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Book Review: The Polyvagal Theory in Therapy

In her new book, The Polyvagal Theory in Therapy: Engaging the Rhythm of Regulation, Deb Dana offers a window into the inner life of a traumatized person and a way out of trauma and back to finding joy, connection, and safety through enlightening theory, rich experiential practice, and practical steps.

“The autonomic nervous system,” Deb Dana writes, “responds to challenges in daily life by telling us not what we are or who we are, but how we are.”

Informing, guiding, and regulating our experiences, the autonomic nervous system tells us when we are safe and can proceed forward and when we are under threat and should retreat.

However, when trauma disrupts our experience, it also disrupts the autonomic nervous system, and the result is dysregulation, the interruption of the ability to feel safe.

“Trauma compromises our ability to engage with others by replacing patterns of connection with patterns of protection,” Dana explains.

Because our lived experience relies on our autonomic nervous system’s ability to detect safety — a term known as neuroception — when the autonomic nervous system becomes disrupted, it affects everything about how we move through the world, interact with those around us, and attune to ourselves and the world around us.

Yet trauma survivors are often judged by their actions. Dana writes, “We still too often blame the victim if they didn’t fight or try to escape but instead collapsed into submission. We make a judgement about what someone did that leads to a belief about who they are.”

The polyvagal theory, however, sees every response as an action in service of survival. In trauma, safety has been threatened, and the system that helps to regain a sense of safety is no longer able to regulate, detect safety, or restore connection.

Dana writes, “If we think of trauma as Robert Macy (president of the International Trauma Center) defined it, “an overwhelming demand placed upon the physiological human system,” then we immediately consider the autonomic nervous system.”

And because the autonomic nervous system is shaped over time through the experiences we have, we develop a habitual pattern — known as a personal neural profile — that then guides our actions and responses.

“We live a story that originates in our autonomic state, is sent through autonomic pathways from the body to the brain, and is then translated by the brain into the beliefs that guide our daily living. The mind narrates what the nervous system knows. Story follows state,” writes Dana.

Polyvagal theory describes the neural experience as well as the expectations for reciprocal connection it holds. When those connections are violated, the result is what is known as “biological rudeness” and an immediate feeling of threat.

The work of the therapist using polyvagal theory is to interrupt the traumatized client’s neural expectations in positive ways.

Dana writes, “Repeatedly violating neural expectations in this way within the therapist-client dyad influences a client’s autonomic assumptions. As a client’s nervous system begins to anticipate in different ways, the old story will no longer fit and a new story can be explored.”

Humans are social animals dependent on connection and coregulation for a sense of safety. Yet trauma makes connection dangerous and interrupts the process of coregulatory development.

While trauma can make clients feel as if they no longer need or want connection, their autonomic nervous system relies on connection, and it suffers.

“Chronic loneliness sends a persistent message of danger, and our autonomic nervous system remains locked in survival mode,” writes Dana.

Through mapping their autonomic states, clients begin to understand what triggers move them into a state of sympathetic activation and perception of danger, and what glimmers help restore them to a state of safety, hope and growth.

Developing present moment awareness and the ability to detect autonomic nervous system states opens the door for clients to experience state and story as separate experiences and ultimately reshape their nervous system.

The nervous system is relational in nature and Dana describes how therapists can help clients build their capacity for connection, reciprocity and repair: “When a rupture in the therapeutic relationship occurs, look for the moment when the work became too big of an autonomic challenge, name it for your clients, and take responsibility for the misattunement.”

Ruptures, much like trauma itself, can be opportunities for change, growth, and a deeper understanding. While the experience can feel uncertain and the path unknown, the ability to intertwine states — and disrupt the all-or-nothing responses so common in trauma — is crucial to experiencing play, intimacy, awe, and elevation.

The hope polyvagal theory offers is that, in time, clients feel attuned to their autonomic nervous systems, develop a sense of self-compassion that allows them to see their responses as attempts at survival and not simply clinical diagnoses, and honor the innate wisdom of the autonomic nervous system to find their way back to safety, connection, and the rhythm of regulation.

The Polyvagal Theory in Therapy: Engaging The Rhythm Of Regulation

W.W. Norton & Company, June 2018

Hardcover, 320 Pages

Book Review: The Polyvagal Theory in Therapy

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Claire Nana

Claire Nana is a regular contributor and book reviewer for Psych Central.

APA Reference
Nana, C. (2018). Book Review: The Polyvagal Theory in Therapy. Psych Central. Retrieved on September 29, 2020, from
Scientifically Reviewed
Last updated: 14 Oct 2018
Last reviewed: By a member of our scientific advisory board on 14 Oct 2018
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