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Isn't the Polyvagal Theory the whole story…?!

We now know that body and mind are connected. We also know how important this is for physical and mental health. To explain this in cases of prolonged stress and trauma, Stephen Porges' Polyvagal Theory1 is currently very popular. This is not surprising, since this theory explains, among other things, how trauma is stored in the body and disrupts the processes that are controlled by the autonomic nervous system. These processes serve survival and balance and drive our daily functioning. Because these processes occur at an unconscious, non-cognitive level, they are sometimes difficult to put into words. Polyvagal theory helps to understand what is happening. This theory also provides insight into how to influence these processes. Not so much verbal and cognitive, but mainly action and experience oriented as in in the creative arts therapies (see also the blog "The Polyvagal Theory and the Creative Arts Therapies").

But this is not the whole story. Not in terms of explaining the mind-body connection. Not in terms of health. And not in terms of explaining how the creative arts therapies work.


Why is the Polyvagal Theory not the whole story?


Apart from all sorts of (increasing) scientific criticisms of the evolutionary, anatomical and methodological aspects of the theory, the Polyvagal Theory is "only" one piece of the puzzle. For even though this theory places a heavy emphasis on the vagus nerve of the autonomic nervous system, we are not entirely at the mercy of it. In fact, our functioning is determined by an ingenious interplay of various neurobiological and psychological processes. This is because our autonomic nervous system is connected to all the organs in our body and to other subcortical and cortical structures. For example, the amygdala activates and deactivates the hormonal and immune systems (the so-called HPA axis) and the limbic system, which plays an important role in emotions and emotional memory. But also cortical processes such as the regulatory effect of the (pre-)frontal cortex, which plays an important role in executive functions such as attention, concentration and planning. And Broca's area, which as a language center is important for language expression, among other things. Together they form what Gabor Maté calls a "super-system" 2. The regulation and integration of these different networks is important for healthy functioning.

Neuroscience research shows that the integration of various neural networks and systems is disrupted during prolonged stress and trauma. The processes that are so important for physical and mental health become dysregulated (see the post on neuroplasticity and chronic stress). People then become stuck in unconscious and often rigid patterns of thinking, feeling and acting. The result is a variety of physical and psychological ailments.

Image: Queensland Brain Institute

The Importance of Integration

Healthy functioning requires a close integration of subcortical and cortical processes. When this integration is disrupted, e.g. by physical or psychological stress or trauma, we become unbalanced; we do not (fully) recover and continue to overreact to stimuli, for example. In ArTA 3 I called this "imbalance", where the cortical processes (thinking) or the subcortical processes (feeling) take over and determine our behavior. We can no longer respond adaptively to the small and large challenges that life brings. In ArTA I have called this "adaptability". The result is physical, psychological and/or social discomfort.

How exactly contribute the creative arts therapies to integration?


Art-making in the creative arts therapies takes place on an unconscious, non-cognitive level. Doing and experiencing are central and initially no words are involved. Dysregulations in the neural networks mentioned above are expressed in a person's movement and become visible and audible the visual art form, dance, drama and music. And because movement is strongly related to emotion 4, it is also palpable. So the processes activated in the creative arts therapies are analogous to the processes that drive functioning outside of therapy.

And this is good news, because it also means that when you allow someone to make and experience art in a different way, you are influencing these processes and working toward change. By initiating a different directed movement, accompanied by a different directed experience, someone can experience "first hand" what this does. An interesting concept in this context is neuroplasticity, but more on that in the post “neuroplasticity, chronic stress and the arts therapies”.

The art therapist is in an excellent position to use the arts methodically in this process and to tailor it specifically to the client. Especially on the strengths of the client. For in spite of dysregulation, there is always a healthy part. Through constructive art-making in the creative arts therapies,  this healthy part is addressed. This increases the sense of direction or "sense of agency" 4. This enables the client to move toward change and health. For example, through (controlled) mobilization or relaxation, sensing how the body responds to sensory stimuli (e.g., in interaction with the art form), observing what emotion is involved, and how that emotion can be felt, tolerated, and expressed in a safe context. This helps to restore balance and increase adaptability.

An art-making process in the creative arts therapies requires both thinking and feeling. For example, reflecting (together) activates cortical processes and thus contributes to awareness and meaning making. This creates understanding and (self-)compassion for one's own survival reactions and allows them to be placed where they belong: in the past. This leads to a new narrative, meaning and perspective for the future. Space is created for adaptive healthy(er) functioning within the client's capacity.

Want to learn more about balance and adaptability as aspects of mental health and in relation to art therapy?




  1. Porges S. W. (2011). The Polyvagal Theory: Neurophysiological foundations of emotions, attachment, communication, and self-regulation. WW Norton.

  2. Maté, G. (2019). When the Body says no. The Cost of hidden Stress. Vermilion.

  3. Pénzes, I. (2024). Art Therapy Observation and Assessment in Clinical Practice. The ArTA Method. Routledge/ Taylor Francis.

Pénzes, I. (2020). Art form and Mental health. Studies on art therapy observation

and assessment in adult mental health. (PhD dissertation). Behavioural Science Institute. 216188.pdf (

4. Stern, D.N. (2010). Forms of Vitality. Exploring Dynamic Experience in Psychology, The Arts, Psychotherapy, And Development. Oxford University Press.

Image at top of post: Freepik

41 views2 comments


According to biologists there is not a shred of evidence to support Porges' proposition. It seems to have become a very comfortable way of "explaining" behaviour. Paul Grossman from Basel University, has spent at least 20 years discussing it and waiting for evidence. I'd very much like to share my paper in J of Public Health 2022 with you. How am I able to send you a copy? I do so like your blog! I'm looking forward to your EFAT presentation,

Cheers for now,

Dr. Marie-Christina Virago (nee van Epenhuijsen)

Replying to

Thank you for sharing, Marie-Christina. I enjoyed reading your article! Nice of you to join the EFAT presentation on the research behind the ArTA method, see you there! Ingrid

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