Polyvagal Theory and The Face Heart Connection

5/9/2016
The Polyvagal Theory and the

Face-Heart Connection:
Neural mechanisms mediating social
behavior
Stephen W. Porges, Ph.D.

Distinguished University Scientist
Kinsey Institute
Indiana University Bloomington
Copyright © 2016 Stephen W. Porges
Connectedness
A Biological Imperative
‘the fittest may also be the gentlest,
because survival often requires mutual
help and cooperation’
Dobzhansky, T. (1962). Mankind evolving. New Haven, CT: Yale

University Press.
Neurobiology is our guide

• Helps identify environmental features
that foster feelings of safety.
• Explains how feeling safe “optimizes”
behavior by turning off defense and
increasing social behaviors.
• Explains the positive and negative
feelings associated with social
interactions.
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Connectedness is Dependent
on Safety
Feeling safe is a necessary prerequisite
before strong social relationships can be
established and before social support
can be effective in “healing” physical
and mental illnesses.
Connectedness:
A Biological Imperative
 The body’s need to co-regulate biobehavioral
state through engagement with others
 Connectedness is the ability to mutually
(synchronously, and reciprocally) regulate
physiological and behavioral state.
 Connectedness provides the neurobiological
mechanism to link social behavior and both
mental and physical health.
The Neural Love Code
Social Social
Engagement + Bonding
Safety Proximity Contact Bonds
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Building “Blocks” of Healthy

Relationships
Social Social
Engagement + Bonding
Safety Proximity Contact Bonds
Features of Clients with

Psychiatric/Behavioral/Educational
Problems
Difficulties
1. Feeling “safe” with others
2. Being in physical proximity with others
3. Being touched or touching others
4. Establishing “trusting” social relationships
X
Safety X
Proximity X
Contact X
Bonds
Co-regulation: Phase I
Social Engagement Behaviors
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Co-regulation: Phase I
Social Engagement Behaviors
Face to face behaviors

•Facial expressions
•Gestures
•Prosodic vocalizations
Co-regulation: Phase II
The importance of physical contact while
immobilizing without fear
• Maintains a physiological state that

supports health, growth, and restoration.
• Optimizes the ability to rest, relax, sleep,
digest, and perform bodily processes.
• Enables feelings of trust, safety, and love.
• A challenge for mammals!
Mammal-Reptile Interactions:
Immobilization without fear
• Reciprocity is missing!
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“Safety” Optimizes the Human

Experience
• Safety is based on social

connectedness providing a “neural”
expectancy, which promotes both
• Being safe is not the equivalent of
removing threat
Trauma:
Chronic disruption of connectedness
 Distorts social awareness

 Displaces social engagement behaviors
with defensive reactions
 fight/flight
 immobilization (dissociation)
 Interferes with healthful reciprocal “co-
regulation” of state
The Vagal Paradox
• Bradycardia are mediated by the vagus

and a risk index (potentially lethal)
• Heart rate variability is primarily mediated
by the vagus and a protective factor
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Vagal Paradox
• 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.
The Autonomic Nervous System:
Supra-diaphragmatic
(above diaphragm, new,
ventral, myelinated,
mammalian) vagus
Sub-diaphragmatic
(below diaphragm,old,
dorsal, unmyelinated)
vagus
Supra-diaphragmatic
vagus (myelinated)
Sub-diaphragmatic
vagus (unmyelinated)
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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 phylogenetically-
ordered 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.
Evolution and the ANS
“new” vagus
“old” vagus
SNS
Three Phylogenetic Stages of

Neural Development of ANS
Stage 1: Primitive unmyelinated vagus (DVC)
• immobilization behaviors (i.e., fainting,
shutdown, dissociation)
Stage 2: Sympathetic Nervous System (SNS)
• “fight-flight” behaviors
Stage 3: Myelinated mammalian vagus (VVC)
• social communication  homeostasis
• enables social interactions to regulate
physiology and promote health growth and
restoration (balance between unmyelinated
vagus and SNS) Copyright © 2016 Stephen W. Porges
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Physiological State Colors our

Perception
S - -R
Physiological State
The Quest for Safety:

Emergent Properties of Physiological State
Environment
outside the body
inside the body
Nervous System
Neuroception
Safety Danger Life threat

Spontaneously engages others
eye contact, facial expression, prosody Defensive strategies
supports visceral homeostasis death feigning/shutdown (immobilization)
Defensive strategies
fight/flight behaviors (mobilization)
Phylogenetic Organization of
the ANS: The Polyvagal Theory
head
“old” vagus
limbs viscera
trunk
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Immobilization With Fear:
…. I read about the body immobilizing instead of
fighting or fleeing. I am now 69 and when I was
18 I was nearly strangled and then sexually
assaulted. Years later I was speaking with my
daughter about this incident and she was
disbelieving that I did what I did and that I froze. I
felt so ashamed and judged. After reading your
theory I cannot tell you how excited and
vindicated I feel.. I am crying right now.
(personal communication, September 6, 2013)
Corticospinal Pathways
Sympathetic Nervous head
System
limbs viscera
trunk
Corticobulbar pathways head

“new” vagus
limbs viscera
trunk
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The Face-Heart Connection:

A Critical Component of a Social Engagement System
• At birth mammals have bidirectional neural
communication between the face and the heart,
which 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.
• The face reflects Polyvagal state.
Deconstructing the “Mammalian”

Social Engagement System
cortex
brainstem
Muscles of Head Turning

Mastication Cranial Nerves
V,VII,IX,X,XI
Middle Ear Bronchi
Muscles
Facial Larynx Pharynx Heart

Muscles
environment

Observable Deficits in Autism (and other psychopathologies)
• Lack of prosody
• Poor eye contact and difficulties in social communication
• Blunted facial expressivity
• Difficulties in behavioral state regulation (hypervigilant,
anxious, distractible, impulsive, tantrums, hypoarousal)
• Compromised vagal regulation (e.g., state regulation,
digestion)
• Difficulties in listening, following verbal commands,
speech-language delays
• Sound sensitivities
• Oral motor defensiveness (e.g., ingestive behaviors)
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cortex
brainstem

V,VII,IX,X,XI
Middle Ear Bronchi
Muscles

Muscles
environment
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!
The Role of the Middle Ear:

Extraction of Human Voice
• Evolution and middle ear bones

• Transfer function of the middle ear
• Frequency band of perceptual advantage
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Facial Nerve (cn VII)
Structures of the Ear
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What happens when the middle

ear muscles are not working
correctly?
Middle Ear Muscles:

Role in Extracting Human Voice
Borg &t Counter, 1989

Scientific American
Atypical Sensory Experiences

“… the prevalence of abnormal sensory
phenomena may be over 60% for
individuals with autism. …..Difficulties in auditory
perception can be disabling, especially for children, who may become
distressed and unable to understand speech in a noisy classroom
environment, and therefore find themselves at an educational
disadvantage relative to their peers. The development of language and
use of language in a social context may also be adversely affected.
"(Alcantara et al., 2004) .
“… abnormalities are particularly evident in hearing (Goldfarb, 1963;

Ornitz, 1974; Grandin & Scariano, 1986) and a hyper-reactivity to
auditory stimulation (i.e., hyperacusis) (Grandin & Scariano, 1986;
Rosenhall, Nordin, Sandstrom, Ahlsen, & Gillberg, 1999). “
“An increased awareness of environmental noises and difficulty in

hearing speech in background noise are also prominent auditory
features in autism (Grandin & Scarianoi, 1986; Boatman, Alidoost,
Gordon, Lipsky, & Zimmerman, 2001). “
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Auditory Hypersensitivities:
A Feature of Autism?
46% autism (n=146)

Porges et al. (under review)
46% autism (n=230)
Dr. Ira Cohen (personal communication)
57% autism (n=177)
Dr. David Skuse (personal communication)
Auditory Processing: Autism
Porges et al (2013) International Journal of Psychophysiology
HIV: Auditory Processing
Heilman et al (2013) Biological Psychology
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Bell’s Palsy:
Lateralized paralysis of the facial nerve
Impact on the social engagement system

• Drooping of the muscles of the face
• Inability to close the eyelid and to blink
• Difficulty chewing
• Hyperacusis
http://www.famouspeoplearehuman.com/famous-
people-bells-palsy.htm

cortex
brainstem

V,VII,IX,X,XI
Middle Ear Bronchi
Muscles

Muscles
environment
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5/9/2016
Autism: Atypical Facial EMG
Typical
Autism
Lower Face Upper Face

The Face-Heart Connection:

A Critical Component of a Social Engagement System
HIV disrupts the Social Engagement System

resulting in a face that is not “social” and a
physiological state (decreased vagal regulation
of the heart) that promotes defensive behaviors.
When Faces Do Not Work!
Gabriel Metzu, The Sick Child
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Disruptions in the Social

Engagement System
• The Social Engagement System is
disrupted in PWS.
• Different facial cues
Disruptions in the Social

Engagement System
• The Social Engagement System is
disrupted in PWS.
• Different facial cues
• Different features conforming
Obicularis Oculi and Gaze
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Muscles of the Upper Face
Autism: Atypical Affect Recognition
Autism: Atypical Affect Recognition
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Oxytocin: Affect Recognition
Domes et al., 2012, Psychoneurocrinology

cortex
brainstem

V,VII,IX,X,XI
Middle Ear Bronchi
Muscles

Muscles
environment
Respiratory-Heart Rate Rhythms
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5/9/2016
Cardiac Vagal Tone:

Model of State Regulation
Porges et al. (1996) Developmental Psychobiology
Neural Platform for Social Behavior:

A Developmental Model
Porges & Furman (2010) Infant and Child Development
Developmental Model of
Self-Regulation
Level IV: Appropriate Social Interactions
Level III: Motor Behavior Control
Level II: Regulation of the Vagal Brake
Level I: Baseline Vagal Tone (RSA)
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Level I Assessments
Homeostatic Functions
RSA in Preterm and Fullterm

Infants
30
25
Preterm (n=116)
Fullterm (n=125)
20
PERCENT
15
10
0
0 1 2 3 4 5 6 7 8 9 10
VAGAL TONE INDEX (RSA)

Porges (1992) Pediatrics.
Maturational Shift in RSA in

Preterm Neonates
1.50
Respiratory Sinus Arrhythmia
1.25
1.00
(VNA)
0.75
0.50
32 33 34 35 36 37
Gestational Age (weeks)
Doussard-Roosevelt et al. (1997) Child Development
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5/9/2016
Autism: Depressed Vagal Regulation
Bal et al. (2010) Journal of Autism and Developmental Disorders
Autism: Depressed Vagal Regulation
Van Hecke et al. (2009) Child Development
HIV: Depressed Vagal Regulation
Heilman et al. (2013) Biological Psychology
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Level II Assessments
Challenge to Homeostasis
(“The cost of doing business”)
The Vagal Brake:

Model of Self-Regulation
Porges et al. (1996) Developmental Psychobiology
State Regulation Disorders
• Are there individuals who have great

difficulties regulating state, especially in
presence of others?
• Are these difficulties indexed by a
compromised social engagement
system including depressed vagal
regulation of the heart?
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Borderline Personality Disorder:

Loss of Vagal Regulation in Social Context
Austin et al. (2007) Brain and Cognition
Abuse History:
Poor Recovery of Vagal Regulation
Dale et al. (2009). Applied Psychophysiology and Biofeedback
EC infants have dampened

vagal reactivity
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Dissolution: Definition
The higher nervous arrangements

inhibit (or control) the lower, and thus,
when the higher are suddenly rendered
functionless, the lower rise in activity
John Hughlings Jackson
Dissolution:
Polyvagal response strategies are

phylogenetically ordered with newest
components of the ANS responding
first
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5/9/2016
Polyvagal Theory:
A Phylogenetic Hierarchy of Response
Strategies
Structure Function VVC SNS DVC
Head Communication +
Limbs Mobilization +
Viscera Immobilization +
Dissolution:
Polyvagal Response Strategies
• Removal of VVC Tone
• Increase in Sympathetic Tone
• Surge in DVC Tone
Hierarchical Model
Polyvagal State
Myelinated (supra-diaphragmatic) Vagus
Sympathetic Nervous System
Unmyelinated (sub-diaphragmatic) Vagus
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Safety:
Neural and Cultural Definitions
The social, cultural, and legal

definitions and expectations of safety
and risk often have little to do with how
our nervous system reacts!
Detecting Safety:
Neuroception
• The nervous system’s detection of risk in others
– without awareness.
• Can dampen defensive systems and facilitate
social behavior (safety).
• Can promote defensive strategies of mobilization
(fight/flight) or immobilization (shutdown,
dissociation).
• Triggers of “defense” are often related to a
history of physical restraint or social isolation.
Neuroception
Environment Behaviors
Safe Social Engagement
Danger Fight/Flight
Life threat Shutdown
Physiological State Copyright © 2016 Stephen W. Porges
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5/9/2016
Neuroception
Environment Visceral state

Safe Ventral vagus
Danger SNS
Life threat Dorsal vagus
Neuroception
Environment Behaviors
Safe Social Engagement
Play
Loving Behaviors
Neuroception:
Promotes mental and physical health
Environment Visceral state
Safe Ventral Vagus
SNS
Dorsal Vagus
28
5/9/2016
Connectedness is Dependent
on Safety
Feeling safe is a necessary prerequisite
before strong social relationships can be
established and before social support
can be effective in “healing” physical
and mental illnesses.
“Safety” Optimizes the Human

Experience
• Safety is based on social

connectedness providing a “neural”
expectancy, which promotes both
• Being safe is not the equivalent of
removing threat
A New Paradigm?
• If social behaviors are not learned, are they

emergent properties of specific neurophysological
states?
• Could intervention strategies be focused on
manipulating or supporting the neurophysiological
states (e.g., engaging and exercising feedback
loops) from which social behavior would
spontaneously occur?
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Hierarchical Model
Polyvagal State
Myelinated (supra-diaphragmatic) Vagus
Sympathetic Nervous System
Unmyelinated (sub-diaphragmatic) Vagus
New Model
Clinical Polyvagal State Behavior
Optimal regulation
Social communication
Myelinated Vagus State regulation
Learning
Fight/flight
Hyperacusis Hyperarousal
Hypertension Hypervigilance
Gut problems SNS Avoidant
Anxiety disorders Oppositional behaviors
Drug abuse Social withdrawal
Affect limitations
Self-medication
Hypotension Immobilization
Vasovagal syncope Unmyelinated Vagus Behavioral shutdown
Fibromyalgia Dissociative states
Risk of suicide
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
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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
• Atypical state regulation
• Low threshold to become fight/flight
• Low threshold to be dissociative
• Fibromyalgia
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
• 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)
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
• Fibromyalgia
Stage IV (chronic shutdown and dissociative)
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Therapeutic Model
Intervention
Therapeutic Presence
Polyvagal Processes in Therapy

Stage Polyvagal Process
1. Experience therapy in safe • Neuroception of safety
context • Remove predator cues
• Add acoustic cues of a loving
mother (prosodic voice)
2. Perform ‘neural’ exercises moving • Exercise ‘vagal brake’ to enhance
between biobehavioral states autonomic flexibility and
resilience
3. Become explicitly aware of • Mental exercises involving brain
subjective experiences associated functions that are dependent on
with each biobehavioral states maintaining ‘ventral’ vagal state
4. Develop personal narrative and • Emergent property of resilience,
new ‘neural expectancies” of safety while moving between states of
while shifting biobehavioral states immobilization, mobilization,
and safety (‘ventral’ vagal, social
engagement).Copyright © 2014 Stephen W. Porges
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5/9/2016
The Autonomic Nervous System:

A Polyvagal Perspective
The autonomic nervous system “reacts” in a

predictable hierarchical manner.
The Polyvagal Theory uses evolution as an
organizing principle to identify three neural
ANS circuits, forming a phylogenetically-
ordered response hierarchy, that regulate
adaptation to safe, dangerous, and life
threatening environments.
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.
The Look of Love*
The look of love is in your eyes

The look your smile can’t disguise
The look of love is saying so much more
Than just the words could ever say
And what my heart has heard
well it takes my breath away
I can hardly wait to hold you

Feel my arms around you
*Burt Bacharach & Hal David
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5/9/2016
The Look of Love:

The look of love is in your eyes
[gaze- orbicularis oculi]
The look your smile can’t disguise
[facial muscles]
The look of love is saying so much more
[facial, neck, lip muscles]
Than just the words could ever say
[prosody]
The Look of Love:

And what my heart has heard
[vagal regulation of the heart, middle ear
muscles, face-heart connection]
well it takes my breath away
[vagal regulation of the bronchi]
I can hardly wait to hold you
Feel my arms around you
[immobilization without fear (not restraint)
Additional Information
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5/9/2016

The Polyvagal Theory and the

Stephen W. Porges, Ph.D.

Copyright © 2016 Stephen W. Porges

Dobzhansky, T. (1962). Mankind evolving. New Haven, CT: Yale

Copyright © 2016 Stephen W. Porges

Neurobiology is our guide

Copyright © 2016 Stephen W. Porges

Copyright © 2016 Stephen W. Porges

Copyright © 2016 Stephen W. Porges

The Neural Love Code

Safety Proximity Contact Bonds

Copyright © 2016 Stephen W. Porges

Building “Blocks” of Healthy

Safety Proximity Contact Bonds

Copyright © 2016 Stephen W. Porges

Features of Clients with

Copyright © 2016 Stephen W. Porges

Copyright © 2016 Stephen W. Porges

Face to face behaviors

Copyright © 2016 Stephen W. Porges

• Maintains a physiological state that

Copyright © 2016 Stephen W. Porges

Copyright © 2016 Stephen W. Porges

“Safety” Optimizes the Human

• Safety is based on social

Copyright © 2016 Stephen W. Porges

 Distorts social awareness

Copyright © 2016 Stephen W. Porges

The Vagal Paradox

• Bradycardia are mediated by the vagus

Copyright © 2016 Stephen W. Porges

Copyright © 2016 Stephen W. Porges

The Autonomic Nervous System:

The Polyvagal Theory

Copyright © 2016 Stephen W. Porges

Evolution and the ANS

Three Phylogenetic Stages of

Physiological State Colors our

The Quest for Safety:

Safety Danger Life threat

Copyright © 2016 Stephen W. Porges

Immobilization With Fear:

Copyright © 2016 Stephen W. Porges

Corticobulbar pathways head

Copyright © 2016 Stephen W. Porges

The Face-Heart Connection:

Deconstructing the “Mammalian”

Muscles of Head Turning

Facial Larynx Pharynx Heart

Social Engagement System

Copyright © 2016 Stephen W. Porges

Deconstructing the “Mammalian”

Muscles of Head Turning

Facial Larynx Pharynx Heart

Detached Middle Ear Bone:

The Role of the Middle Ear:

• Evolution and middle ear bones