Nervous System Regulation in Therapy
Polyvagal Theory (PVT), introduced by Dr. Stephen Porges, offers therapists a nuanced understanding of the autonomic nervous system's role in emotional regulation and social engagement. By integrating PVT into clinical practice, therapists can enhance their approaches to treating trauma and stress-related disorders.
Autonomic Nervous System Explained
The autonomic nervous system (ANS) is a component of our peripheral nervous system. This segment of our nervous system regulates involuntary processes. It does so by employing 2 functions that communicate with our central nervous system (CNS) - the sympathetic nervous system (AKA “fight or flight”) and parasympathetic nervous system (AKA “rest and digest”). Both the SNS and PNS, as well as our correlated emotional responses, are fundamental to our survival as a species.
In order to explain this to clients, I like to liken the 2 parts of the ANS to the gas and breaks of the car. The SNS serves as the gas pedal - it gets us moving & responding to both internal and external cues. The PNS functions like the breaks, which allow us to slow and stop safely. A car without either of these essential functions would at best simply not achieve its function. At worst, it could put us in serious danger. It is essential that both of these vital functions in our body are working in tandem, with balance and flexibility.
PVT further delineates responses of our SNS and PNS as influenced by the 2 branches of the vagus nerve, which is the longest cranial nerve in our body. Dr. Porges has dedicated his career to expanding evidence-based interventions through the science behind PVT, which enables therapists to put effective tools into practice with clients.
How might a therapist use PVT in my treatment?
Creating a Safe Environment: Establishing a therapeutic setting that fosters safety is crucial. A calm environment and strong therapeutic connection can help clients achieve greater regulation within their own ANS, facilitating greater openness and connection.
Body-Oriented Therapies: Integrating techniques such as diaphragmatic breathing and similar somatic interventions, which can stimulate the vagus nerve and promote relaxation. Engaging in group physical activities also activates the social engagement system, enhancing feelings of safety and connectedness.
Rhythmic Activities: Incorporating rhythmic elements including bilateral stimulation can aid in emotional regulation. Such activities align with PVT principles by supporting clients in managing dysregulated stress responses and processing traumatic memories,
Listening and Music Therapies: Engaging clients in listening to modulated vocal music or participating in singing can exercise the neural regulation of middle ear muscles. This stimulation sends feedback to the nervous system, signaling safety and enhancing the social engagement system.
By integrating Polyvagal Theory into clinical practice, therapists can better understand and address the physiological underpinnings of their clients' experiences, leading to more effective and compassionate interventions.
Sources
Porges SW. The polyvagal theory: new insights into adaptive reactions of the autonomic nervous system. Cleve Clin J Med. 2009 Apr;76 Suppl 2(Suppl 2):S86-90. doi: 10.3949/ccjm.76.s2.17. PMID: 19376991; PMCID: PMC3108032.
Waxenbaum JA, Reddy V, Varacallo MA. Anatomy, Autonomic Nervous System. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539845/
Meet the Author
Cassie Thomas, MA, LPC
Cassie is a Licensed Professional Counselor in Colorado and Wyoming. Cassie loves to support adolescent girls and gender non-conforming clients of any age in their exploration of identity.
Cassie is certified in EMDR and is skilled in supporting clients who struggle with chronic health conditions and CPTSD.
