trauma conferences. And by 1999, I was a familiar figure talking at these conferences. And at that time I was actually working with autistic children and I was developing an intervention, acoustic intervention, that literally triggered sociality in them by calming them down. And I would give this narrative about the physiology and the physiology of literally shutting down like the preterm baby. And I found out this was knowledge to me that within the world of trauma, I was telling the story of those who had experienced severe trauma. And so I was literally taught by the survivors of severe trauma and several of their therapies that I had uncovered the missing mechanisms of what they had experienced. And that this inability to move, this shutting down had a very deep physiological mechanism. And they were not literally crazy. It was their body was doing something special for them. This now framed this whole concept of literally respecting the heroic actions of one's body. And that's really my story. I'm still doing it, I'm still talking, still developing and revising it and trying to develop mechanisms where we can recruit this more positive social engagement system. Literally signaling to the body that it's safe enough to interact with others.
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A
Well, yeah, that was an amazingly succinct description of a very long career of many, many, many feel like areas of study and interesting discoveries.
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B
Really it's, you know, the one, you know, for me when I again, I always like to say looking through the rearview mirror because that's really what this whole career has been about. And it's been a remarkable privilege to be on that journey. Remarkable. And I, when I start to dissect it, it's not really that interesting research questions. I took side trips to develop methodology, I developed patents. You know, I went to these trips. But at the end it all looks like it's this integrated, well planned study. But along the way there were all these different parts coming in. It was like a vision. But, you know, I couldn't really. I didn't have the narrative to put it all together.
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A
Yeah. So if you had, if you'd been trying to follow a path or track, there wasn't one, but it was developing as you were going.
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B
Yeah. Well, so again, through life, through the rearview mirror, what do I think about the young Steve? What did he do? I just, I'm just kind of like, it's the boldness that, you know, in retrospect, I didn't even know I was so bold that I, this is what I was going to do. It didn't fit the models of other people and I I knew it was right, but why did I know it was right? Why was I bold? Now remember, academic world is kind of like social media. It's pushed by influencers. And we may think that the academic world has objective criteria. It has those, but it has a lot of others. I actually, in terms of social pressures or what are the common paradigms? If so when I started to focus on heart rate variability, the pushback was really interesting. It was like this. You have heart rate variability because you're not controlling your subjects well enough. You're a shitty researcher, basically, is what they were saying. Which meant at that point in time, my colleagues in the discipline had no idea about neural regulation of the heart. So the fact that heart rate variability is now in our jargon, our everyday language is just remarkable given the fact. It was kind of like saying it doesn't exist.
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A
Right? Yeah, well, I, I feel that so much where that you can be when you're trying to advance something that isn't accepted by everyone. For example, like talking about trauma and dissociation. It's not really, it's still not super popular and it's. It to many people it's controversial or they challenge those, those concepts or you know, like you talk about in your newest book that we'll get into, talking about how people don't think that their experiences are shaped by trauma. They think this is just how I am or this is what I went through wasn't that bad. And it's like challenging that narrative that's so firmly held in the public imagination or in an academic, you know, setting.
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B
Is even in, even in parenting and early education. It's really the world is a top down intentional world that you, you make the choices, you create your behavior. If you want to get out of that bad relationship, you move. But it really is not very respectful to the actual reactions that our body has. And I think we're just poorly informed about the degree of reflexive behaviors that are locked into our system. And that meaning that under many situations our physiology gets triggered and then our behavior just follows it. With the. A term I use is you ride that horse, you create a justification for the body being in this outrageously aggressive state. It's because of the other person. They did this to you. So you're, you're literally given permission to act out on them when it may not have anything to do with that person. It could, could be something else had happened in the environment and your body reacted to it.
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A
Yeah, well, I appreciate that and something that you said in. Let me just Say, your newest book is written together with your son Seth, and it's called Our Polyvagal World. What's the title?
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B
How Safety and Trauma. Actually, I have it in front of me, so let's take a look.
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A
What's that book look like? There we go. Beautiful. How Safety and Trauma change us. So safety is one of the big things that we want to talk about because there's like perception of safety from a cognitive perspective and then there's a deeper understanding of safety.
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B
Yeah. From a polyvagal perspective, we throw the perception out. The body doesn't follow the rules of perception. And that's where it gets into trouble. You say, I'm frightened here. And someone will say, what do you have to be frightened about? And the answer is, there's no danger here.
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A
We're fine.
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B
I feel frightened. What you're really there is your body's detecting certain signals in the environment. Now, they may not fit the common definition of danger, but your body doesn't know that. And in many ways, we need to not only be aware of what our body is telling us, we have to honor it. And so if we are going through those feelings and we have to stay in that environment, we should be with someone that we feel safe enough to give up our hypervigilance. So when we get into those states, we lose our ability to really recruit those higher brain structures for problem solving, for thinking. You know, we can even go into the issues like spirituality and anything we want to talk about those things are accessible when our bodies are not as state of defense. And we evolve as a species that craves safety through co regulation with another. And now what you know, as a trauma therapist is that if a person experienced severe trauma, especially early in life, they have great difficulty feeling safe with any other human being. They may gravitate to horses and dogs or maybe even a cat. But people, even if they get close, will give them a physiological response and they can't handle it. And the interesting part that I found this is, is that they want to have that relationship. They want to be held, but their body is saying no. And this has taught me so much. I like to always say I learned what it is to be a human from the narratives of people who. Who have had severe trauma. Because they've told me what they've lost, but they have also told me they never lost the vision, the dream, the narrative of being safe with another.
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A
Well, I think that's beautiful about the dream, but it's. It's painful in that how we want to be connected and we can't, we can't do it, you know, when we, when we can't get there because something.
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B
Yeah, well, Laura, you're actually, in your expression of it, you're getting the answer because what you're saying we want and that's intentional. And when we can't, we're not listening to what our body's telling us. The body is saying. It's not that I can't through my intentions or my desires, it's that my body's detecting threat. So where is the focus of a therapeutic intervention? It's on the physiological state. How do I calm the body? How do I literally import signals of safety? And this was really the basis of that intervention that I developed, the safe and sound protocol, because it was literally modeled on what a mother does with her crying baby as she's using a very prosodic intonation of voice. And we've found in our research that the intonation, the prosodic, the emotional, positive, emotional characteristics of the voice are related to whether or not a mother can effectively calm her baby down. The baby is detecting, it's wired into them. It's not that the baby learned to associate the voice with being calm. It's wired in how do you talk to your dog or cat or your horse? You use the same prosodic voice. Now you may not talk that way to your children, you may not talk that way to your spouse. And. But when you're in this early phase of relationship, you probably were talking that way. So in a sense we reflexively do that. But what I learned also from the trauma community is that when their nervous systems get triggered through prosodic voice and accessibility of another one, there's appear start when they start to open up and become, let's say, accessible, their interoception, their bodily feelings now percolate upward in their top down memory. Say when I felt that way, I was vulnerable. And then they just, they're not articulating that, but their body is doing that. So literally they'll jump out of the room. They'll just get out of there and say, you know, they'll look anxious. And you can see this even in terms of relationships that people with severe trauma often start developing. They start getting close to someone and their nervous system says, can't handle that, too vulnerable. And so when we start to deconstruct it from a polyvagal perspective, we see the cues coming in, the body becoming accessible. But now we see the interoception feelings being interpreted as vulnerability and danger. And of Course, when you have that model, it all makes sense. So now when people become aware of these things, they start to say, how can I titrate and resolve? Literally, how can I resolve those visceral feelings that are now triggering me to go into defense? And there are a lot of somatic experiencing. And the safe and sound protocol that I develop can be used literally to titrate, to signal these basic signals of safety in the body reacting just little bits of it, until the body legally resolves and doesn't have these overreactions.
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A
It's amazing. And I was. I was very interested. And I do have the safe and sound protocol training to complete. It's not completed, but I first signed up to do that when it was really more in the realm of occupational therapy and the training. I just was like, I don't understand how I'm going to use this with my trauma clients. Then it was changed, and I didn't catch back up to it until Leah Duang sent it to me recently.
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B
That's a real interesting story because it came out of my lab working with autistic children. But then as I got as pulled into the trauma world, I would talk about this. So the trauma therapist said, where is this? And when we launched, it was really focused for autistic kids. And the trauma therapists start to use it. And then we learned a hell of a lot because, in fact, it. Because it became a trigger for many of the clients. And when I heard that, you know, this is. You have to understand who I am. I don't want anything to be hurtful to anyone. And so I really almost wanted to pull it from the marketplace, pull it from at least adults. The trauma therapist reassured. He said, we'll figure this out. This is fantastic because you're using learning, what may appear to be a very neutral stimulus to trigger this reaction. We can work with that. And they did, and they taught me. So there's one therapist, Liz Charles, she was. She was there at the conference. She's quite amazing. She basically calls her approach the sensitive approach. Maybe a few seconds rather than a half hour or an hour session. And I got an email from someone working with misophonia who was doing the same thing. Just titrating a few seconds and getting effects on that. So the nervous system gets triggered, then it gets resolved. It can say, I can only handle a few seconds. I do want to tell you a very short little story. Short story about this. A few months ago, or misbe. Last year, the Polish. Several of the Polish therapists were dealing with Ukrainian refugees and their children. And they were really child focused. And they contacted me about using ssp and I said to them, first you need to work with the parent because the parent has to feel safe to be supportive of the child. So they tried it with a woman who came in there with her child. The woman lasted 42 seconds before she pulled the headset off. And it became. I mean it's so obvious that if you come from a war zone, your body is not going to give up its defenses immediately. It will give it up, but the body wasn't sure and the body had to be in defense. If you have a child, new environment and you know, we kind of live in a world where we think that people's certain aspects of their behavior is under their intentional control. And what polyvagal theory has taught me is yeah, it's under intentional control if your nervous system is relatively calm. But if your nervous system shifts into these defensive modes, forget it. And that's when people get into fights and arguments and they don't even remember what they're saying.
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A
Yeah, well, so this brings me to something that was. That came up at the Master Series when we were both in Oxford and I. I had a couple things from there that I wanted to ask you about. One was there was a. I guess I'll start off with one that I already had mentioned to you before we started recording, which was about how I felt. I was up on the second level balcony and it was a tight space that first day when the Legacy talks were going on. And I was. I just kept needing to go. Go outside and like hold on to a tree and get myself re centered. And I was like, first of all, nothing that I'm hearing. There's no graphic trauma material being mentioned here at all. And I am exposed to trauma literally all day, every day. I think about it all the time. Why am I having this reaction? But I finally realized like collectively the nervous systems that were there. It just felt like there was this buzz in the space. And it was like I just kept having to recenter myself to tolerate being in the space.
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B
No. After I'd say it's almost 30 years that in kind of like in the world of trauma. And I've learned lots of things and what we first start with is many of the therapists who work in the world of trauma carry with them a trauma history. It's a double edged thing. It gives them a way of relating, it makes them more relevant in many ways as a therapist. But they still carry that history. And at times it does come out. We found out that especially the somatic oriented therapists, I think was over 50% carry a significant trauma history. But because they're doing therapy and co regulating work with people, they're doing better than those who are not therapists. So it's really kind of interesting the relevance to co regulation. It's this type of social nourishment and proximity. But if you call a meeting anywhere, anywhere and say, I want the trauma therapist to come here, you're going to get many who are more fragile. And I, you know, the legacy discussion, you probably remember me saying it. It's not my day job. And for Bessel and for Peter was their day. This is Bessel, van der Kolk, Computer Levine, very close friends over a long journey. With Peter it's from the late 1970s, with Bessel it's from the early 90s. So these are long relationships of closeness and understanding. But they both come at it through their own personal traumas and their own desire to make the world world better place. I came at it through my own curiosity. It's kind of, I mean we all think that our, hey, I gotta be very, I have to honor the other people because there are people who have severe trauma in their histories. But many people think all families are kind of screwed up and they survive. And people often make that statement. And I didn't really understand, I would say, the benefits of the family that I came from. And I kind of tease my sister, who's a retired psychiatric nurse who lives in the world of trauma as well, about how what a good child and a good family we came from, because we never acknowledged that. But the issue is when you start getting the narratives, when people feel so safe with you that they are very willing to tell you their whole life history in a few minutes. And they do. And you know, and I, and I find my role in that very special. And I honor it because they feel safe enough to talk to this white male about what's happened to them. And often I will say to them, would you like a hug? And you probably saw me doing some of that at Oxford. And they will say, look at me with a smile and say, yes, I'll give them a hug. And then I have gotten emails back saying, you're the first male that I let touch me in 20 years. And the issue is it's extremely important to feel safe enough with another to allow that proximity. And I, I basically am honoring their bodies if that's what they want. I can, I can do that. It's not it's not a. It's not hard for me to, to be available to them and I'm very respectful of those needs and I'm not aloof. And that was really the whole issue. And when you, when you deal with this fragile population, you literally have to give up some of your own needs because you have to be accessible. Once you show cues of self need, self protection, those are cues of dismissiveness to people who need to be in your presence.
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A
That's an interesting point that you're raising. I think that was something that I actually, I'll admit I left in the second, the middle of the second half of the day that day because I was just like, okay, I gotta rest. I was jet lagged and I just gotten there the day before. But I think that was one of the things that both Peter and Bessel were talking about, about how they, you know, respond to like people and you obviously about people approaching and, you know, there can be a real tension between wanting to be accessible and needing your own personal space. And, and we have our different levels of how, you know in any given day, how well you feel, how tired you are, you know, how how saturated you are with listening to other people's stories or how well you rested that night, whatever it is.
- [32:34]
B
Yeah, it's a. Interesting and I hope that came across during the discussions. Both Peter and Bessel have a specific obligation because they're therapists, they're there to be helpful. My role I always took as different than being the helpful one. I was the explainer, so I was giving a narrative and I didn't internalize the responsibilities that they did and which basically gave me greater freedom to be accessible.
- [33:02]
A
That makes sense. Well, and we, we carry people's stories because we take them in and then we sift it through and then we give them back maybe a small piece to develop, you know, something to explore, be curious about or some insight. But we hold. We hold it.
- [33:20]
B
Yeah, yeah, yeah. And that's part of what I really. Okay. About my personal journey is I. I'm not required to hold it. And it's really quite a remarkable gift of the people who engage me. They don't expect me to hold. They expect me to witness them and to be present with them for that short period of time. And I can do that.
- [33:43]
A
Yeah. Well, that's a, that's a nice explanation of that difference. And in that same day, one of the things that. Well, actually let me go back to the idea about the jangly nervous systems because I was curious if it was about how people were in like an academic, you know, listening, intellectual space and maybe disconnected a little bit from what their body is.
- [34:10]
B
You're feeding my intellectual problem solving strategies. Okay. What I would make it quite simple. What is a university setting? It's a setting of evaluation. And what you often find in the world of therapists is most of them are independent practitioners. They don't want to report to anyone. They don't want evaluation. So the environment may carry with it an implicit sense of evaluation and hierarchy. Oxford certainly has a hierarchical concept, and so it might be this aloofness. And if you're a marginalized person on any level, being in that type of environment may make you feel like you don't belong or you're uncomfortable. So you can go into different levels. I also noticed that there wasn't much diversity.
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A
Yeah. And among the people who did come from non white backgrounds, there was, you know, there was a thread of conversation that I was picking up about just the, you know, the, like, the feeling of the, like Oxford.
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B
Yeah.
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A
Something. Some eliteness.
- [35:21]
B
Yeah.
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A
I don't really too. I'm not, you know.
- [35:23]
B
Yeah, you're building on exactly. What I'm saying is that there is a narrative about Oxford. And whether you've been there before or not, you have this implicit embedded narrative and your body's reacting to that. The, the other part is, I think close proximity for fragile nervous system without the ease of getting out of seats. So if you're kind of like in the middle, even me, I, who I think, I think I have a reasonably regulate nervous system, I always will take an ilc. And that is because if I feel restless, I want to be able to leave without being disruptive or disrupt others.
- [36:04]
A
Today's episode is sponsored by Psychotherapy Networker and pesi. If you're a therapist, be sure to check out the partner page, which is linked in the show Notes where you can get discounted trainings with previous therapy chat guests like Courtney Armstrong, Dr. Leslie Korn, Dr. Arielle Schwartz, Dr. Tammy Nelson, Dr. Janina Fisher, Rebecca Case, Dr. Peter Levine, Dr. Lindsay Gibson, Deb Dana, Lori Gottlieb and many, many others. You'll find the link in the show notes to my partner page with PESSI and Psychotherapy Networker where you can find all these discounted training. If you need CES, this is a great place to go. TherapyNotes is consistently transforming the way therapists manage their practices with continuous updates designed to save money and improve efficiency. Their latest Game Changer therapy Fuel a powerful and fully integrated suite of AI tools That streamline documentation so you can focus more on your clients. With AI features that help by generating progress notes from summaries or transcriptions, creating contact notes directly from client secure messages, and automated summaries of client history forms. TherapyNotes users are already reporting hours of saved time and energy. Some other recent feature improvements include automated recurring client payments, electronic secondary insurance billing, and their constantly expanding library of outcome measures. The best time to give TherapyNotes a try is now. Sign up for your free trial by going to therapynotes.com, clicking Start My Free Trial and accessing your first two months free with the promo code CHAT. See why TherapyNotes is the most trusted EHR for behavioral health professionals today. Yeah, so that part was definitely true. You couldn't move very freely because it was tight squeezed in, it was very warm in there. Which also again, I think from a sensory perspective that impacts how, you know, this isn't like complaining about the master series, just being curious about the reaction.
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B
Well, you, you're not complaining, but you're giving a lot of information about how your nervous system dealt with it. And when your nervous system got defensive, the ability to process the information, it's is compromised, compromise. So the part for you, your experience was your body's uncomfortable and that's now taking priority and now you can't is as import or process all the information going on.
- [38:24]
A
Yeah, that makes sense. But it's, you know, one thing that I really appreciate about polyvagal theory and I think I've learned this. I began learning this through my initial study of SSP and then as I've learned, learn more about polyvagal theory over time, kind of from the sensory motor psychotherapy perspective and you know, which is aligned with the somatic experience.
- [38:49]
B
Yeah, but it's Pat's work and Pat is another. Pat was supposed, Pat was invited to be on stage with us, but she stopped traveling. So there were three people who were instrumental in, in my life enabling polyvagal theory to be incorporated or engaged at it in trauma work vessel. Peter and Pat.
- [39:08]
A
I, I heard when they said I wish Pat Ogden was here and I, that I didn't catch that she had been invited. So I think that's wonderful.
- [39:15]
B
She stopped traveling. We were, you know, she really wanted to be there, but these are health issues and yeah, she was. So you have to understand Peter found me in the 70s because he was kind of discovering physiology and trauma and he didn't, couldn't quite understand what was going on. So he, he developed a relationship with me in the late 1970s and that relationship stuck. And as somatic experience started to take form, he would come visit me and download on me. And I met. I started talking for Bessel's group in the late 90s, and Pat was instrumental in helping organize the West Coast. They were called attachment meetings, and they became attachment meeting trauma in the earlier 90s. So it's. It's like Pat opened the door to that group, Bessel that group, and Peter opened the door to the. What I called the most unusual people. So, like, he brought me into the world of Rol Rolfers. He brought me to Esalen. You know, all these innocence. Peter knew interesting people, and he would, like, take me along.
- [40:23]
A
It was cool to hear the. The three of you talking about how your relationships have developed over time and. And, you know, what things were like back then. I mean, I was alive in the 70s, but I wasn't aware of any of this stuff for sure. But one thing that, you know, I've begun to realize is how much, you know, I know a lot about trauma. But what was missing from the discussion about trauma for a long time has been the sensory aspects. And, you know, it's like a memory you think of that is sensory in a way, if it's something you see. But like the heat in the auditorium on that first day was something that my nervous system was reacting to as overstimulating, you know.
- [41:06]
B
Oh, yeah, yeah. Well, think about what it does to your metabolic resources. Your body wants to cool down, so it starts perfusing in a different way. You start to sweat. It's a metabolic demand. And when you're having those types of metabolic demands, it interferes with your ability to be present and process information. So. And then it basically probably got amplified because you could feel and got going. The issue is that when we talk about trauma and sensory information, we're talking about sensory from outside the body and sensory from inside the body. Body and the outside is really our hypervigilance, where we detect threat. And if you have a trauma history, what is neutral to a lot of people is threatening to you. And then the interoception is this detection that your body is now under a state of threat. Because the neuroception of threat shifts our physiology. And our physiology now triggers interoception, which is the feeling of our body. And that's what goes up and disrupts us because we don't like those feelings. And in a sense, when we. When our interoception is quiet, we're normally in states of homeostasis, meaning our body is serving us well for Health, growth and restoration. And it's during those states that we have the opportunity to feel safe, to engage, to be creative, to be spiritual. But if our body gets triggered, whether it's from external, from thermal, challenges are real. But if our body gets triggered to try to deal with those signals, we don't have access to the higher parts of our brain and the intentionality that comes with it and the beautiful ability to solve problems.
- [42:54]
A
Right. And be connected. And that's the part that I think is standing out to me so much from, from the way you've been speaking about this and, and the, your newest book. So if I may read a little quote from the book. This is just right from the beginning of it. It says when we feel safe, we are capable of generosity, empathy, altruism, growth and compassion. When we don't, or perhaps never feel safe, our sense of self preservation trumps all else. And selfish, desperate and aggressive behaviors are all but inevitable for most people. And that's in relation to are are humans inherently good or are they inherently bad?
- [43:38]
B
Oh there, okay, this, that, that's a great question because what you're really asking is what's our default state? Polyvagal theory says our default state is benevolence, loving connection and cues of safety reciprocal which create co regulation. It's only when we are bombarded with cues of threat that we lose that capability and we evolve to be able to lose it for periods of time to enable us to move our bodies into safe places. So we're always on the quest for safety. And if we get triggered out of that state, we should be able to move us move ourselves. What's interesting is we live in a society or human society for perhaps millennia. Never caught on. They basically said well wow, when we scare people, they work harder, they fight harder, and they don't challenge authority in the same way. So it's, it's very interesting. If you keep people literally hungry, they don't solve problems and everything becomes like this, so proximal. And we can see this in, in politics today that people get riled up. They're not, they lose their benevolence. What they're concerned about is their self survival. And for many of them, they're not even generous to their own families. So it's like there is, there's the boundary is my body versus everyone else.
- [44:59]
A
Yeah. And I mean what you said about for millennia and it's kind of like figuring out that you can kind of conquer people by terrorizing them and they won't fight back as much or they'll stop fighting back.
- [45:14]
B
They won't organize, will not cooperate. They won't cooperate. And this is the really interesting part. And you can actually see it in politics about like unions, the anti union bit, because if people cooperate, they have a degree of power. And it's really interesting to watch the politicians talking about the UAW strike from different perspectives. One, of course, this is empowerment. The other one, this is horrible because they're destroying the big business. So, you know, but what I'm really. It's also telling you a lot about those people in terms of what physiological state they're in. Because our natural state of when we're safe in our own bodies, it's our. We're spontaneously more accessible to others, more compassionate, we're nicer people. And I think we've been led to believe that our default is evil and that we need to inhibit the, the evil. And religions have had a lot to do with this. And also religions, of course, were a mechanism of controlling people. I'm not going to get into that, but I will talk about my view on spirituality. And I think there's a bifurcation, two different types of spirituality. When your body's in a safe state, you have a spirituality of connection, which is connection with other people, connection with nature, connectedness. But when you're under a state of great threat, you can have a spirituality, but it's a dissociative spirituality. You have this reaching out to a deity that is not connected to the physical reality you're living in. And many people are very comfortable with that relationship. But what I like to say is the true path is through others. So that is what we evolved to do. And that's our fulfillment, from my perspective. And that's what Polyvagal theory basically says, that our physiology can enhance our experiences and our relationships with others if we're able to be safe enough. What that means is to give up our defense reactions with a few trusted individuals. We don't have to trust everyone, but we need selected people to feel safe with.
- [47:27]
A
So then you're coming to a point that I wanted to talk about anyway. So I'm glad we, we're getting there. Which is. And this goes back to the, the talks on the first day at the Master series. Again, you know, there was one point I won't, I won't name any names, but there was one point where someone who was on the stage became a little bit focused on negative view.
- [47:52]
B
Yes. He got dysregulated. And his own perception of that is different than everyone Else's I know, as.
- [48:00]
A
When he came back, he said, no, I'm the most positive person you've ever met. I'm not pessimistic. But it was, it was, it's not certainly unique to that person to look at what's happening in our world and go, what, you know, what possible hope can there be for us? We're destroying the planet. We're war, war everywhere. We're, you know, violent. We can't agree on anything. Our politics are a mess and I can't live that way. I have to believe that there is hope and that we can do. And it's not about fighting evil. Like you said. I really need to believe for my spiritual life that connection and you know, positivity are hopeful are possible.
- [48:48]
B
So I can reframe and I can even tell you a narrative about that. I've had some interactions, but what I really am saying is when you get 800 people together in a room like at Oxford, who are there because they want to make the world better, and if you turn the clock back 20 years, you might have 30 people in that room. So you know that the world is expanding. And if we even talk about polyvagal theory, which came out of a laboratory and you know, came and was published in 1995, there are tens of thousands of people interested in it, which is literally a shock to me. And when we talk about the safe and sound protocol, there are tens of thousands of people who have been affected by that in the few years it's been out. So we know that there are people who want desperately to make the world better and want to be helpful. The, the. So I go into this optimistic viewpoint now. I'll tell you a real life example of. I was going. So I had a colleague who I liked very much and he was a physician and MD, PhD. And I wanted to mentor him into the world of trauma because I wanted someone in medicine to start looking literally at gut issues. And he would spend a day, a week and we would discuss papers and do things and I talk about trauma. Well, he took it upon himself to do something that we know no clinician should ever do without proper training. He decided to ask his patients if there was something they wanted to tell him before they left. Okay, 12 in a row, row told him about basically severe abuse. Most of it was sexual and most of it was in the home. It affected him to such a degree that he couldn't work anymore. He got, he really, he had to retire. He had to be self admitted himself to hospitalization for A while.
- [50:51]
A
Oh, my goodness.
- [50:52]
B
And. And. And, I mean, he's a sweetheart. It was.
- [50:56]
A
Yeah. He wasn't ready for that information.
- [50:58]
B
Wasn't ready. And he said to me, just like what you were saying, how can I live in this world? It's so horrible. I said, it's not horrible. We're here. We're here. We're listening to these people. We are enabling them to do that transition back into a more benevolent, generous life of experiences. So the point is, yeah, we have to be prepared. But with him, there was something else. I learned. I learned that he. His own narrative got uncovered when he got triggered.
- [51:30]
A
Yeah.
- [51:30]
B
And. And so he had talked about all this, you know. You know, his child. Everything was just great. And when it came, this happened was whoosh. It's like. Yeah. So what we start realizing is that if we have these complex histories, we may start basically. I wouldn't say actively hiding them, but we're using a lot of our resources to keep them covered. It's not like it's intentional. It's just our life was formed that way. And when we get triggered, our body may not be able to handle that defense shield anymore. And then we hit. Basically, it can be manifested, and it probably is the manifestation for many types of mental disorders that have different diagnoses. So, like with schizophrenia, this is called, like, second hit or first hit. You know, there's issues, and we may find out that, you know, so actually what's reflecting in my mind was my grandfather, who had escaped in the turn of the 20th century from the czar's army in a coffin, more or less. So we know there's severe trauma there. So he came over, and he was relatively successful. Then he lost everything in depression. And when I met him, of course, I was born in the late 40s. All he did was sit in a chair. He just sat. You know, we would call this, you know, severe depression. And my father used to be very upset with him. He says he never smiles. He never does this. The implication that this was intentional, but he was really. He got. It was that second hit, the loss of the resources that basically immobilized him. And it was really something interesting to experience. So you see different types of transgenerational traumas mapped into the life that you're around. So I think there's a lot of earlier things that we don't know about that set the vulnerability for these other hits. I will give you a finding from our own work, like, about COVID So we're all survivors of COVID but we Did a study with about 2,000 people, a survey study. We asked about trauma history and we asked about autonomic regulation. And what's interesting is trauma history, severity of it, or the adverse index that we were using maps into autonomic regulation. The more adversity, the more dysregulated. And if they have no adversity, the autonomic nervous system looks great. But now the story gets more really interesting. How did these people respond to Covid if they didn't get Covid? So we looked at depression symptoms, PTSD symptoms, anxiety and worry. And if they had no trauma, no problem. If they had no. If the autonomic nervous system was fine, everything looked good. The paths were trauma retunes, autonomic nervous system results in PTSD symptoms, result in anxiety and worry. Then out of about 2,000, a hundred got Covid because it was very early. It was March through May 2020. If they had no adversity history, none of them got Covid.
- [54:45]
A
Wow.
- [54:46]
B
If they had a high adversity history, the probability was over 75%. And this is talking about only a hundred people out of 2000. So it's early through the whole pandemic. Those numbers of course, would not be as predictive. This is the early wave. But that to me was really powerful in saying that. It was literally the protective aspect of having not going into trauma. But it was teaching me that we were talking about the retuning of these systems. So the curves for medical trauma, medical adversity, mental health, adversity and autonomic reactivity were all the same curves. If they're instance, low on those and including then no disease.
- [55:30]
A
So just when, for my clarification, when you say medical adversity, does that mean that they had physical health problems before or they had had medical trauma?
- [55:39]
B
No. Well, it's, it's, it's combination. So it's going to be, it's going to be measures of medical procedures, definitely difficulties, surgery, illness, you know, those things. So it's medical adversity. And the point that I try to make is it doesn't matter whether it's mental issues or physical. The body goes into states of threat and the autonomic nervous system doesn't distinguish it. And it affects our mental processes, how we see the world, how we interact with others. So being chronically ill or chronic pain is going to distort how you relate to the world?
- [56:15]
A
Yes. I was just talking about this the other day. Was someone, a therapist who. Well, I have chronic pain and I have a. And I'm a trauma history. And I have a therapist friend I was talking to who has chronic pain and talking about how being in community might change their pain symptoms in some way if they feel like safe. Ventral connection.
- [56:40]
B
Yeah. So I'm part of a, I used to call it a think tank, but it was for the past three years. What happened was during the pandemic, some pain physicians focusing on pain and pain psychologists created kind of like a Wednesday night group. And it grew. And so we started to invite speakers. So we meet every couple of weeks. And they brought in because they had in a sense discovered polyvagal theory on their own. They realized that surgery and medicine didn't work for chronic pain, but groups did, social community, and they needed an explanation. So they found me. And when they found me, I said, look, I know nothing about pain, but it's just like the world of trauma. It makes a lot of sense because what is pain? Pain's very much linked to the sympathetic nervous system. It's very much linked to fight flight. It's a neurotransmitter. When you have pain, it's an unambiguous neuroceptional threat. So the body is moving into that state and suddenly if you see it that way, everything makes sense. And the issue is, do cues of safety downregulate that system? And it does. And that's really the whole theory of the safe and sound protocol. Now I will tell you my real life example. During the pandemic I twisted my back and I was in chronic excruciating pain for several weeks. I could not get into a bed. But you know, I'm a professional and I had talking engagements. So I was doing, I did an eight hour webinar in that state and I was pain free while talking, even on a two dimensional screen. Now when I was done, I was in excruciating pain. But to me, the fact that I was engaging using my social engagement system, my ventral vagal system nullified or dampened the pain. The pain was not gone, it was just in background. And that to me was, it wasn't like I was trying to do this, it just, it was a demonstration that if I, if you engage with people, your feelings of pain become very manageable.
- [58:49]
A
Yeah. Well, I know it's almost time for us to stop, but I, I'm dying to ask you one more thing about that, but it might open a little bit more. But just the, you know, the idea that there is the parasympathetic. I'll try to say this fast. You can probably explain it way better. Parasympathetic nervous system is both fight or flight. And rest and digest. No, no. Okay.
- [59:17]
B
No, the. Okay, let's simplify it. Okay. We have a sympathetic and a parasympathetic nervous system. And that had been taught, I would say, incompletely, as parasympathetic is a health, growth and restoration system. And the sympathetic is a fight, flight. But they miss both. A lot of parts there. The sympathetic's not just fight or flight. It's exuberance, it's energy. But the parasympathetic nervous system is not always a restoration system. It can be parts of it, can be repressive, prudent in defense. And that's because we can see this in the vagus. The vagus has two different branches. The vagus is the primary nerve of the parasympathetic nervous system. One branch is this new mammalian ventral vagus that enables social engagement. And basically is the choreographer of the rest of the autonomic nervous system. So when that system gets on, it's sending signals to the sympathetics and to the dorsal vagus that we can cooperate. Think of a parts model and say, I have a manager. And the parts model can take the sympathetic, give me exuberance and energy. So rather than fight or flight, it's play and dance. And when I immobilize, rather than shutting down under threat, it's moments of intimacy where my body is just comfortable in the presence of another. And that's the world we would really like to be in. And so it basically says when we have that ventral vagus, it can repurpose these other systems. But when we lose that ventral vagal control and that gets pulled away to. It optimizes our defenses. That's the adaptive bit. It doesn't get in the way of moving quickly and defending. And if we move quickly and use that sympathetic nervous system, it functionally is actively inhibiting our dorsal vagus. We know this because it inhibits digestion if you move. So it's like running. Defecating and running don't quite work together. It's. It's Exactly. It's a switch that if you're mobilized, highly mobilized, it turns off the gut. Now, when the mobilization doesn't get you to a place of safety, what does your nervous system do? It says, I have one system left. I'm going to pull that lever and I'm going to shut down. And this is the story. This is the story of trauma. That shutdown can be manifested in different ways. It can be manifested as passing out it can be manifested as literally immobilizing but maintaining enough muscle tone. We call that freeze, meaning some sympathetics on board. It can be manifested as basically defecating your pants, which is part of that system. But in general, what we have is a very smart nervous system that takes those immobilization responses and then literally titrates them to serve the body's survival. So let's say initially the first reaction to a catastrophic adverse event was you passed out. But that's not a safe reaction. It's not good for your. Basically, it's potentially lethal. You can get injured falling, all these things. So what does the body do? The body's smart. So it says, what if I titrate sufficient sympathetic activity so that I maintain my stature? I'm still standing there, but I don't pass out. We call that freeze. Then what happens to the real nuanced one, the totally successful person who has these defense reactions? But they have to. They've adapted so well that they can literally hold a job and create relationships. We call that dissociation. So in a sense, the body, in a sense, on a physiological level, maintains its. Its regulation and the. The mind goes someplace else. And we, you know, whether we call this borderline or we call it dissociative disorders, but in a sense, these are nuance and adaptive features of this big brain that we have finding out a solution that will work. So when we see it in that nuanced way, I would almost say that we see dissociation as this really remarkable adaptive reaction as opposed to something. When I first heard about dissociation, I thought it was a frightening, frightening bit. But when you start seeing it within the polyvagal context, you almost have a smile on your face, say, what an amazing nervous system to figure this thing out. And when we start talk, when I would say therapists start talking to their clients, clients now the clients lose some of the fear of moving into these states, and they now see what that was doing for them, and they become more aware.
- [63:53]
A
Well, so where does the. On that, what you just said, where does the person who is being robbed or threatened to be raped, who goes, look, looks like from the outside that they're going along with what's, what's happening, what we, you know, you want to.
- [64:13]
B
Get into word appeasement.
- [64:15]
A
Yeah.
- [64:15]
B
Peaceman is a very, very remarkable state. Or it's not an intentional one. It's. There are certain nervous systems that have this capacity, and what that does is. Enables you to be in all three states simultaneously. So in a Sense you're still using cues of social engagement so you don't trigger a physical reaction that could get you killed with the attacker. And you're not, you know, so there's an acknowledgment of fear, there's an acknowledgement of life threat. But the body still has this great resilience to almost smile and engage. And I, we wrote a paper, it's called Peace. It was to replace Stockholm syndrome. If you'd like a copy, I'll send it to you. Okay. And it was one of the co authors had been a abducted for 19 years. It's J.C. dugard. And what was interesting was she and her therapist, Rebecca Bailey, were so angry about the Stockholm syndrome as a construct that they engaged me about a decade ago. It took me about a decade to kind of mold this over to come up with a theme to write the paper from a polyvagal perspective. And I basically ended up saying, and that this is a remarkable, literally it's a super, super skill. It's a super talent. It's not something that's learned. And I want to make sure that that was stated otherwise people will be blaming themselves for not being effective piece. And I juxtapose this to fawning, which is really, you just give up. And when individual fawns, they become more vulnerable to injury and, and in the animal world, that's when, let's say animals get killed and that's when humans get killed because they have no value to the predator anymore. They're just immobile. And when someone, in terms of a captor, a person who kidnaps someone, keeps them for years, they're keeping them for years for, in a way, their entertainment or their interaction. And they're going to do that if that person in a way makes them feel safe. If that person withdraws too much or that person disappears on that, they're going to get angry and then they're going to just hurt the person.
- [66:31]
A
Yeah. And so amazing because all of that is happening outside of really any conscious.
- [66:38]
B
Yeah.
- [66:39]
A
You know, it's not like the abductor is like following a manual that all the kidnappers use, but it's just like somehow innately something they can figure out.
- [66:50]
B
Okay, so let's say now, let's say it's, it's 25 years or close to 30. I've heard trauma stories and in a way they become scripts because you hear.
- [67:02]
A
The same stories, the same patterns.
- [67:05]
B
And if, but for most individuals, they don't know that they're common.
- [67:10]
A
Right.
- [67:10]
B
Feel that they feel it's, it's just they can't share it because people think they're too scary, you know, but the issue is it's, it's a common script of a nervous system on a heroic journey of survival. And I, that's how I saw it from the get go and now it's becoming easier to describe that way and, and to really teach people and let them respect what their body is trying to do for them.
- [67:36]
A
Well, Steve, if I may still call you that. Thank you so much for spending your time with me this afternoon on Therapy Chat. I'm so excited to share our conversation with, with our listeners and you know, and I want to just name that. It's, it's about, it's tens of thousands of listeners who are hearing this who will say, you know, oh, the more we can get into ventral vagal, you know, the better our world is going to be. And that's what, you know.
- [68:06]
B
Yeah. Yeah. Basically the, the message is don't be scared. Find a few trusted individuals in which your body feels safe enough to go into ventral sleep.
- [68:18]
A
Yeah. Well, I'm very excited that you were willing to share your time with us today. And do you have where people can find, follow and pay attention to all the stuff you're doing? Do you have all that on your website or.
- [68:33]
B
I would send people, I would send people to the Polyvagal Institute website. Polyvagal Institute, one word.org and they keep track, they have courses, they have basically a lot of materials online and I also have a website@stephenporte.com and. But Polyvagal Institute would also put other people into a community of people interested in these questions.
- [69:00]
A
Beautiful. Wonderful. Well, thank you once again for being my guest today.
- [69:06]
B
Well, thank you Laura.
- [69:07]
A
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