Written by Jan Winhall, Stephen W. Porges
This two-part paper begins with a discussion by Stephen Porges, whose pioneering work revolutionized our understanding of the autonomic nervous system. In part one, Porges applies his Polyvagal Theory to under- standing addiction. In part two, Jan Winhall, a seasoned trauma therapist, lays out her Felt Sense Polyvagal ModelTM of understanding and treating addiction that integrates Polyvagal Theory’s safety-based neuroception with Eugene Gendlin’s felt sense interoception. This paper provides a generic framework that complements and can vastly strengthen any therapeutic modality. This non-stigmatizing, embodied, strength-based model departs from the current top-down, disease-based understanding of addiction that dominates current clinical practice.
Revolutionizing Addiction Treatment with The Felt Sense Polyvagal ModelTM
The development of Polyvagal Theory was not targeted towards explaining or treating addiction. Rather, the theory provided a more general explanation of how the mammalian autonomic nervous system adaptively adjusts in complex environments to support survival. This perspective emphasizes two important points relevant to addiction: 1) context functionally defines what is appropriately adaptive; and 2) behaviors are emergent properties of a neural platform mediated by autonomic states. Thus, the adaptive characteristics are dependent on the appropriateness of the behaviors within a specific context. Conceptualizing behavior (addiction) in these terms could change our understanding of behavioral pathologies. We might end up interpreting a behavioral pathology as a behavior that might have been adaptive in one setting, and is now being elicited in a setting where it is maladaptive. For example, trauma survivors, who may be dissociating or shutting down through the use of addictive substances and behaviors, might be expressing a reaction that would be adaptive during a past traumatic event, but maladaptive in a current social setting.
As the principles of the theory as a science of feeling safe and sociality are outlined ahead, consider the quality of feelings and sociality of those who are addicted. Does addiction disrupt feelings of safety and sociality? Note that within the theory, autonomic state functions as an intervening variable biasing reactions to context. Reflecting on this latter point, consider addictive behavior as a valiant and yet failed strategy in regulating autonomic state, and as a poor substitute for the potent co-regulatory influences on calming autonomic state attributed to social behavior. As you read the sections on calming mechanisms and sociality, consider the limitations of the self-regulatory and co-regulatory repertoire of those who are addicted.
Polyvagal Theory emerged from the identification of the phylogeny of the vertebrate autonomic nervous system. The phylogenetic transition from asocial reptiles to social mammals required a repurposing of the neural regulation function of the autonomic nervous system, which had efficiently supported asocial reptiles. The repurposed system provided mammals with new pathways to downregulate defensive states, and to signal cues of safety. The title of the initial presentation of the theory (Porges, 1995) succinctly summarized its essence: Orienting in a defensive world: Mammalian modifications of our evolutionary heritage. A polyvagal theory. The theory provided a neurophysiological understanding of how mammals were capable of sufficiently downregulating the autonomic pathways that support defense in order to promote proximity, establish social bonds, and serve supportive roles in caring for their offspring and select others. This process of downregulating defensive states provides insight into understanding the link between sociality and health, as well as the negative consequences of addictive behavior on relationships (i.e., co-regulation) and self-regulation. Consistent with this theme, Polyvagal Theory focuses on the evolved neural circuits that enabled mammals to downregulate the sympathetic activation that could support mobilization to fight or flee, to reduce psychological and physical distance with conspecifics, and to functionally co-regulate physiological and behavioral states.
The core of the theory emerged through the identification of a phylogenetic transition in the regulation of vertebrate autonomic nervous systems that provided the neural resources for mammals to become social and to cooperate. The theory provides an innovative scientific-based perspective that incorporates an understanding of phylogenetic shifts in vertebrate neuroanatomy and neurophysiology. This perspective identifies neural circuits that downregulate neural regulation of threat reactions, and functionally neutralize defensive strategies via neural circuits communicating cues of safety. The theory proposes that feelings of safety are operationally the product of cues of safety via neuroception (see below), downregulating autonomic states that support threat reactions, and upregulating autonomic states that support interpersonal accessibility and homeostatic functions. Basically, when a human feels safe, their nervous system supports the homeostatic functions of health, growth, and restoration, while they simultaneously become accessible to others without feelings of threat and vulnerability. In the optimal social context of humans, social interactions serve as the prominent mechanism to calm the autonomic nervous system. However, in the world of addiction, we learn that social interactions are displaced by drugs and behaviors to regulate the autonomic nervous system, and these strategies result in poor outcomes, disrupting homeostatic functions and potentially compromising mental and physical health.
The theory focuses on the transition from reptiles to mammals, and emphasizes the neural adaptations that enable cues of safety to downregulate states of defense. Within Polyvagal Theory, the evolutionary trend has led to a conceptualization of an emergent and uniquely mammalian social engagement system, in which a modified branch of the vagus is integral. Neuroanatomically, this system is dependent on a brainstem area known as the ventral vagal complex. This area not only regulates the mammalian ventral cardio-inhibitory vagal pathway, but also regulates the special visceral efferent pathways controlling the striated muscles of the face and head. This does not preclude other structures being involved in mammalian social engagement behaviors, or homologous structures in other vertebrates who do not share our phylogenetic history having social engagement behaviors.
Polyvagal Theory proposes that the neural evaluation of risk and safety reflexively triggers shifts in autonomic state without requiring conscious awareness. Thus, the term neuroception was introduced to emphasize a neural process, distinct from perception, capable of distinguishing environmental and visceral features that are safe, dangerous, or life-threatening (Porges, 2003, 2004). A form of neuroception can be found in virtually all living organisms, regardless of the development of the nervous system. In fact, it could be argued that single-celled organisms and even plants have a primordial nervous system that responds to threat. As mammals, we are familiar with reactions to pain, a type of neuroception. We react to pain prior to our ability to identify the source of the stimulus, or even to be aware of the injury. Similarly, the detection of threat appears to be common across all vertebrate species. However, mammals have an expanded capacity for neuroception in which they not only react instantaneously to threat, but also respond instantaneously to cues of safety. It is this latter feature that enables mammals to down- regulate defensive strategies to promote sociality by enabling psychological and physical proximity without anticipation of potential injury. It is this calming mechanism that adaptively adjusts the central regulation of autonomic function to dampen the metabolically costly fight/flight reactions dependent on sympathetic activation, and to protect the oxygen-dependent central nervous system, especially the cortex, from the metabolically conservative defensive reactions of the dorsal vagal complex (e.g., fainting, death feigning).
Is it possible that those most vulnerable to addiction are in an autonomic state that promotes feelings of threat, and biases neuroception to detect cues of danger and adaptively be less sensitive to social cues of safety? Are those with addictions more likely to misinterpret positive social engagements via prosodic vocalizations, facial expressions, and gestures? If the addicted individual is chronically in an autonomic state that supports threat reactions and biases the detection of cues of threat, then these features would limit opportunities to co-regulate through the ventral vagal pathways and to successfully engage the social engagement system. The consequence of supporting an autonomic nervous system tuned for defense is to limit the functional neuromodulation benefit we derive from sociality, and become more reliant on the use of addictive substances and behaviors to modulate state. Ironically, this strategy of state modulation will not produce the physiological calmness that supports homeostatic processes, although it might numb bodily feelings of distress and physical pain.
Polyvagal Theory suggests a hierarchical conceptualization of feelings, as higher brain structures interpret the neural signals conveying information from visceral organs (e.g., heart, gut, etc.) to the brainstem. This psychophysiological perspective emphasizes the foundational function of autonomic state in the subjective experience of global feelings and emotions. Within this hierarchical conceptualization, feelings of safety are preeminent, and form the core of an enduring motivational system that shifts autonomic state, which in turn drives behavior, emotion, and thought. The resulting model suggests that feelings of safety reflect the foundational autonomic state supporting maturation, health, and sociality.
Feeling safe functions as a subjective index of a neural platform that supports both sociality and the homeostatic processes optimizing health, growth, and restoration. Operationally, feeling safe is our subjective interpretation of internal bodily feelings that are being conveyed via bidirectional neural pathways between our bodily organs and our brain. Feelings of safety are not equivalent to objective measurements of safety, which could pragmatically be defined as the removal of threat. Feeling safe is more akin to the felt sense described by Eugene Gendlin (2018). Although Gendlin, as a philosopher and psychologist, was not physiologically oriented, he described a “felt sense/shift” as not just a mental experience, but also a physical one.
Polyvagal Theory provides the science to understand the profound role of feelings of safety in the expression of sociality. The theory leads to a re-examination of the roles that feelings of safety and social behavior play in understanding addiction, and vulnerabilities to become addicted. Polyvagal Theory provides a perspective to understand addiction as a disruptor of the autonomic state that would support sociality and promote feelings of safety.
Humans, as social mammals, are on an enduring lifelong quest to feel safe. This quest appears to be embedded in our DNA, and serves as a profound motivator throughout our life. The need to feel safe is functionally our body speaking through our autonomic nervous system – influencing our mental and physical health, social relationships, cognitive processes, behavioral repertoire, and serving as a neurophysiological substrate upon which societal institutions dependent on cooperation and trust are based. While the optimal outcome occurs through fulfilling our biological imperative of connectedness, this is the product of individuals feeling safe through the co-regulatory properties of interactive social engagement systems. While the motivation to feel safe can be intense, the opportunity to feel safe may be difficult to achieve.
This may occur due to work schedule and location, in which proximity might limit availability of individuals who broadcast and are receptive to cues of safety. In addition, marginalized individuals experience barriers to the establishment of safe trusting relationships, even in their own community. Being marginalized through being identified by race, sex, ethnicity, religion, or disability frequently places an individual in a state of chronic threat, and greatly limits opportunities to co-regulate in work, school, and community settings in which those who are not marginalized can feel safe and co-regulated. However, in those experiencing limited access to positive cues of safety, the motivation to feel safe remains high, although the availability of appropriate individuals with whom to feel safe is low.
Although co-regulation and the use of sociality as a neuromodulator to regulate autonomic state is the neurobiological norm for our species to down-regulate threat reactions, the norm is predicated on safe relationships. At times, opportunities to co-regulate with a trusted other are not available, and feelings of safety are not easily accessible. This may occur through either physical or social isolation. It also can involve an inability to feel safe with others. For example, individuals with severe adversity histories often experience feelings of threat in the proximity of others, and are unable to use sociality as a neuromodulator to calm autonomic state. Without access to sociality as a calming neuromodulator, individuals may be vulnerable to addiction, in which the bio-behavioral richness of sociality is replaced with substances or behaviors. Unfortunately, the substitution of co-regulation with addictive substances and behaviors will fail, and disrupt mental and physical health.
The literature confirms the strong link between trauma history and addiction. A survey conducted by SAMHA confirmed that approximately 75 percent of women and men in substance abuse treatment report histories of abuse and trauma (see samhsa.gov). From a polyvagal perspective, this link reflects an attempt to regulate autonomic state by numbing feelings of threat. This supports the proposed consequence of trauma history, especially in abuse experienced during childhood, as retuning the autonomic nervous system to be locked in to states of defense that would lead to mental health vulnerabilities, and attempts to ameliorate feelings of threat via addictive behavior (e.g., Carliner, Keyes, McLaughlin, Meyers, Dunn & Martins, 2016; En- och,2011; Felitti, 2006). Unfortunately, these strategies mistakenly assume that numbing feelings of threat will lead to sociality.
The use of addictive substances and behaviors are effective in changing autonomic state, although the autonomic changes do not reliably support co-regulation, and frequently lead to poor outcomes. Two important factors contribute to these changes in state disrupting both feelings of safety and sociality. First, addictive substances and behaviors often downregulate the bi- directional feedback loops through which our nervous system communicates and regulates visceral organs. This numbing process may have short-term benefits, such as reduction of physical pain and mental distress, but it does not promote feelings of safety or spontaneous social engagement behaviors. Moreover, by damping the neural regulation of visceral organs, it might lead to end organ damage. Second, addictive substance and behaviors often recruit an autonomic state that supports defensive threat reactions, which may result in abusive and aggressive behaviors.
On the surface, addiction is related to difficulties in feeling safe and maintaining trusting relationships. Addiction, from a polyvagal perspective, reflects an unsuccessful strategy to reduce the impact of threat by numbing or mobilizing. Addiction can appear to successfully mask, distort, or numb feelings of threat. Interestingly, the strategy of numbing and masking seems to follow implicit strategies frequently employed to foster a dissociation between feelings and actions, and frequent valiant attempts to prevent bodily feelings from disrupting intentional behaviors. However, unlike the neurobiological potency of sociality in generating feelings of safety, these strategies fail, and over time exacerbate feelings of threat.
A polyvagal perspective of addiction focuses on the attempted use of addictive substances or behaviors to damp underlying feelings of threat. This perspective frames the client’s behavior within a quest to feel safe. Unfortunately, feeling safe is dependent on an autonomic state that can only efficiently be reached through sociality, while recruiting ancient neurobiologically-based survival strategies that are insensitive to the intentions of higher brain circuits will fail.
If the therapist’s intention is to enable clients to feel safe, then it is important not to use evaluative phrases suggesting that their behavior is wrong or bad. By moving outside the moral veneer of societal norms, we need to explain to the client how their body responded in specific contexts. This exercise helps the client interpret their behavior not as an intentional violation of an expectancy, but as an adaptive feature of a nervous system that evolved to survive, and to explore potential pathways towards safety.
The client needs to appreciate this adaptive feature, and to understand that this adaptive feature is flexible, and can change in different contexts. The first step is to replace an evaluative focus with a curiosity about the adaptive survival prioritized repertoire of the nervous system. This curiosity leads to an appreciation of the emergent behaviors, which are dependent on the flexibility of autonomic state regulation while adapting to the challenges of complex contexts. A product of this journey is the development of alternative perspectives and personal narratives that would lead to greater bodily awareness, and an understanding of the difference between primitive neural pathways that support survival, and higher brain structures detailing intentions. With this rich information, the client can develop a narrative that treats atypical behaviors not as bad, but as understandable in terms of adaptive functions that may often be heroic.
Keywords; Addiction, felt sense, polyvagal