What is polyvagal theory?

Dr Martina Melzer, published: 07/24/24

Anyone on Instagram in the “recovery bubble” of ME/CFS and Long Covid will inevitably come across the “polyvagal theory”. But also with fibromyalgia, irritable bowel syndrome and issues such as stress or trauma.

The polyvagal theory was developed by US psychiatrist and neuroscientist Professor Stephen Porges. In principle, it states that our autonomic nervous system not only consists of the sympathetic and parasympathetic nervous system (= vagus nerve), but that the latter also has two main branches.

The part that is older in evolutionary terms is the so-called dorsal vagus. According to Porges' theory, its nerve fibers extend into the organs below the diaphragm in the abdominal cavity. The younger part in terms of evolutionary history is the ventral vagus. Its nerve fibres are located above the diaphragm and have connections to the facial and laryngeal muscles, among others.

According to the polyvagal theory, the autonomic nervous system follows a kind of hierarchy that can be compared to a ladder. At the top of the ladder is our autonomic nervous system in its healthy state.

This means that the ventral vagus is active. At the same time, the sympathetic nervous system is in its healthy state, or the dorsal vagus. The ventral vagus is active when we feel safe. It also signals to us that we can approach another person and connect with them. If the sympathetic nervous system is in a healthy state at the same time, we feel full of energy and drive, are motivated and agile. If the dorsal vagus is in a healthy state at the same time, we can relax, rest, wind down, sleep well and digest, become intimate.

In the middle of the ladder, the autonomic nervous system goes into survival mode. The ventral vagus is blocked, we feel threatened and in danger. The sympathetic nervous system goes into its long-term unhealthy fight and flight mode. We become aggressive, anxious, nervous, perhaps sweat more or freeze and shiver. We burn a lot of energy in this state. We tense our muscles and slow down our digestion.

If the danger seems great and we feel that we cannot fight or flee, our nervous system puts us into a freeze state. In English, this is called “freeze mode”. We virtually freeze with fear, hold our breath and hide. Perhaps the danger is passing us by. The sympathetic nervous system is still active, the dorsal vagus is already in its unhealthy state. We are somewhere between nervous and exhausted, tired but wired.

If we cannot defend ourselves against (real or perceived) danger or flee from it, we reach the bottom of the ladder. We cannot escape the danger, we feel helplessly at its mercy. This is where the dorsal vagus jumps into its permanently unhealthy state. It shuts down all body systems and organ functions, we go into a kind of energy-saving mode, no longer feel as much and withdraw.

People with mind-body syndromes typically oscillate back and forth between an unhealthy sympathetic nervous system and an unhealthy dorsal vagus. These reactions happen involuntarily in response to danger. We are neither “at fault” nor “responsible” for reacting this way. It is simply our nervous system. And it reacts to stimulus xy with response xy, just as it learned at some point early in life to always react in this way to precisely this stimulus. Due to stressful childhood experiences, chronic stress and trauma, there are simply more and more stimuli that the brain and nervous system classify as dangerous.

By training our self-awareness, getting to know our nervous system and sensing the first signals when it goes into survival mode, we can retrain it. We can teach our brain and nervous system what is really dangerous and what is actually safe. We can learn to better regulate our nervous system ourselves and in contact with other people (or pets).

Tranlsated with the help of a translator program

Important: The statements in this text are the result of my research from scientific studies, professional articles, books, courses, education and training as well as my own recovery process. I have done the best possible research, but nevertheless make no claim to accuracy. In science, something is considered a hypothesis until it is clearly proven (or disproven). That is then evidence, a fact. The statements in this text are a combination of hypotheses and facts.

Also, the content on this page is for informational purposes only and is not a substitute for talking to your doctor or other therapist. Please talk to your doctor or therapist before making any decisions about your physical or mental health. Every way into a mind-body syndrome is something individual, and every way out.