Hi,

I agree that Polyvagal approach it is not applicable for every pathology . Most important, psychological and body-oriented Psychotherapies, which have introduced the theory as a must. There is no need for Body oriented Psychotherapies since the understanding of interrelations mind-body or body-mind could be explained in terms of neurophysiology and neuropsychology.

Sorry if I do not explain my self too clear...

María Eugenia Moneta, Thanks Maria, I am not absolutely sure what you mean (thanks for writing in English, but an American living in Germany for a long time, I know how difficult writnig in a foreign language can be).

Anyhow, do you mean that the polyvagal approach is unnecessary for psychological and body-oriented therapies because there are other scientifically validated neurophysiological and neuropyschological explanations that better clarify relations? Or do you mean something else?

By the way, your recent English-languagepapers on attachment and embodiment look very interesting.

I mean Body oriented psychotherapy does not need from Polyvagal theory for validation. See my last publication!

María Eugenia Moneta, I completely agree with you.

Paul Grossman, have you seen this publication? "The vagal paradox: A polyvagal solution" from November 2023. I interpret the introduction as an attempt to suggest that if someone criticizes the polyvagal theory, they simply don't understand it because it was too difficult for them.

I don't know who was labelled an influencer; I hope it wasn't you or James C Coyne.

María Eugenia Moneta , Aleksandra Kraszczyńska ,

Thanks for the comments. Maria, I look forward to reading your latest.

Aleksandra, my coauthor EW Taylor is, in fact, certainly the leading living authority on vertebrate evolution of the autonomic nervous system. So the comments of the new Porges paper should be taken less than seriously. The paper was an attempt to discredit Taylor and me because of our recent publications in Biol Psychol seriously challenging the polyvagal conjectures. In reality, the evolutionary aspects are moot points since the neuroanatomical and functional hypotheses of the polyvagal edifice do not correspond to what we know about the ventral snd dorsal brainstem vagal centers, but Porges fails to address that at all in his recent piece.

I am unsure what you mean about “influencers“. Where was that mentioned. In any case, I hardly see myself in that role.

Hello Paul,

Thank you for opening this discussion. I am also amazed to see that this "theory" is becoming more and more widespread among therapists. Here are my assumptions:

- The vast majority of therapists are pure "users" and do not read any scientific literature, certainly not outside their own specialty. For many therapists, biological psychology is probably beyond their scope.

- The phenomena described by Porges are well known to trauma therapists. Most clinicians are happy when there is (apparently) a scientific explanation for their actions (see, for example, the not infrequent reference to "quantum physical explanations", e.g. of the effects of constellation work)

- In general, in my experience, many therapists do not like to question the foundations of their work, but - like all people - prefer to seek confirmation for what they do and their point of view.

- Prominent representatives of psychotherapy now mention the polyvagal theory in their lectures and articles, which gives the impression that it is a recognized theory.

In my view, polyvagal theory has no practical use for therapeutic work, as this takes place on a purely phenomenal level. It simply gives many therapists the feeling that their work is neurophysiologically based (which it probably is, just differently...)

Best regards

Daniel

Translated with DeepL.com (free version)

Just chipping in because I thought about this extensively during my bachelor thesis, and want to thank you for your thorough well-researched critique of the polyvagal theory.

Purely from a sociological perspective and without delving into the underlying neuroscientific arguments, I think that the polyvagal theory has found a niche in which it can provide a biological unifying model to a diverse and sometimes paradoxical cluster of psychological and behavioural symptoms. This helps to make a case that trauma can indeed lead to a "true" disease or disorder, and is not just a weakness of character. Nowadays, a lot of the "reality" of psychiatric disorders is established through neuroscientific arguments, and polyvagal theory fits in there.

Importantly, it provides a cohesive and understandable story, and part of the success of therapeutic concepts is not just their objective truth value in describing pathology, but also the degree to which these concepts enable patients to structure their own perception and interpretation of reality and can be used guide their everyday actions to better their life. Here, even false theories can become useful. Some recommendations that are given from the background of the theory (feeling safe, developing trust) are very important for those suffering from PTSD, and are especially for complex traumata, which have long been underexplored in therapy.

Best,

Josh

I will add my answer with the deepest of respect. My contention, in agreement with Daniel Waltz, is that it's basic lack of biological knowledge on the part of psychotherapists, who have almost en mass leaped on the "neuroscience" band wagon to justify their practice, rather than engaging in research to justify their stance. To be fair, funding for such research is very difficult to obtain, because of our society's similar attachment to "objective science". The Milgram phenomenon is also an issue; Porges has built a huge following on the back of his "theory", (and you quite rightly name it an enterprise, Paul). Milgram fudged his data and used spurious methods; his contention, however, fitted the post WWII zeitgeist; people do horrendous things when personal agency is overridden by authority. Finally and perhaps the most apposite, from where I sit, is the Emperors Clothes phenomenon. No-one, save a very tiny fist full, and especially not in the "trauma informed" (by what else is psychotherapy informed?) community is brave enough to be the first to call out the invisibility of the famed garment! I have been roundly castigated......and expelled.....for so doing. Eventually, as with Milgram, he will be recognised as having built his fame on a fable. Until then, we hang in, with thanks for your steady voice Paul.

No-one would advocate for ice pick lobotomies anymore, treatment with laudanum, nor deep sleep therapy. It is a concept that adds weight to what is essentially an art, and research to refute it will eventually be undertaken. Let us hope that there are funders with similar faith to provide the resources.

Thanks to all so far for your reflections. I had an interview with a medical journalist from a major Swiss newspaper about the vagus nerve, which seems to bear on aspects of this discussion. I include my responses to the questions below (comments, critique and requests for clarification very welcome).

What influence do vagal signals or vagal tone have on stress or panic situations?

PG: Unfortunately, that is a very difficult question to answer for a number of reasons:

1. Researchers interested in examining the effects of stress, panic and trauma on the parasympathetic nervous system during real-life situations essentially only have one noninvasive and nonintrusive vagal measure available, respiratory sinus arrhythmia (RSA; or heart-rate-variability proxies of RSA). Pretty much every other measure of vagal activity requires invasive procedures (e.g. difficult surgical procedures to get at vagal fibers of the vagal nerve or pharmacological interventions); neither allows monitoring under naturalistic conditions, and surgical procedures can only be done on animals.

Also, the single measure we do have, RSA, is an imperfect and very approximate index of vagal influences upon only heart rate—no other organ system, not the gut, the lungs, the genitals, etc. The various branches of the parasympathetic system—and distinct bundles of fibers of the vagus nerve—are active throughout the body but often do not operate in unison (i.e. in a simultaneously synchronous, parallel fashion). Thus, they are said to show significant target-organ specificity, i.e. vagal outflow from the brainstem centers may be different to one organ system than to another, so one cannot generalize about general “vagal tone”.

Furthermore and very importantly, RSA is only an index of vagal heart rate: it does not even reflect all the other vagal effects upon additional distinct aspects of heart functioning (e.g. how well the heart pumps blood through the body [left ventricular contractility]; the extent of vagal effects upon the coronary arteries that supply blood to the heart [how dilated or contracted they become under different cicumstances])!

And to underline once again, RSA is frequently not even a very accurate index of vagal control of heart rate: there are at least 9 serious caveats or limitations that temper its usefulness, although with some care and caution, RSA can sometimes reflect vagal impact upon heart rate. But that’s solely heart rate: to repeat, it does not say anything about whatever else the vagus is doing in other parts of the body.

What is certainly of additional significance is that a) profound bradycardia (a large sudden decrease in heart rate) has never been documented as a common response to dissociation or emotional freezing (although it may very occasionally occur among physiologically susceptible individuals)—all the research and meta-analyses I could find report no-to-very-small decreases in heart rate (on the order of a beat of 2 per minute, which might be often explained by normal physiological accommodations to immobility and are definitely not perceptible); and b) should such bradycardia occur, it is certainly not mediated by brainstem dorsal vagal centers (dorsal motor nucleus) but rather via ventral vagal mechanisms, which completely contradicts the polyvagal conjectures about hierarchical organization of stress-related responses, representing one of the 3 stated “principles” of the polyvagal enterprise.

2. So, what can we say about the vagus and the psyche? It seems certain that the vagus nerve is involved in behavior and psychological states. The vagus is obviously important for sending commands from the brain to the heart (as well as many other organ systems) and sending information about the state of the organ system back up to the brain. The best evidence, when focusing on the heart, indicates rather complicated combined effects of vagal and sympathetic output coming down from the brain, also transmitting information about what is happening moment-to-moment at the heart back to the brain via other “afferent” vagal fibers. Additionally, very significant local sets of neurons scattered over much of the surface of the heart have also been recently documented, and these neurons are in constant interplay with vagal and sympathetic input. The magnitude of RSA (or one of its surrogates) is affected by the joint action of all these factors.

I think we can clearly say, primarily based on animal studies, that the vagus nerve during stress interacts with sympathetic activity and local events, in complicated ways we do not yet fully understand. Generally, though, vagal outflow from the brain to the heart will slow heart rate—provided none of those other factors or interactions interfere. And with stress and panic, there tends to be a withdrawal of vagal discharge to the heart and an increase in sympathetic stimulation that results in higher heart rate. Thus, the autonomic nervous system (both vagal and sympathetic) interacts with local factors at the heart to finally determine heart rate (and sometimes in very unexpected ways, as recent exercise studies have shown).

Certainly, the hierarchical assumptions of the polyvagal theory regarding autonomic function are thoroughly unsubstantiated and would, anyhow, be vastly oversimplistic. And our sense of well-being does not hang mainly on the vagus nerve, nor would we currently have any way of proving that, with our meager single index of vagal heart-rate control.

Can these connections be utilised in everyday life for our own well-being, for example through simple "tricks" such as breathing, ice water, diving reflex?

PG: These supposed “vagal hacks” sometimes do involve vagal control of heart rate, but they often are very short-lived events of seconds or minutes; they may also have very minor effects upon changes in average heart rate (if any). Therefore, it’s hard to believe that they can evoke significant long-term psychological relief for trauma or panic patients. They often additionally involve complex exercises that can produce other nonvagal physiological responses. Additionally, I am not aware of any serious large-scale trials that have evaluated any of these techniques.

It seems more plausible that expectation of improvement will play the prominent role in patients’ reports of improvement. By now, we are well aware of the importance of suggestion, expectations, placebo and so-called common factors (nonspecific, usually relational, aspects) in effective treatment of psychological and psychosomatic problems.

We can often be aware of how relaxed or not we are, but we certainly cannot directly feel our vagus. Brainstem vagal centers are definitely not the source, or wellspring, of our socioemotional lives. If anything, the vagus nerve is the messenger, not the message. Short-circuiting, or “hacking” the vagus is akin to shooting the messenger, rather than dealing with the origin of the message. Learning to relax, calm oneself, or distinguish between safe and unsafe situations doesn‘t require knowledge about the autonomic nervous system. It is the awareness of the lived experience that helps one learn to discern. The great masters of emotional balance, calm and equanimity have not needed elucidations of physiological mechanisms to achieve such states, even not nonspurious explanations.

Do such effects go beyond the well-known effects of the vagus on the heart rate (and in turn its significance for emotional self-perception)?

PG: I think I more or less answered this question earlier (a. vagal control of heart rate is complex, and our single index is only sometimes an approximately good measure; b. even accurate estimation of vagal influences on heart rate don’t tell us how the vagus is acting with other systems).

However, let me further add that the large-scale evaluations (meta-analyses and very large single studies) of relations between socio-emotional self-regulation and RSA almost all show very small effects, when any. This means that differences in RSA are really not predictive of variations in self-regulation: Typically, correlations in these studies are small, very small or nil, indicating that 0%, 1% or 2% of the variation in these psychological measures can be related to RSA. There are one or two studies with severe depression, perhaps another serious disorder (definitely not trauma, so far as I am aware), that do somewhat better, but it’s hard to know whether that has anything to do with other factors, like physical agitation or drugs (which independently may often affect RSA levels).

• Is the vagus as a "health nerve" ascribed an exaggerated, too unspecific significance in the health literature??

PG: That’s for sure. The vagus nerve is certainly important, but primarily as a relay station and messenger of information from higher brain centers going down, and from organ systems coming up, and integrating with central, sympathetic and local factors. Time will tell us more about exactly how this all works during different states of the organism or person. But there really is zero evidence that the vagus nerve or its centers in the brainstem outweigh other brain mechanisms for influencing our psychosocial functioning. The distinctions made in the currently very popular polyvagal enterprise have been shown to be patently false in terms of neuroanatomy, brain function and evolution. And respiratory sinus arrhythmia, our one vagal index, can, in fact, tell us very little about “vagal tone.”

Upon rereading my last comments, I noticed several typos, which have been corrected above. One section might have particularly provoked confusion (first question, 2nd paragraph of point 2) should read:

“I think we can clearly say, primarily based on animal studies, that the vagus nerve during stress interacts with sympathetic activity and local events, in complicated ways we do not yet fully understand. Generally, though, vagal outflow from the brain to the heart will slow heart rate—provided none of those other factors or interactions interfere. And with stress and panic, there tends to be a withdrawal of vagal discharge to the heart and an increase in sympathetic stimulation that results in higher heart rate. Thus, the autonomic nervous system (both vagal and sympathetic) interacts with local factors at the heart to finally determine heart rate (and sometimes in very unexpected ways, as recent exercise studies have shown).“

Sorry, but I edited in yet another paragraph to main comment above.

Ah! This puts a slightly different gloss on Porges' work then, however it still does nothing to support the social contentions he proposesn or the isolation of the vagus from all other nerves, does it....unless there is still more to the autonomic nervous system of which we are unaware, a bit like the infrasound communications used by both whales and elephant; is there perhaps a type of social contagion stimulated by the autonomic nervous system?

Josh, this is something that Paul addressed in the previous thread: the use of a myth. Yes, it can be useful if one includes the use of folk remedies as also being useful. If they are they work on a very different system to the one the

trauma informed" community posits this concept; it works by the same mechanisms as what is generally understood as the "placebo phenomenon" (cf; the Klopfer story), nonetheless powerful. It is, however. not a replicable scientific theory, which the "trauma informed" as the mob purport and therefore falls into the worst of "scientism". Psychotherapy is an art, and the sooner THAT is recognised, the better everyone will be, in my very humble opinion....and yes, I've engaged in both "scientific" enquiry and practice. Our society is far too much enamoured of "science" which results in hypotheses such as Milgram's and Porges' which can actually do harm. I recently contributed to an online course, marketed as "re-wiring your nervous system", based on the "polyvagal" stuff and the number of people expressing distress at their perception that they were failures resulting from their inability to so "re-wire" their nervous systems was horrific. I was roundly chastised because I questioned the veracity of the paradigm.