In this episode, Deb discussed how she was inspired after hearing Stephen Porges, Ph.D. speak about his polyvagal theory, and found ways to use this theory in helping clients to heal. She explained that there are three states of the autonomic nervous system, which are the ventral (feeling regulated, safe, connected), sympathetic (fight or flight, activated), and dorsal (collapse, shut down, disconnected) and that there are cues that trigger these states. We discussed how emotions are the labels that we attach to these states, although the same states may have different labels (anxiety vs. excitement). She pointed out that our nervous system takes in information from three pathways, which are embodied (interoceptive or internal sensations), environmental (external cues), and between nervous systems (how our nervous system is reacting to another’s nervous system). She discussed how the polyvagal theory allows therapists to help clients identify the cues that trigger these states, understand these states, and they also inform the therapist as they help coregulate the client through the therapist being in a ventral state. The polyvagal theory, she pointed out, sees these states in a hierarchy, where when the sympathetic is overwhelmed, then the person moves into the dorsal state of collapse or dissociation, and to move from the dorsal state, one must go back through the sympathetic, fight or flight, state to return to a ventral state. Deb discussed how we learn to move through this system through coregulation and we discuss how this plays out with parents and children and in couple relationships. She explained that survivors of Complex PTSD, who grew up in an unsafe and/or unpredictable environment, weren’t able to get that experience of coregulation to internalize, so they had to regulate themselves, and these solutions may have become maladaptive. This also creates difficulty for the client because their experience is that people are dangerous, so it is dangerous to be in the presence of another, making coregulation very difficult. Part of the therapist's work with trauma survivors is to be able to help coregulate them in a ventral state, while they also access those other states while revisiting the trauma, experiencing the coregulation in the present while engaging with the experience of the past. She discussed techniques she uses with clients such as breathing techniques, connecting to memories of times in ventral state, using objects that cue a time when in a ventral state, and a discernment question where the person is able to reflect on whether the current activation is needed for the current situation, and notice, name, and then turn towards the nervous system experience.

Deb Dana, LCSW is a clinician, consultant and author specializing in complex trauma. Her work is focused on using the lens of Polyvagal Theory to understand and resolve the impact of trauma, and creating ways of working that honor the role of the autonomic nervous system. She is a founding member of the Polyvagal Institute, consultant to Khiron Clinics, and advisor to Unyte. Deb is the developer of the signature Rhythm of Regulation Clinical Training Series and is well known for translating Polyvagal Theory into a language and application that is both understandable and accessible for clinicians and curious people alike. Deb’s clinical work published with W.W. Norton includes The Polyvagal Theory in Therapy: Engaging the Rhythm of Regulation, Polyvagal Exercises for Safety and Connection: 50 Client Centered Practices, the Polyvagal Flip Chart, and the Polyvagal Card Deck. She partners with Sounds True to bring her polyvagal perspective to a general audience through the audio program Befriending Your Nervous System: Looking Through the Lens of Polyvagal Theory and her print book Anchored: How to Befriend Your Nervous System Using Polyvagal Theory. Deb can be contacted via her website www.rhythmofregulation.com