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Writer's pictureDr. Ingrid Pénzes

The Polyvagal Theory and the Creative Arts Therapies

Updated: May 22



The Polyvagal Theory. No doubt you've heard of it.

It was developed by Stephen Porges 1. Deb Dana translated it for use in practice 2. And although it was not originally developed for therapy purposes at all, this theory is used primarily for trauma therapy. The theory may help explain the working mechanisms of the creative arts therapies. I also believe that this explanation, about which more later, can be supported from multiple perspectives and that the Polyvagal Theory is only one part of it. See also the blog "Isn’t the Polyvagal the whole story...?!" where I critically review the Polyvagal Theory. Nevertheless, a good understanding can help you to form your own opinion.


The purpose of the polyvagal theory is to help you understand how the behavior of yourself and your clients is automatically driven and how you can tune into it. Since it is a rather complex matter, I will try to explain it step by step.


The Nervous System

The entire nervous system is divided into the "central nervous system" and the "peripheral nervous system"3. The central nervous system consists of the brain and the spinal cord. The peripheral nervous system consists of the nerves that connect the brain and spinal cord to all other parts of the body. The peripheral nervous system is further divided into the "somatic nervous system" and the "autonomic nervous system". The somatic nervous system consists of the cranial and spinal nerves, which provide sensory input to the brain and spinal cord and transmit commands to the muscles. The autonomic nervous system regulates the actions of smooth muscles, glands, and organs. The autonomic nervous system is further divided into the "sympathetic nervous system" and the "parasympathetic nervous system". I have summarized them in the figure below.




The Autonomic Nervous System

The primary functions of your autonomic nervous system are survival and homeostasis. The autonomic nervous system actually controls all the "automatic" functions in your body, such as your breathing, digestion, heart rate, etc. Think of it as your cruise control. It's a good thing you don't have to think about it too much, otherwise you wouldn't have time for other things! These processes are responses to stimuli from your body (hunger, sleep) and stimuli from your environment. Being able to adequately signal stimuli of safety and insecurity helps your body respond adaptively and thus survive. When your body signals danger, the sympathetic nervous system is activated: your heart rate increases, your breathing accelerates, and you produce cortisol and adrenaline. In short, your body prepares to fight or flight. When your body signals safety - often with the help of specific brain regions that help you make sense of the signals you receive - the parasympathetic part is activated: your body returns to rest and recovers. In this way, a healthy autonomic nervous system is flexible and adaptive.


The Polyvagal Theory of Stephen Porges

The Polyvagal Theory focuses on how the most important nerve pathway works: the vagus nerve, or wandering nerve. Because that's what this nerve does: it fans out from the brain stem down to your heart and all your organs, and up to your facial muscles, among others. Porges states that the vagus nerve consists of two bundles that did not evolve at the same time, evolutionarily speaking. There is a more primitively organized bundle: the dorsal vagus, which controls all sorts of functions below the diaphragm, such as your stomach and intestines. And a smarter, more modernly organized bundle: the ventral vagus, which controls all sorts of functions above the diaphragm, like your heart and lungs. Hence the name Polyvagal (poly meaning multiple).

Porges has discovered several aspects of how this works. I will mention here the concepts of "neuroception", "hierarchy" and "co-regulation".


Neuroception

Your autonomic nervous system reacts very quickly and without thinking to stimuli from your body, your environment, or in contact with others. Because this happens at an unconscious level, it is called neuroception. It is actually the precursor to perception: the process by which your brain thinks analytically about the signal and assigns meaning to it.

 

Hierarchy

Your autonomic nervous system (ANS) responds to stimuli in three ways.


  1. Your ANS signals safety: your body is at rest and recovering from any tension you may have experienced. You are in touch with yourself and others and attuned to the situation in the here and now. You are in control of your actions, open to possibilities and curious. There is room for play and creativity. At this time, the evolutionary youngest part of the vagus nerve, the ventral vagus, is activated.

  2. Your ANS signals danger: your body mobilizes. It prepares to respond to the threat by fleeing or fighting. Your muscle tension increases, and your heart rate and breathing increase. Your ANS also activates the adrenal glands, which produce adrenaline and cortisol - also called the "stress hormone" - to help your body prepare. Your sympathetic part of the vagus nerve is active in this process.

  3. Your ANS signals danger as too threatening: your body freezes. This is called the "freeze" or "shutdown" response. You are no longer able to react to the situation, you lose contact with yourself and your environment, resulting in dissociation. Situations in which you cannot leave trigger this reaction, which activates the oldest part of the vagus nerve, the dorsal vagus.


These reactions are often related to trauma because reactions to trauma are anchored in the body 4. These experiences disrupt healthy functioning of the ANS and often lead to dysfunctions in thinking, feeling and acting. Especially in the case of early childhood trauma, this has a major impact: the ANS is programmed incorrectly. As a result, even long after the trauma, a person might have difficulty signaling safety (safe stimuli are more quickly signaled as unsafe), so the body remains in a constant state of readiness and/or dissociates easily.


But even without trauma, you can recognize these three responses. For example, your sympathetic part of the vagus nerve is active when you experience a "stressor," such as taking a test. Your body prepares to deal with this tension, this short-term stress, and this is a very healthy response from which the body also recovers once the stressor is over.


If the stress is prolonged, your sympathetic part stays active. Your body stays in a constant state of readiness with all the physical reactions that go with it. Similarly, cortisol stays in your system for a long time. This affects your immune system and can lead to all kinds of physical ailments 5.


When stressors go on for too long, demand too much of you, or you don't see a way out or a solution, your body responds with numbness. You don't know how to deal with it and see no way out. You lose touch with yourself and feel no room for social interaction. This can leave you feeling powerless, hopeless, and lonely. You feel like you have too much to do, but you are getting nowhere and are constantly tired.


When your body reacts to being mobilized or immobilized for too long, there is no rest and recovery; your body becomes dysregulated. The connection between these autonomic, subcortical processes and the more conscious cognitive, cortical processes of the brain is also disrupted. Your body and associated emotions or thoughts take over: an imbalance occurs and you are less able to respond adaptively to stimuli 6. These processes drive daily behavior.


Co-regulation

Anatomically, the ANS is basically the same in everyone. The way it is programmed takes place at a very early age and depends on the co-regulation of the parent/caregiver. Infants and toddlers are not yet able to regulate themselves and depend on the co-regulation of the caregiver. Learning self-regulation is developed in interaction with a caregiver in whom it is being developed. This is why early childhood development is so important. In a healthy attachment relationship, co-regulation occurs naturally: The parent's ventral vagus regulates the child's ventral vagus. For example, providing comfort when the child is upset allows the child to feel safe again and to come to rest and recovery. If the caregiver is unable to help regulate the infant, let alone if they are the actual threat, then the ANS is not properly programmed.


Co-regulation also occurs between adults. The vagus nerve has many branches with the facial nerves, especially with the nerves of the eye muscles. This means that the response of our ANS becomes visible in our facial expressions, head movements, eyes, and voice, among other things. This is for all responses, i.e. ventral vagus (safe, rest), sympathetic (flight/fight) and dorsal vagus (freeze, shut down). People respond to these in interaction. You can probably recall a situation where someone was so tense that you "took over” some of that tension.

This also means that when you meet someone who exudes calm and confidence, it can help you regain your own calm and experience safety. A therapist consciously uses this to influence the processes of the ANS and increase self-regulation.


Compassion

The ANS is programmed based on experience and the processes take place automatically on an unconscious level. If we want to influence these processes, it is not so easy through language and cognition. This might however be an important first step, especially for developing self-compassion. When a person learns to understand that the reaction to an overwhelming situation was "involuntary" and automatically directed in the service of one's own survival, it can remove all feelings of shame and guilt. It gives a different perspective on one's body's response. But understanding that you feel and behave this way does not change that you feel and behave this way. But how then?


Influencing the ANS

If there is a dysregulation, the primary goal of therapy is to restore the healthy functioning of the ANS. But how to do that? Some points of interest:


  • No rush!

 

As a therapist, there may be a tendency to get someone into ventral neuroception (safety) as quickly as possible. However, it is important to realize that in people with (severely) disturbed ANS processes, neuroception is also disturbed. As a result, safe situations are more likely to be perceived as unsafe. Furthermore, safety may feel uncomfortable or unpleasant. For this reason, movement from dorsal (immobilization) or sympathetic (overmobilization) is always via "controlled mobilization". It is the initiation of a new movement in response to manageable signals from the body. This takes time. Time to learn to trust that interaction with and support from others is healing. And that being in touch with one's body, and the emotions and feelings that come with it, helps one to respond adaptively.


  • Addressing the healthy part

Despite dysregulation, there is always a healthy part 7. It is important to take symptoms seriously, but to shift the focus to what is working and where there are opportunities. Tapping into the healthy part increases the sense of direction, or "sense of agency. And with it, the ability to adapt.


  • Here and now

A sympathetic (mobilizing) or a dorsal (immobilizing) response have in common that someone is out of touch with themselves, others, and their environment. One is not present in the here and now. It can be helpful to get in touch with oneself through co-regulation. Awareness of one's own body, emotions and feelings contributes to adaptability.

 

  • Doing and Experiencing

 

The processes controlled by the ANS are expressed in the movement of the body. Movement is closely related to emotions and feelings. Thus, by initiating a different directed movement accompanied by a different directed experience, these processes can be influenced. By approaching something in a different way, a person can experience "first hand" what it does. This allows someone to get back in touch with their own world of experience and to experience that the body is giving reliable signals.


Are you beginning to see ways in which the creative arts therapies can contribute to restoring the healthy functioning of the ANS? Below are my thoughts on why the creative arts therapies offer an ideal entry point for restoring healthy functioning of the ANS and thereby increasing balance and adaptability 6.


Polyvagal theory and the creative arts therapies

The processes that drive the ANS are expressed through the body and become manifest in the way a person moves. Methodical action and experience-based work in one of the art forms such as visual art, dance, movement, drama and music makes this movement visible, tangible, audible and workable. What is it all about?


Analogy

Art-making processes in the creative arts therapies activate the same processes that are driven by the ANS. Art-making also takes place on an unconscious, non-cognitive level. Experience is central and words are not initially involved. A person responds to the art form primarily from the ANS. These processes are expressed in the movement a person makes in visual art, dance, drama, and music. They become visible, audible and palpable and are thus analogous to functioning outside of therapy.

This also means that when you allow someone to make and experience art differently, you are affecting the same processes that drive functioning in everyday situations. I believe that three characteristics of the creative arts therapies contribute to this. The creative arts therapies are action-oriented, experiential, and integrate cortical and subcortical processes.


Action-oriented

The creative arts therapies are action-oriented; doing is central and appeals to controlled mobilization. The client is addressed in the here and now, in the healthy part, in what is still possible and manageable. This creates a sense of agency. Art-making is constructive and interactive. In a safe context, there is interaction with the therapist and with the art form. This provides space for co-regulation, for example through synchronization. Creating in the here and now in a different way allows someone to move, to break free from unconscious patterns that hinder healthy functioning. This contributes to self-regulation, flexibility, adaptability, and problem-solving skills.


Experiential

The creative arts therapies are experiential; by interacting with the art form, a person can feel body signals and related emotions in the here and now. Particularly when a client has difficulty recognizing, acknowledging, or expressing emotions, the therapist can first engage the parasympathetic system by offering the art form in such a way that a person can experience relaxation, enjoyment, and other positive emotions and dare to acknowledge and tolerate them. From there, the client can experience that it is not necessary to avoid emotions, and space is created to experience and redirect negative emotions as well.


Integration

Art-making processes in the creative arts therapies require both thinking and feeling. Allowing the experience to be there and reflecting on it (together) contributes to awareness and restores the balance between thinking and feeling. By distancing oneself from the act and the experience, one becomes aware of patterns in one's own functioning and can assign a different meaning to them. This contributes to understanding and self-compassion for one's body. Understanding that your body is helping you survive and that you are not stuck in patterns that are no longer functional adds meaning and helps redirect negative thoughts and feelings and do things differently than before. This contributes to rest and recovery and a healthy(er) functioning ANS that keeps the body balanced and adaptable to a variety of situations.


Conclusion

Polyvagal theory shows how trauma is stored in the body and disrupts the processes that are driven by the autonomic nervous system. These processes serve survival and rebalancing and drive our daily functioning. Because these processes occur at an unconscious, non-cognitive level, it is sometimes difficult to put them into words. Polyvagal theory want to help understand what is happening. This theory also provides insight into how to influence these processes. Not so much verbally and cognitively, but primarily action and experience oriented as in the creative arts therapies.

 

In this way, this theory may help to explain the working mechanisms of the creative arts therapies. However, I personally think it 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. Read more about this in my other blog "Isn’t the polyvagal theory not the whole story...?!"


Want to learn more about balance and adaptability as aspects of mental health and in relation to art therapy? https://www.routledge.com/Art-Therapy-Observation-and-Assessment-in-Clinical-Practice-The-ArTA-Method/Penzes/p/book/9781032549613


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

2. Dana, D. (2018). Die Polyvagal Theorie in Therapie. Den Rhytmus der Regulation nutzen. G.P. Probst Verlag.

3. Freberg, L.A. (2019). Discovering Behavioral Neuroscience. An Introduction to biological Pychology (4th ed.). Cengage.

4. o.a. Kolk, van der, B. (2014). The Body keeps the score: Mind, Brain and Body in the transformation of trauma. Pinguin.

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

Maté, G. (2022). The Myth of Normal: Trauma, Illness & Healing in a toxic Culture. Vermilion.

6. 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 (ru.nl)

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

7. Antonovsky, A. (1979). Health, stress and coping. Jossey-Bass.

Antonovsky, A. (1987). Unraveling the mystery of health. Jossey-Bass.

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


Photo: Pexels

Image: Ingrid Pénzes

 

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