The Dark Side of Polyvagal Theory

Mental health care is important. Often it is literally a lifesaving practice. And so the various improvements to the science of mental health have been vital steps forward. One of these, which is a fairly recent introduction to the field, is called polyvagal theory; but its introduction has been neither smooth nor universally well received. Consequently its practice, and its use in therapy, has been fragmented — with part of the market providing it as a framework for conventional psychotherapy, and part of the market offering it for sale by untrained, unlicensed providers who call themselves coaches.

As always, we'll get started with a quick overview of polyvagal theory (PVT) — which, by necessity, is going to be an abbreviated high-level view. Under PVT, there are three states your autonomic nervous system might be in. The first of these is called safe. This is the desirable one, and it's ideally where you always want to be. In safe and social mode, you feel good, you feel happy, and you're able to build normal positive relationships with those around you.

The second state is mobilized, meaning you're in the fight or flight mode, the physiological reaction to danger. It's also called hyperarousal or the acute stress response. All sorts of chemicals are dumped into your bloodstream: epinephrin, cortisol, dopamine, and more. Your body stops nonessential tasks like digesting food and sucks blood away from vulnerable extremities. Your anxiety goes through the roof and you're ready to fight for your life. PTSD episodes often involve this state.

The third is immobilized. You're in such extreme danger that you're shut down. In some cases, actually frozen and unable to move. The worst PTSD dissociative episodes can put you into this state.

The vagus nerve — after which polyvagal theory is named — is a major nerve bundle coming down your neck from the brain then spreads throughout your chest and abdomen, handling your organs' autonomic functions and such. Without detouring into a physiology lesson, suffice it to say that it handles the sympathetic and parasympathetic nervous system functions mainly responsible for putting you into and out of the three states. All of this is accepted physiological science and is not in any dispute.

The dispute arose in 1994 when Stephen Porges gave a talk at the annual meeting of the Society for Psychophysiological Research, in which he proposed polyvagal theory. He suggested that the parasympathetic system is split into a ventral branch, active when you're in safe mode; and a dorsal branch, active when you're in immobilized mode. The middle mode, hyperarousal, is controlled by the sympathetic nervous system, and Porges kept that, only giving it the name mobilized.

You can already sense a little bit of the controversy to follow. PVT came from a completely legitimate and respected distinguished Professor of Psychiatry with solid neurological credentials, yet he made some proposals in physiology that are not widely accepted, and in some cases outright rejected. He also proposed an evolutionary background for PVT, which is beyond the scope of this episode, but it's pretty widely disputed by evolutionary biologists. He also paved the way for PVT to be used in psychotherapy, with many in the field embracing it, and many in the field dismissing it as pseudoscience. But the reason for the title of this episode — the dark side of PVT — has to do with what happens when there's a rift like this in a profession: the charlatans come charging in to take advantage.

These charlatans come in the form of — as they call themselves — polyvagal coaches. What these coaches sell is something that should be of grave concern to the psychological profession — and by extension, to everyone.

Porges' original idea with PVT was to help victims of trauma; to propose a framework for therapists to help people get out of the mobilized state and learn to live in the safe state. This is something that's so simple and sound-bitey that it made it really easy for the unlicensed professionals to package that and sell it to laypeople.

The effects of trauma, often suffered in childhood, and often in the form of sexual or physical abuse, is perhaps the single greatest unnecessary cost to society. Trauma victims are all around us, and many of us are counted among them. Untreated trauma can be found at the root of much harmful and destructive behavior. Our prisons are full of trauma victims. Poor neighborhoods are full of trauma victims. People who drop out of school, who have chemical dependency issues, who have chronic problems with the law or with relationships, almost always have serious trauma in their past. Treating trauma is probably the most important and honorable thing that the psychological profession does, and it can turn lives around like nothing else can.

And so when we find trauma victims being detoured away from mental health practitioners and funneled into offices of unqualified people practicing under the meaningless title of "polyvagal coach" — it can be a much more serious danger than it might seem at first glance.

I know something of how this works. Full disclosure: my wife is a Marriage and Family Therapist, a profession that requires an advanced degree in psychology that includes 700 hours of practicum; 2400 hours of supervised clinical experience over three years (different states vary a bit); a number of different licensing exams administered by the state board; and 40 hours of continuing education every two years. All such practitioners are regulated by the state board. They are mandated reporters. They are required to be HIPAA compliant. The board requires them to follow strict ethical guidelines. They have to carry insurance. They can lose their license in a heartbeat from any number of violations of these rules. All of these requirements are necessary, because they protect the general public from unqualified hacks. Many counseling clients are on the verge of suicide or have a history of violent crime, and even the best therapists don't have a 100% success rate at saving lives. That at-risk clients be safely and professionally guided away from destructive behavior is a crucial, crucial service, and it's essential that unqualified hacks not be allowed to masquerade as psychological care providers. This is really important stuff.

However, the law allows it. Anyone can simply call themselves a "coach" of anything, PVT included.

To be a coach? No experience needed at all, and no guidelines. "Coach" is not a recognized psychological or medical profession, so nobody regulates it. Many polyvagal coaches sell certifications to one another through contrived institutes, allowing them to deceive clients by calling themselves "certified" polyvagal coaches or whatever; but such certifications are legally meaningless, they're simply marketing gimmicks invented by the coaches themselves. Certainly many of these certifications provide professional guidelines to the coaches, and usually with the best of intentions; but as there is nothing legally binding to them, they provide no meaningful protection to the general public.

Of particular concern is that these polyvagal coaching services are aggressively target marketed at trauma victims — those who are at the most risk. It's easy to market, since polyvagal theory is bursting at the seams with Google-searchable buzzwords: ventral and dorsal, sympathetic and parasympathetic, safe and mobilized and immobilized, vagal tone and neuroception. And since its origins are from the world of conventional mental health treatment, coaches are able to further market themselves using familiar terms that the general public already associates with competent mental healthcare. Looking on one unlicensed coach's website, I find a whole page of familiar pop-psychology jargon: somatic experiencing, attachment theory, inner child work, codependency.

Confusing the issue further is that a lot of polyvagal coaches are, like Porges himself, actually licensed psychological providers. Polyvagal theory is something of a popular buzzword, and so there's consumer demand for it. At-risk trauma victims are on the Internet looking for it. Thus, it makes a certain amount of sense for some therapists to market their services using that terminology, and a client would be in good hands with such a provider. Yet that's only the lucky client who, like spinning a roulette wheel, navigated a confused marketplace and happened to end up with a trained professional. The average person cannot meaningfully distinguish any difference between a "certified polyvagal coach" and a licensed "polyvagal therapist". The bottom line is that having actual trained professionals mixed in with untrained and possibly incompetent coaches leaves the general public vulnerable.

Particularly distasteful is the high-end of the market. While you have to look pretty hard to find mental health care sessions for more than about $175/hr — that's about the top of the legitimate marketplace in most areas — predatorial providers often start at rates more than double this much, capitalizing on naive high-income victims who were drawn in by all the right buzzwords, always presented with a touchy-feely New Age vibe. Google the term polyvagal coaching and you'll find ten-week programs in the mid five figures, or coaching with supplementary yoga or diet services, all comically overpriced. I even found two "clinics" that operate on a multilevel marketing model: they give you polyvagal coaching, and then they sell you a polyvagal certification so you can then coach others. Friends, this is not how legitimate mental health services are provided.

But let's set all that aside for a moment and focus on polyvagal theory as it is practiced by legitimate professionals. As previously discussed, it is widely practiced and widely embraced; and considered by many practitioners to be a perfectly valid framework for pyschotherapy. But that's about where its praises end. The criticism of polyvagal theory is equally widespread, and focuses not on its utility, but on its underlying science.

First, it's considered fundamentally unscientific because it makes no claims specific enough to be testable. There is no evidence supporting most of Porges' proposals for the evolutionary and physiological underpinnings. For example, it's well established that the vagus nerve transmits all the information needed to move the body between the normal and hyperarousal states, but there's neither evidence nor plausible foundation to suggest that anything other than the brain plays any role in deciding to go into these states — a stark contrast to one of PVT's fundamental proposals. Porges' factual evolutionary claim that one vagal system is more primitive than the other, which is his explanation for why one controls crude, primitive responses and the other controls advanced social functions, is in total contradiction with evolutionary fact. This type of criticism goes on at length. If you'd like to read more of it, see the references and further reading suggestions at the bottom of this page (or even just get started on the Wikipedia section).

(It's worth noting, of course, that PVT does not satisfy the requirements to be elevated to the status of a theory, which requires support from multiple lines of evidence, substantial experimental replication, and testable predictions. It is a hypothesis at best, but not so much even that, as it is not really a suggestion to explain an observation. It's best described as a conjecture. But since "polyvagal theory" is its common name, I call it that in recognition of the fact that if I didn't, nobody would know what I was referring to and I'd sound like a maniac.)

Of all the scholarly criticism of polyvagal theory, I think this one line from Wikipedia sums it up best:

Its appeal may lie in the fact that it provides a very simple (if inaccurate) neural/evolutionary backstory to already well-established psychiatric knowledge.

So one final word of caution to anyone who is seeing a polyvagal therapist or coach, or any such person. First, verify that they are licensed to practice psychology in your state. Second, their office should display a master's or doctorate degree in psychology, psychiatry, or social work. If they have both of those things, then you are all set, please enjoy your sessions, and a high five from Skeptoid for bettering your life. If your coach does not have both of those things, then simply stop giving them any more money right now, and switch to a properly trained professional. Mental health services consist of a lot more than properly marketed New Age buzzwords.

By Brian Dunning
Follow @BrianDunning