Polyvagal Theory: Common Neural Mechanisms Mediating Social Behavior, Emotional Regulation and Health

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1 Polyvagal Theory: Common Neural Mechanisms Mediating Social Behavior, Emotional Regulation and Health Stephen W. Porges PhD Department of Psychiatry University of North Carolina

2 Co-regulation: A Mammalian Biological Imperative A neglected biological drive A major mediator of mental and physical health Explains the health benefits of social support

3 Co-regulation Social Engagement + Social Bonding Safety Proximity Contact Bonds

4 Co-regulation: Building Blocks of Healthy Relationships Social Engagement + Social Bonding Safety Proximity Contact Bonds

5 Features of Mental Health Problems Difficulties in co-regulation Feeling safe with others Being in physical proximity with others Being touched or touching others Establishing trusting social relationships X X X X Safety Proximity Contact Bonds

6 What physiological systems are involved in mediating social behavior? Social engagement behaviors Immobilization without fear What physiological systems are involved in mediating defense? Fight/flight Immobilization with fear

7 The Polyvagal Theory 1. Evolution provides an organizing principle to understand neural regulation of the human autonomic nervous system as an enabler of social behavior. 2. Three neural circuits form a phylogeneticallyordered response hierarchy that regulate behavioral and physiological adaptation to safe, dangerous, and life threatening environments. 3. Neuroception of danger or safety or life threat trigger these adaptive neural circuits.

8 Three Phylogenetic Stages of Neural Development of ANS Stage 1: Primitive unmyelinated vagus immobilization behaviors (i.e., dissociation) Stage 2: Sympathetic Nervous System (SNS) fight-flight behaviors Stage 3: Myelinated mammalian vagus social communication homeostasis enables social interactions to regulate physiology and promote health growth and restoration (balance between unmyelinated vagus and SNS)

9 The Polyvagal Theory Not all vagal pathways support social communication, down regulate stress, and enhance resilience. There are vagal pathways that can be recruited for defense and are potentially lethal.

10 Physiological State Colors our Perception S - - R Physiological State

11 The Quest for Safety: Emergent Properties of Physiological State Environment outside the body inside the body Nervous System Neuroception Safety Spontaneously engages others eye contact, facial expression, prosody supports visceral homeostasis Danger Life threat Defensive strategies death feigning/shutdown (immobilization) Defensive strategies fight/flight behaviors (mobilization)

12 Phylogenetic Organization of the ANS: The Polyvagal Theory head old vagus limbs viscera trunk

13 Phylogenetic Organization of the ANS: The Polyvagal Theory Corticospinal Pathways Sympathetic Nervous System head limbs viscera trunk

14 Phylogenetic Organization of the ANS: The Polyvagal Theory Corticobulbar pathways head new vagus limbs viscera trunk

15 Deconstructing the Mammalian Social Engagement System cortex brainstem Muscles of Mastication Middle Ear Muscles Cranial Nerves V,VII,IX,X,XI Head Turning Bronchi Facial Muscles Larynx Pharynx Heart environment

16 The Face-Heart Connection: A Critical Component of a Social Engagement System In mammals at birth the bidirectional neural communication between the face and the heart forms the core of a Social Engagement System. Metabolic demands, perceived danger, life threat, and illness retract the Social Engagement System resulting in a face that is not social and a physiological state (removal of the vagal brake on the heart) that promotes defensive behaviors.

17 Social Engagement System: Observable Deficits in Several Psychiatric Disorders Prosody Gaze Facial expressivity Mood and affect Posture during social engagement State regulation Sound hypersensitivities

18 cortex brainstem Muscles of Mastication Middle Ear Muscles Cranial Nerves V,VII,IX,X,XI Head Turning Bronchi Facial Muscles Larynx Pharynx Heart environment

19 Estimated Marginal Means Autism: Atypical Facial EMG Estimated Marginal Means of MEASURE_ muscle 1 2 Typical Autism Lower Face =autism; 2=TD Upper Face

20 Feature Detectors: The importance of the face-to-face interactions How do we feel when there is a violation of the face-to-face interactions?

21 Violation of Face-to-Face: An experimental manipulation The Face-to-Face Still Face Procedure (Tronick, Als, Adamson, Wise, & Brazelton, 1978) 3 Phases:» 2 minutes Social Play» 2 minutes Still Face» 2 minutes Reunion Play

22 The Polyvagal Theory Emphasis on safety and the adaptive consequences of detecting risk (neuroception) on physiological state, social behavior, psychological experience, and health. Feeling safe is a necessary prerequisite before social support can be effective in healing physical and mental illnesses (i.e., co-regulation).

23 Neuroception The detection of features in others or the environment without awareness that dampens defensive systems and facilitates social behavior OR promotes defensive strategies of mobilization (fight/flight) or immobilization (shutdown, dissociation).

24 Neuroception Environment Safe Behaviors Social Engagement Danger Fight/Flight Life threat Shutdown Physiological State

25 Polyvagal Theory: A Phylogenetic Hierarchy of Response Strategies Structure Head Limbs Viscera Function Communication Mobilization Immobilization VVC SNS DVC + + +

26 Neuroception Environment Safe Behaviors Social Engagement Play Loving Behaviors Physiological State

27 Neuroception: Promotes mental and physical health Environment Visceral state Safe Ventral Vagus SNS Dorsal Vagus

28 Neuroception Safe FFA/STS Motor Cortex Amygdala (central nucleus) Medulla (source nuclei V,VII,IX,X,XI) Social Engagement System Somatomotor (muscles of face & head) Visceromotor (heart, bronchi) Inhibitory pathways Excitatory pathways

29 cortex brainstem Muscles of Mastication Middle Ear Muscles Cranial Nerves V,VII,IX,X,XI Head Turning Bronchi Facial Muscles Larynx Pharynx Heart environment

30 Heart Rate Rhythms RESP HP (ms) RSA BPM 10 HPV SECONDS

31 Autism: Depressed Vagal Regulation Bal et al. (2010) Journal of Autism and Developmental Disorders

32 Autism: Depressed Vagal Regulation Porges et al. (2013) International Journal of Psychophysiology

33 HIV: Depressed Vagal Regulation Heilman et al. (2013) Biological Psychology

34 FXS Syndrome: Depressed Vagal Regulation Heilman et al. (2011) Developmental Psychobiology

35 The Vagal Brake: Model of Self-Regulation Porges et al. (1996) Developmental Psychobiology

36 The Vagal Brake Are difficulties with the vagal brake associated with clinical disorders?

37 Abuse History: Poor Recovery of Vagal Brake Dale et al. (2009) Applied Psychophysiology and Biofeedback

38 Respiratory Sinus Arrhythmia BPD Patients Controls A 5.0 Baseline Film 1 Film 2 Film BPD Patients Controls B Heart Period (msec) Baseline Film 1 Film 2 Film 3 Austin, Riniolo, & Porges (2007) Brain and Cognition

39 Selective Mutism: Sluggish Vagal Brake Heilman et al. (2012) Development and Psychopathology

40 cortex brainstem Muscles of Mastication Middle Ear Muscles Cranial Nerves V,VII,IX,X,XI Head Turning Bronchi Facial Muscles Larynx Pharynx Heart environment

41 Detached Middle Ear Bone: A mammalian feature Detached middle ear bones are a defining feature of mammals. Living mammal species can be identified by the presence in females of mammary glands. Since mammary glands and other soft-tissue features are not visible in fossils, detached middle ear bones are used. Without detached middle ear bones, low amplitude sounds in higher frequencies would not be heard. Thus, enabling mammals to communicate in a frequency band that is difficult to hear for reptiles. Without functioning middle ear muscles we are hypersensitive to the low frequencies trigger predator!

42 Bell s Palsy: Lateralized Symptoms of a Compromised Social Engagement System Drooping of the muscles of the face Inability to close the eyelid and to blink Difficulty chewing Twitching of the muscles Hyperacusis

43 Auditory Processing: Autism Porges et al. (2013) International Journal of Psychophysiology

44 Auditory Processing: HIV Heilman et al (2013) Biological Psychology

45 Play Play is a neural exercise that enables the co-regulation of physiological state to promote neurophysiological states that support mental and physical health.

46 Principles to Establish Relationships (therapy) are Similar to Play Reciprocity Movement and inhibition of movement Face-to-face interactions and/or prosodic vocalizations to dampen potential defensive reactions to movements, proximity, and touch Play (therapy) as a neural exercise

47 Hierarchical Model Polyvagal State Myelinated Vagus SNS Unmyelinated Vagus

48 New Model Clinical Polyvagal State Myelinated Vagus Behavior Optimal regulation Social communication State regulation Learning Hyperacusis Hypertension Gut problems Anxiety disorders Drug abuse SNS Fight/flight Hyperarousal Hypervigilance Avoidant Oppositional behaviors Social withdrawal Affect limitations Self-medication Hypotension Vasovagal syncope Fibromyalgia Unmyelinated Vagus Immobilization Behavioral shutdown Dissociative states Risk of suicide

49 Polyvagal Syndrome? Lack of prosody Poor face face gaze Flat affect (facial expressivity) Sound hypersensitivities Inappropriate posture during social engagement Poor mood and affect Atypical state regulation Low threshold to become fight/flight Low threshold to be dissociative Lower gut problems Fibromyalgia

50 Polyvagal Syndrome? Special visceral efferents Lack of prosody (IX,X) Poor face face gaze (VII) Flat facial expressivity (VII) Sound hypersensitivities (V, VII) Inappropriate posture during social engagement (XI) Vagal regulation Poor mood and affect Atypical state regulation Low threshold to fight/flight Low threshold to dissociation Lower gut problems Fibromyalgia

51 Polyvagal Syndrome? Stage I (dampened Social Engagement System) Blunted affect Lack of prosody Poor face face gaze Flat facial expressivity especially upper face Sound hypersensitivities Inappropriate posture during social engagement Poor mood and affect Atypical state regulation (difficulties self-regulating and co-regulating) Stage II (highly mobilized and reactive) Low threshold to fight/flight Atypical state regulation (varies between apparently calm and reactive)

52 Polyvagal Syndrome? Stage III (vulnerable to shutdown and dissociation) Atypical state regulation (varies between highly mobilized and shutdown) Low threshold to immobilize and become dissociative Lower gut problems Fibromyalgia Stage IV (chronic shutdown and dissociative)

54 Summary Evolution has modified the vertebrate autonomic nervous system (ANS). In mammals the neural regulation of the ANS is integrated with the neural regulation of the striated muscles of the face and head to provide a functional Social Engagement System that promotes health, growth, and restoration. The Social Engagement System is efficiently triggered by face-to-face interactions (i.e., facial expressions, prosodic vocalizations). Mammalian social interactions exercise the Social Engagement System to promote physical and mental health.

55 Conclusions The Social Engagement System is an emergent neurophysiological system that evolved to regulate, via contact with conspecifics, physiological state in order to promote health, growth, restoration, and social behavior. The Social Engagement System is compromised in many behavioral and psychiatric disorders.

56 Acknowledgments Special thanks to: C. Sue Carter, PhD Keri Heilman, PhD Stephanie Aylward Elgiz Bal Danielle Coleman Emily Harden Greg Lewis Matthew Macellaio Kimberly McCue Shannon Stanfill Danielle Zageris Funding provided by: NIH Grants MH-60625, MH-67446, HD Autism Speaks, Nancy Lurie Marks Family Foundation, Cure Autism Now, Unicorn Children s Foundation Copyright 2011 Stephen W. Porges

POLYVAGAL THEORY, OXYTOCIN, AND THE NEUROBIOLOGY OF SOCIAL BEHAVIOR

POLYVAGAL THEORY, OXYTOCIN, AND THE NEUROBIOLOGY OF SOCIAL BEHAVIOR USING THE SOCIAL ENGAGEMENT SYSTEM TO PROMOTE RECOVERY FROM EXPERIENCES OF THREAT, STRESS AND TRAUMA. Stephen W. Porges, PhD C. Sue Carter