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192: What to do with the myth of Polyvagal Theory
Sep 18, 2023
The podcast discusses the popularity of Polyvagal Theory and the lack of evidence supporting it. It explores alternative theories and suggests a path forward. It also covers the concept of the window of tolerance, strategies for managing emotions, and the limitations of science. The podcast raises concerns about the implementation of Polyvagal Theory in therapy and explores indigenous perspectives.
01:17:43
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Quick takeaways
- Polyvagal Theory, although criticized, still lacks enough evidence to be definitively debunked or replaced by alternative theories.
- Individual experiences may vary, and it's crucial to consider other explanations and interventions for specific situations.
- Finding a framework that resonates with individuals and provides understanding is essential, regardless of the strength of evidence supporting it.
Deep dives
Substantive evidence against PBT
Although there are some challenges and criticisms of polyvagal theory (PBT), there isn't a preponderance of evidence against it. Some studies have attempted to debunk or refute it, but there is still ongoing research and debate on its validity.
Alternative theories
There are alternative theories to PBT, such as the neuro-visceral integration model, the biological-behavioral model, the resonance-frequency model, and the psychophysiological-coherence model. While these theories offer different perspectives, none of them have enough evidence to definitively replace PBT as the main explanatory framework.
Potential harm of using PBT
While individual experiences with PBT may vary, there is a concern that relying solely on PBT without seeing improvement in functioning could be problematic. It's essential to consider other explanations and interventions that might better help individuals in their specific situations.
The importance of making meaning
Whether or not PBT is supported by strong evidence, the crucial aspect is finding a framework that helps individuals make sense of their experiences. Our interpretations and meanings of events shape our understanding and guide our actions. If PBT resonates and provides understanding for individuals, it may still hold value in that context.
The Power of Self-Diagnosis and Creating Coherence
Self-diagnosis based on advanced screeners can help create coherence and make meaning out of personal experiences. It provides a macro story that holds individual microstories together, allowing individuals to feel a sense of autonomy. By understanding their window of tolerance and connecting it to their past and present experiences, individuals can widen their window and have a better understanding of their reactions. This knowledge helps to form a coherent story that doesn't blame oneself or others but acknowledges the impact of biology and trauma. Believing in this story allows individuals to make changes and respond differently to challenging situations.
The Importance of Cultural Beliefs and Myths in Healing
Cultural beliefs and myths play a crucial role in healing and therapy. The degree of fit between a therapist's explanation of illness and the client's understanding of suffering is essential. Just as survivors of the Pol Pot regime in Cambodia used culturally specific beliefs and rituals to navigate their trauma, individuals need explanations that align with their cultural beliefs and provide autonomy. Therapy should involve a confiding relationship, a different context, a plausible explanation for the illness, and a ritual or intervention believed to be effective. The power of myths and stories lies in their ability to grant a greater sense of autonomy over one's life and offer a path to healing and change.
Polyvagal Theory is everywhere these days.
Psychologists talk about it; parenting coaches talk about it; if you’re in
the mental health field you’re probably referring to polyvagal theory in some way. So one would assume that there’s lots of evidence for it, right? Well, maybe. Maybe not.
In this episode I dig into the foundational principles of Polyvagal Theory and find that there's a lot less evidence supporting it than you might think, given how many places it's used.
So what's going on? Is it legit? Should we be using a different theory to understand our experience instead?
But all may not be lost! Maybe there are aspects of the theory that we can still use...the episode suggests a path forward on this.
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Jump to Highlights
Other episodes referenced:
018: The Spiritual Child: Possibly exaggerated, conclusions uncertain104: How to help a child to overcome anxiety
132: How implicit bias affect my child (Part 2)References:
Agger, I. (2015). Calming the mind: Healing after mass atrocity in Cambodia. Transcultural Psychiatry 52(4), 543-560.
American Museum of Natural History (n.d.). What is a theory? Author. Retrieved from: https://www.amnh.org/exhibitions/darwin/evolution-today/what-is-a-theory
Barret, L.D. (2017). How emotions are made: The secret life of the brain. Boston: Houghton Mifflin Harcourt.
Barrett, L.D. (2023, March 25). Peripheral physiological changes during emotion. Chapter 1 endnote 26 from How emotions are made: The secret life of the brain. Author. Retrieved from: https://how-emotions-are-made.com/notes/Peripheral_physiological_changes_during_emotion#cite_note-8
Benish, S. G., Quintana, S., & Wampold, B. E. (2011). Culturally adapted psychotherapy and the legitimacy of myth: a direct-comparison meta-analysis. Journal of counseling psychology, 58(3), 279.
Bird, A. (2021). Understanding the replication crisis as a base rate fallacy. The British Journal for the Philosophy of Science. Retrieved from: https://d1wqtxts1xzle7.cloudfront.net/56560473/Replication-base-rate-fallacy_FINAL-libre.pdf?1526290158=&response-content-disposition=inline%3B+filename%3DUnderstanding_the_Replication_Crisis_as.pdf&Expires=1689372953&Signature=HnUWKVi40YZrjWv4RyYGjB8GSt2wRxNSyYdmUe3wNG~NwYkkbMv0rG0Y~PWotaD7xlq6b9DcfQXnwx1ddLVT7nkmX4teXXs9B7iI16d7JnEKVUAzcVXBOuVajgdMQXR~3y1fq1xNfMUXBE-zsqHNV3bSQdReBEMvuIr-l9pNFs~PiSnAaeUe91b-eYy5QCEzvKrTsGN~R-Y~qfEXb3NecIO6kokPLph9H4w0K7cpvu7x72RoBqBT3yIsQmQ5MAoGDrBFW0FnKZuJVUF1LlHBeSGC1ToTJ03feIhLc9OkJJB8i-s3crTxvN5BFdq9oKh-qRUSMAHRE6zmCG-XQ9jR8w__&Key-Pair-Id=APKAJLOHF5GGSLRBV4ZA
Brennan, M.A., Emmerling, M.E., & Whelton, W.J. (2014). Emotion-focused group therapy: Addressing self-criticism in the treatment of eating disorders. Counseling & Psychotherapy Research 15(1), 67-75.
Das, A. (2021). Testing the Longitudinal, Bidirectional Relation Between Respiratory Sinus Arrythmia and Perceived Emotion Regulation (Doctoral dissertation, Miami University). Retrieved from: https://etd.ohiolink.edu/apexprod/rws_etd/send_file/send?accession=miami161688520539524&disposition=inline
deVries, Y.A., Roest, A.M., Turner, E.H., & de Jonge, P. (2019). Hiding negative trials by pooling them: A secondary analysis of pooled-trials publication bias in FDA-registered antidepressant trials. Psychological Medicine 49, 2020-2026.
Doody, J.S., Burghardt, G., & Dinets, V. (2023). The evolution of sociality and the polyvagal theory. Biological Psychology 180, 108569.
Frank, J. D., & Frank, J. B. (1993). Persuasion and healing. Baltimore, MD: Johns Hopkins University Press.
Grossman, P., & Taylor, E.W. (2007). Toward understanding respiratory sinus arrhythmia: Relations to cardiac vagal tone, evolution and biobehavioral functions. Biological Psychology 74, 263-285.
Ekman, P., Sorenson, E.R., & Friesen, W.V. (1969). Pan-cultural elements in facial displays of emotion. Sicnce, New Series, 164(3875), 86-88.
Ekman, P., & Friesen, E.V. (1971). Constants across cultures in the face and emotion. Journal of Personality and Social Psychology 17(2), 124-129.
Graziano, P., & Derefinko, K. (2013). Cardiac vagal control and children’s adaptive functioning: A meta-analysis. Biological Psychology 94(1), 22-37.
Hanazawa, H. (2022). Polyvagal Theory and its clinical potential: An overview. Brain Nerve 74(8), 1011-1016.
Harmer, C.J., Duman, R.S., & Cowen, P.J. (2017). How do antidepressants work? New perspectives for refining treatment approaches. Lancet Psychiatry 4(5), 409-418.
Kawai, H., Kishimoto, M., Okahisa, Y., Sakamoto, S., Terada, S., & Takaki, M. (2023). Initial outcomes of the Safe and Sound Protocol on Patients with Autism Spectrum Disorder: Exploratory Plot Study. International Journal of Environmental Research and Publich Health 20(6), 4862.
Laborde, S., Moseley, E., & Mertgen, A. (2018). A unifying conceptual framework of factors associated to cardiac vagal tone. Heliyon 4(12), e01002.
Lehrer, P. (2013). How does heart rate variability biofeedback work? Resonance, the baroreflex, and other mechanisms. Biofeedback 41(1), 26-31.
Luck, A. (2022, October 29). Polyvgal Theory: A critical appraisal. Author. Retrieved from: https://alyssaluck.com/polyvagal-theory-a-critical-appraisal/
McCraty, R. (2011). Coherence: Bridging personal, social and global health. Alternative Therapies in Health and Medicine 53(3), 85-102.
Poli, A., Gemignani, A., Soldani, F., & Miccoli, M. (2021). A systematic review of a polyvagal perspective on embodied contemplative practices as promoters of cardiorespiratory coupling and traumatic stress recovery for PTSD and OCD: Research methodologies and state of the art. International Journal of Environmental Research and Public Health 18(22), 11778.
Polyvagal Institute (2023, February). Polyvagal Theory: Summary, Premises, and Current Status. Author. Retrieved from: https://www.polyvagalinstitute.org/_files/ugd/8e115b_f8f82f01065b41dc85e7698fd4f99818.pdf?index=true
Porges, S. (2021). Polyvagal Theory: A biobehavioral journey to sociality. Comprehensive Psychoneuroendocrinology 7, 100069.
Porges, S.W. (2007). The polyvagal perspective. Biological Psychology 74(2), 116-143.
Porges, S. (1995). Orienting in a defensive world: Mammalian modifications of our evolutionary heritage. A Polyvagal Theory. Psychophysiology 32, 301-318.
Rutherford, B.R., & Roose, S.P. (2013). A model of placebo response in antidepressant clinical trials. The American Journal of Psychiatry 170(7), 723-733.
Shaffer, F., McCraty, R., & Zerr, C.L. (2014). A healthy heart is not a metronome: An integrative review of the heart’s anatomy and heart rate variability. Frontiers in Psychology 5, 1040.
Siegel, E. H., Sands, M. K., Condon, P., Chang, Y., Dy, J., Quigley, K. S., & Barrett, L. F. 2018. "Emotion fingerprints or emotion populations? A meta-analytic investigation of autonomic features of emotion categories." Psychological Bulletin, 144(4), 343-393.
Turner, E. H., Cipriani, A., Furukawa, T. A., Salanti, G., & de Vries, Y. A. (2022). Selective publication of antidepressant trials and its influence on apparent efficacy: Updated comparisons and meta-analyses of newer versus older trials. PLoS medicine, 19(1), e1003886.
Unyte (n.d.). Polyvagal Theory: Start with safety. Author. Retrieved from: https://integratedlistening.com/polyvagal-theory/
Unyte (2023, June 22). Disrupting overactive survival reactions with the Safe and Sound Protocol (SSP). Author. Retrieved from: https://integratedlistening.com/case-study/disrupting-overactive-survival-reactions-with-the-safe-and-sound-protocol-ssp/
Yasmin (2023). What is the hierarchy ladder in Polyvagal Theory? Polyvagal Teen. Retrieved from: https://polyvagalteen.com/polyvagal-theory-101/what-is-the-hierarchy-ladder-in-polyvagal-theory/
American Museum of Natural History (n.d.). What is a theory? Author. Retrieved from: https://www.amnh.org/exhibitions/darwin/evolution-today/what-is-a-theory
Barret, L.D. (2017). How emotions are made: The secret life of the brain. Boston: Houghton Mifflin Harcourt.
Barrett, L.D. (2023, March 25). Peripheral physiological changes during emotion. Chapter 1 endnote 26 from How emotions are made: The secret life of the brain. Author. Retrieved from: https://how-emotions-are-made.com/notes/Peripheral_physiological_changes_during_emotion#cite_note-8
Benish, S. G., Quintana, S., & Wampold, B. E. (2011). Culturally adapted psychotherapy and the legitimacy of myth: a direct-comparison meta-analysis. Journal of counseling psychology, 58(3), 279.
Bird, A. (2021). Understanding the replication crisis as a base rate fallacy. The British Journal for the Philosophy of Science. Retrieved from: https://d1wqtxts1xzle7.cloudfront.net/56560473/Replication-base-rate-fallacy_FINAL-libre.pdf?1526290158=&response-content-disposition=inline%3B+filename%3DUnderstanding_the_Replication_Crisis_as.pdf&Expires=1689372953&Signature=HnUWKVi40YZrjWv4RyYGjB8GSt2wRxNSyYdmUe3wNG~NwYkkbMv0rG0Y~PWotaD7xlq6b9DcfQXnwx1ddLVT7nkmX4teXXs9B7iI16d7JnEKVUAzcVXBOuVajgdMQXR~3y1fq1xNfMUXBE-zsqHNV3bSQdReBEMvuIr-l9pNFs~PiSnAaeUe91b-eYy5QCEzvKrTsGN~R-Y~qfEXb3NecIO6kokPLph9H4w0K7cpvu7x72RoBqBT3yIsQmQ5MAoGDrBFW0FnKZuJVUF1LlHBeSGC1ToTJ03feIhLc9OkJJB8i-s3crTxvN5BFdq9oKh-qRUSMAHRE6zmCG-XQ9jR8w__&Key-Pair-Id=APKAJLOHF5GGSLRBV4ZA
Brennan, M.A., Emmerling, M.E., & Whelton, W.J. (2014). Emotion-focused group therapy: Addressing self-criticism in the treatment of eating disorders. Counseling & Psychotherapy Research 15(1), 67-75.
Das, A. (2021). Testing the Longitudinal, Bidirectional Relation Between Respiratory Sinus Arrythmia and Perceived Emotion Regulation (Doctoral dissertation, Miami University). Retrieved from: https://etd.ohiolink.edu/apexprod/rws_etd/send_file/send?accession=miami161688520539524&disposition=inline
deVries, Y.A., Roest, A.M., Turner, E.H., & de Jonge, P. (2019). Hiding negative trials by pooling them: A secondary analysis of pooled-trials publication bias in FDA-registered antidepressant trials. Psychological Medicine 49, 2020-2026.
Doody, J.S., Burghardt, G., & Dinets, V. (2023). The evolution of sociality and the polyvagal theory. Biological Psychology 180, 108569.
Frank, J. D., & Frank, J. B. (1993). Persuasion and healing. Baltimore, MD: Johns Hopkins University Press.
Grossman, P., & Taylor, E.W. (2007). Toward understanding respiratory sinus arrhythmia: Relations to cardiac vagal tone, evolution and biobehavioral functions. Biological Psychology 74, 263-285.
Ekman, P., Sorenson, E.R., & Friesen, W.V. (1969). Pan-cultural elements in facial displays of emotion. Sicnce, New Series, 164(3875), 86-88.
Ekman, P., & Friesen, E.V. (1971). Constants across cultures in the face and emotion. Journal of Personality and Social Psychology 17(2), 124-129.
Graziano, P., & Derefinko, K. (2013). Cardiac vagal control and children’s adaptive functioning: A meta-analysis. Biological Psychology 94(1), 22-37.
Hanazawa, H. (2022). Polyvagal Theory and its clinical potential: An overview. Brain Nerve 74(8), 1011-1016.
Harmer, C.J., Duman, R.S., & Cowen, P.J. (2017). How do antidepressants work? New perspectives for refining treatment approaches. Lancet Psychiatry 4(5), 409-418.
Kawai, H., Kishimoto, M., Okahisa, Y., Sakamoto, S., Terada, S., & Takaki, M. (2023). Initial outcomes of the Safe and Sound Protocol on Patients with Autism Spectrum Disorder: Exploratory Plot Study. International Journal of Environmental Research and Publich Health 20(6), 4862.
Laborde, S., Moseley, E., & Mertgen, A. (2018). A unifying conceptual framework of factors associated to cardiac vagal tone. Heliyon 4(12), e01002.
Lehrer, P. (2013). How does heart rate variability biofeedback work? Resonance, the baroreflex, and other mechanisms. Biofeedback 41(1), 26-31.
Luck, A. (2022, October 29). Polyvgal Theory: A critical appraisal. Author. Retrieved from: https://alyssaluck.com/polyvagal-theory-a-critical-appraisal/
McCraty, R. (2011). Coherence: Bridging personal, social and global health. Alternative Therapies in Health and Medicine 53(3), 85-102.
Poli, A., Gemignani, A., Soldani, F., & Miccoli, M. (2021). A systematic review of a polyvagal perspective on embodied contemplative practices as promoters of cardiorespiratory coupling and traumatic stress recovery for PTSD and OCD: Research methodologies and state of the art. International Journal of Environmental Research and Public Health 18(22), 11778.
Polyvagal Institute (2023, February). Polyvagal Theory: Summary, Premises, and Current Status. Author. Retrieved from: https://www.polyvagalinstitute.org/_files/ugd/8e115b_f8f82f01065b41dc85e7698fd4f99818.pdf?index=true
Porges, S. (2021). Polyvagal Theory: A biobehavioral journey to sociality. Comprehensive Psychoneuroendocrinology 7, 100069.
Porges, S.W. (2007). The polyvagal perspective. Biological Psychology 74(2), 116-143.
Porges, S. (1995). Orienting in a defensive world: Mammalian modifications of our evolutionary heritage. A Polyvagal Theory. Psychophysiology 32, 301-318.
Rutherford, B.R., & Roose, S.P. (2013). A model of placebo response in antidepressant clinical trials. The American Journal of Psychiatry 170(7), 723-733.
Shaffer, F., McCraty, R., & Zerr, C.L. (2014). A healthy heart is not a metronome: An integrative review of the heart’s anatomy and heart rate variability. Frontiers in Psychology 5, 1040.
Siegel, E. H., Sands, M. K., Condon, P., Chang, Y., Dy, J., Quigley, K. S., & Barrett, L. F. 2018. "Emotion fingerprints or emotion populations? A meta-analytic investigation of autonomic features of emotion categories." Psychological Bulletin, 144(4), 343-393.
Turner, E. H., Cipriani, A., Furukawa, T. A., Salanti, G., & de Vries, Y. A. (2022). Selective publication of antidepressant trials and its influence on apparent efficacy: Updated comparisons and meta-analyses of newer versus older trials. PLoS medicine, 19(1), e1003886.
Unyte (n.d.). Polyvagal Theory: Start with safety. Author. Retrieved from: https://integratedlistening.com/polyvagal-theory/
Unyte (2023, June 22). Disrupting overactive survival reactions with the Safe and Sound Protocol (SSP). Author. Retrieved from: https://integratedlistening.com/case-study/disrupting-overactive-survival-reactions-with-the-safe-and-sound-protocol-ssp/
Yasmin (2023). What is the hierarchy ladder in Polyvagal Theory? Polyvagal Teen. Retrieved from: https://polyvagalteen.com/polyvagal-theory-101/what-is-the-hierarchy-ladder-in-polyvagal-theory/
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