Friday, February 16, 2024

Introduction to Polyvagal Theory (PVT)

 Polyvagal theory (PVT) is a multi-disciplinary approach to understanding the effect of trauma on the body and mind.  The term “poly” is used here to denote the two branches of the Vagas nerve, a dorsal primitive branch that is unmyelinated, and a ventral branch that develops after birth and is tied to volitional motor function, primitive instincts, and social behavior. (Porges) While complex, the theory describes a more primitive “dorsal vagal complex,” tied to patterns of “immobilization and freezing” which result in elevated levels of stress, social anxiety, fear, anger, and dissociation.  Polyvagal theory stresses the importance of the Vagas nerve as the primary part of the parasympathetic nervous system (PANS).  Vagal tone is a descriptive term for the body’s ability to adapt to stress and describes the ability to self-soothe and return to a calm baseline.     

Polyvagal theory and modern neuroscience intersect with much of classical oriental and traditional Chinese medicine (hereafter TCM).  By examining where these fields of study intersect, amazing correlates are found.  Expanding classical TCM theory to include aspects of polyvagal theory and neurodevelopmental psychology offers new insight into aspects of TCM that were poorly understood by including the role of the nervous system in traditional oriental medicine (TCM).  Reinterpreting the classics of TCM with the understanding of how the nervous system affects the fluid, qi, and blood dynamics in the body offers exciting new possibilities for the role of our medicine in the integrative treatment of trauma, certain types of neurological disease, and PTSD. 

Development of the Nervous System

To show a neurological approach to TCM, it is necessary to expand and redefine aspects of the nervous system to include TCM principles.  Our nervous system is made up of two components:  the central nervous system (the brain and spinal cord), and the peripheral nervous system.  The peripheral nervous system (PNS) serves as the connection between the brain and the body and regulates many body processes that are outside of our conscious control and automated.  The involuntary, automatic part of the PNS is called the autonomic nervous system (ANS), and it has three components: the sympathetic autonomic nervous system (SANS), parasympathetic autonomic nervous system (PANS), and the enteric nervous system (ENS).  For the purposes of traditional Oriental Medicine, the balance of yin and yang in the body is most closely reflected by the balance between the sympathetic and parasympathetic nervous system.  (Fang Li, 2015)   

The sympathetic or SANS is the yang part of the nervous system.  It is a measure of the effect of sensory stress on the body.  It has a positive charge on a voltmeter or galvanometer.[1] It provides stimulation, the jump start so to speak for movement, and integrates the fight/flight/freeze response. (Alshak & Das., 2023)  Upon stimulus, hormones target adrenergic receptors to release neurotransmitters such as epinephrine or norepinephrine to cause contraction, and in states of high arousal, O2-rich blood is shunted to the large motor muscles in the body:  contractile strength increases through the heart, respiratory rate increases, medial muscles groups, and digestion are denervated (down regulated or frozen) to allow the body to mobilize resources in preparation for flight. 

The yin aspect of the ANS is called the parasympathetic autonomic nervous system (PANS).  It has a negative charge on a voltmeter.[2] The PANS serves to calm, inhibiting stress hormones that cause contraction, redirecting resources to digestion, growth, and development. Gastric secretions, smooth muscle interaction, heart rate variability, AV node conduction, and erection in the penis are dictated by the PANS.  (Waxenbaum JA, [Updated 2023]) The Vagas nerve (cranial nerve 10) is the largest part of the PANS and vagal tone is a qualitative description of the body’s adaptability to stress, either physical or emotional.  It exits from a more primitive region of the cervical spine and intersects with many organs and regions in the body including the limbic system.  As such, it is deeply involved in emotional regulation.  (McLaughlin KA, 2015)   The Vagas nerve (CN X) includes both motor and sensory functions and serves as a counterbalance to the SANS. 

Working together, sympathetic and parasympathetic work in harmony to regulate vital processes and coordinate our sense of time and space through the vestibular system. These are mutually antagonistic systems, and except for the heart, stimulating one system diminishes the effect of the other.  A biceps muscle held in a strongly flexed position, for example, a (+) sympathetic charge, will show corresponding inhibition of its antagonist muscles in extension, the triceps (a (-) charge).  In its role of helping digestion, rest, reproduction, and a state of emotional well-being, the Vagas nerve reflects the patency of yin/Jing in the body. 

 The largest and most complex part of the ANS is called the Enteric Nervous System (ENS). Having approximately 400 – 600 million neurons, the human ENS is found in two major networks—the myenteric and submucosal plexuses below the diaphragm.  ​(Waxenbaum JA, [Updated 2023 Jul 24])​   It is formed in utero, and has its most active developmental state in the peri-natal period through the first several years.  Its innervation is both sympathetic and parasympathetic and is the entire pathway for the absorbing the nutrients of food and drink.  (referred to in TCM as the production of post-natal qi).  It begins with a series of ganglionic plexuses which follow the line of digestion from the trachea to the anus.  The ENS is supported through near-constant parasympathetic innervation, with SANS and stress hormones down-regulating its function proportional to the insult.  “Rest and digest,” repair, and other parasympathetic functions are inhibited under patterns of fight/flight/freeze.   

The ENS is made up of the autonomic nervous system, but it works independently of the central nervous system and can stand alone.  For this reason, it is called the gut-brain. 


[1] In his book “Chinese Acupuncture” Goerge Soulis de Morant includes polarity charges when describing the sympathetic and parasympathetic nervous system.  165 acupuncture points were measured with distinct decreases in electrical conductivity on actual sites versus just a few mm away for a point. Additionally, earth scientists have proved that the earth has a mildly negative charge (-), while everything ‘not earth’ has a mildly positive charge.  A human who stands on an un-grounded surface has a mildly positive charge.

[2] Multiple clinical trials of the polarity effects of grounding have found that the human body (un-grounded) keeps a mildly positive charge, and when standing on a grounded surface will hold a slightly positive negative charge.  Un-grounded, we are slightly yang, and grounded we are more yin.

 

 

The Bibliography

 In lieu of a references page for each blog post, I have a included the references for the entire subject, to be expanded as content increases. For ease, I reference the last name of the author in the blog paragraph for more important works.

Sources:

https://en.m.wikipedia.org/wiki/Vagal_tone. (n.d.). Retrieved from https://en.m.wikipedia.org/wiki/Vagal_tone

Alshak, M. N., & Das., J. M. (2023). Neuroanatomy, Sympathetic Nervous System. In https://www.ncbi.nlm.nih.gov/books/NBK542195/. StatPearls Publishing; 2023 Jan-. Retrieved from https://www.statpearls.com/

 Brampton, Scott.  The Nature of Trauma: My talks with a Dead Guy. Decemebr 2021

Casale J, B. T. (2023). Physiology, Vestibular System. Treasure Island, FL: StatPearls Publishing. doi:https://www.ncbi.nlm.nih.gov/books/NBK532978/

Fang Li, T. H.-T.-X.-Z. (2015, October). What is the Acupoint? A preliminary review of Acupoints. Pain Medicine, Volume 16, 1905–1915. Retrieved from https://doi.org/10.1111/pme.12761

Feldenkrais, Moshe.  Awareness Through Movement.   2978. Paris France.

Gieysztor EZ, C. A.-B. (2018). Persistence of primitive reflexes and associated motor problems in healthy preschool children. Arch Med Sci., 167-173. doi:10.5114/aoms.2016.60503. Epub 2016 Jun 13. PMID: 29379547; PMCID: PMC5778413.

Greenwood, MD, Michael Braving the VOID.

Heller, Lawrence PHD.  LaPierre, Aline. Healing Developmental Trauma: How Early Trauma Affects Self-Regulation, Self-Image, and the Capacity for Relationship. 2012 by North Atlantic BooksISBN: 9781583945117 (ISBN10: 1583945113)

 Lowen, Alexander.  https://en.wikipedia.org/wiki/Body_psychotherapy

 Masgutova, P. S. Svetlana (2015). Reflex Integration for Post-Trauma Survival and Recovery. Por t a l t o Ne uro d e v e l op m e n t a n d Le arn i n g, 22.

McDonald, K. G. (March 23, 2020). Integrating Primitive Reflexes Through Play and Exercise (5 Books).

McLaughlin KA, R.-N. L. (2015). Low vagal tone magnifies the association between psychosocial stress exposure and internalizing psychopathology in adolescents. . J Clin Child Adolesc Psychol., 44(2):314-28. doi: 10.1080/15374416.2013.843464. Epub 2013 Oct 24. PMID: 24156380; PMCID: PMC4076387.

Modrell AK, T. P., & Jan-., 2. (n.d.).

Myers,  LMT. Thomas. Anatomy Trains:  Myofascial Movement for Manual and Movement Therapists.   2009 Elsevier Limited.  ISBN: 978-0-443-10283-7

Page, C. t. (May 2023). Physiology, Vestibular System. https://www.ncbi.nlm.nih.gov/books/NBK532978/.

Porges, S. W. (n.d.). The vagal paradox: A Polyvagal Solution. (K. I. Traumatic Stress Research Consortium, Ed.) Comprehensive Psychoneuroendocrinology. doi:https://doi.org/10.1016/j.cpnec.2023.100200

Pryor, Karen P.P. (ND)  2-Day Advanced Course: Primitive Reflex Integration. PESI. Retrieved from https://catalog.pesi.com/item/2day-advanced-primitive-reflex-integration-117797

 Reich, Wilhelm.  https://en.wikipedia.org/wiki/Body_psychotherapy

 Soulie De Morant, George  (Author), L. G. (January 1, 1994). Chinese Acupuncture (978-0912111315 ed.). Paradigm Pubns.

Svetlana Masgutova, P. S. (2015). Reflex Integration for Post-Trauma Survival and Recovery. Por t a l t o Ne uro d e v e l op m e n t a n d Le arn i n g, 22.
 
Van der Kolk, Bessel MD. The body keeps the score: Brain, mind, and body in the healing of trauma

 Waxenbaum JA, R. V. ([Updated 2023 Jul 24]). Anatomy, Autonomic Nervous System. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK539845/

Thursday, February 15, 2024

The Role of Primitive Reflexes

The development of the ANS, including proper vagal tone and a healthy fight/flight/freeze response is dependent on primitive reflexes that present in the earliest life stages.  Primitive reflexes are innate instinctual and involuntary movements that initially offer protective movements to sensory stimuli. (Pryor) More simply, they are life-saving movements to protect us from harmful sensations.  The withdrawal from a hit object wasn't learned - it is a reflex.

Located in the dorsal part of the spinal cord (hence the intersection with PVT), the reflexes are present in the pre- and perinatal period.  Many of the primitive reflexes help safe passage of an infant’s head and neck through the birth canal and disappear after birth.  (McDonald, March 23, 2020)   The most primitive of these reflexes are tied to the breath and freeze responses, and over time ideally lead to both coordinated muscle movement and the development of a healthy fight-or-flight response. It is the soothing an infant receives in the formative years that creates the parasympathetic baseline for the child as it matures through growth, development, and socialization. A peaceful baby learns the world is a safe place, and the body-type that develops reflects, in part, the level of safety and comfort they experienced the first years of life.

In a healthy environment, primitive reflexes integrate into postural reflexes that allow for balance and coordinated movement in the vestibular system (standing, rotating, seeing, hearing and time). The vestibular system is the sensory system “that creates the sense of balance and spatial orientation to coordinate movement.”  (Page, May 2023) It integrates all 5 senses, with visual stimuli accounting for about 70% of neural input. (Casale J, 2023) Put more simply, every new movement a baby makes while exploring its new world is overwhelming to a developing nervous system until it can support a sense of orientation and safety. (Where, when am I?) From the perception of a developing child, many sensations are overwhelming to the nervous system, reigniting a freeze response.

In its elegance, the nervous system adjusts for changes to body position in time and space with each millimeter of movement.  This is done by incremental changes in vagal tone to preserve just the right amount of tension and relaxation in a muscle group – too much tension, and you cannot turn your head. Too little tension, and your head would flop to the side.  It requires ‘just the right amount’ of coordinated flexion-extension-rotation for smooth movement in the body, and this is LEARNED!  We don’t come into this world with the ability to grasp or move the way we might like.   The clumsy attempts that a baby makes to grasp the bottle or toy builds myelin in the nervous system, allowing the nervous system to coordinate intentional movement.  Myelinated nerves are what allow you to grab the cookie or pet the dog.

The movement patterns of these reflexes also help to build the limbic aspect of our brain, the emotional center. As previously said, for infants, movement and external stimuli are potentially life-threatening dangers, and each new skill (such as holding the head up) involves exploring the movement, chemically self-soothing, and then laying down new vagal pathways that ensure an internally safe environment for the child.  As children mature and begin school, a higher level of behavior must be integrated to include social interaction and this is called socializationSocialization addresses all my primitive reactions when interacting with the outside world, including potential conflict.  When Tommy takes my ball on the playground, will I take a rock to him, or can I shake this off and find another activity?  To a 4-year-old, biting Tommy may seem an obvious solution to the problem.  As a 40-year-old, biting Tommy might not be the best choice in terms of reconciling differences (or creating meaningful connection).  The limbic system receives the nerve impulses from emotional experience, determines the threat level (friend or foe? e.g., primitive reactions), and integrates that into the vestibular system.  Your sense of time, space, and safety (hence your musculature) are learned responses to stimuli that you had before you could speak, walk or think. Ideally, a child who has been properly "socialized" learns to refrain from social interactions that have the potential to cause harm to self or others, either physically and emotionally. 

Enter Character Structure and the Physical Body

Without understanding the role of early reflexes, early psychologists, psychiatrists and somatic body workers explored the role that the external environment of the child plays on emotional character development.  They saw a consistent pattern of body type, musculature and frame that correlated to certain types of behavior or emotional defenses.  Alexander Lowen, MD called these “muscle defenses.” The premise was that people develop ways of moving and “being” that are reflective of their early childhood experiences; we never leave them behind but integrate these experiences into a full personality.  This style of body-type psychotherapy never took hold, however, in part due to the negative associations made with the NAMES at certain developmental stages in a child's life.  Perceived as pejorative rather than simply an illustration of normal developmental stages, the names referenced in Reich and Lowen's work had strong negative associations in the culture and were basically dismissed.  [1]

(Feldenkrais) 

Fast forward 60 years to Dr. Lawrence Heller and his work on developmental psychology.  Mirroring the understanding provided by these early pioneers in mental health, the Neuro-attunement Relational Model (NARM) offers a clear, cogent breakdown of the development of the child personality and defensive structure in clear, time dependent levels. With the understanding that 100% of us go through these developmental stages, my internal narcissist stands for a 3-year-old aspect of my personality: “ME" "I’M THE BEST.”  Learning to recognize, acknowledge and release these primitive emotional states is part of maturation.  

Family Systems and Constellation Work

Later therapeutic models offered new understanding of how external conditioning creates both positive and negative associations, including birth order, affect the psyche of a young child.  Family Systems and Constellation Work has appeared as an offshoot from Family Centered therapy by examining how various members of the family group reflect aspects of our own personality structure, some positive, some that need some help.  Words like “protector,” “martyr,” “controller,” “nurturer,” reflect aspects of the personality that are externalized in childhood (meaning someone represented this aspect of the personality), with an eye to both recognizing those aspect within self, and then healing, or refining the behavior to include empathy and compassion. 

There are many subsets to these types of therapy and many areas where they overlap.


[1] Schizoid, Oral, Masochist, Rigid, Psychopathic

Introduction to Polyvagal Theory (PVT)

 Polyvagal theory (PVT) is a multi-disciplinary approach to understanding the effect of trauma on the body and mind.  The term “poly” is u...