Can you feel unsafe even when you don’t know it?

How does the body perceive cues of safety?

How does soothing through social engagement help one cope?

How has the pandemic compromised our ability to cope?

In our last pandemic hub post, “Embrace Your Suffering,” founder Kimberly Keiser mentioned that requests for mental health services have been significant during the pandemic.

Kimberly also appeared on Dakota News Now at the start of the pandemic to discuss the increased need for couples therapy and the escalation of relational distress between couples during the pandemic.

A new study published in October 2020 shows how adverse or traumatic histories impact the way our nervous system reacts to the trauma of the pandemic — and how mental health has been subsequently impacted.

To better understand the outcome of this study, it is useful to get some basic information about Steven Porges’ Polyvagal Theory. Polyvagal Theory helps us understand how behavioral and emotional states are driven biological states, specifically, our evolutionary survival defense system.

In this pandemic hub post, we will briefly outline some of the main aspects of Polyvagal Theory and discuss how the pandemic may impact overall relational and mental health, especially in those who were previously exposed to and impacted by trauma.

What Is Polyvagal Theory?

Perception is the conscious awareness of a stimulus or experience. Neuroception is the body’s detection of the perception of safety or risk in the environment without awareness.

Our emotional world is linked to a physiological state that also supports what Dr. Porges calls “health, growth and restoration.” In this way, there isn’t a distinction between mind and body; there is an integration of and communication between mental and physiological processes.

In a culture in which we typically think of mind and body being separate, this way of thinking about emotions being expressed through the body is a paradigm shift not only for many people, but also for clinical therapists.

Polyvagal Theory also describes how autonomic, or automatic, nervous system states are optimized during safe social interactions and disrupted during states of defense.

Trauma is a physiological reaction to threat, and anxiety is a physiological state of distress — both of which may lead to a retraction away from social engagement. Polyvagal Theory explains how safe social interactions recruit neural circuits that support health, growth, and restoration, while cues of danger and life threat recruit neural circuits that disrupt bodies’ processes.

Many people come to therapy because they don’t feel safe enough to have social interactions — or, in the case of sex therapy, because medically unexplained physical sexual dysfunctions are creating, among other symptoms, a social disconnect. During the pandemic, our bodies are reacting to cues of threat, and our physiological states alter our perception of the world.

The pandemic presents a bit of a “chicken and egg” effect in the sense that, if threatened, we may be less likely to lean into healthy attachments and social interactions — but, given the nature of the pandemic, even if we are adapted to engage in social interaction as a form of self-soothing, we are unable to, due to physical and social distancing required to be safe. In either case, our ability to regulate effectively may be compromised.

Polyvagal Theory uses evolution as an organizing principle to understand neural regulation of the human autonomic nervous system and an enabler of social behavior.

In general, social engagement occurs during states of physiological relaxation. While we can’t describe the entire neurological basis for Polyvagal Theory here, those interested can start with Dr. Porges resource page of publications.

Essentially, the theory proposes that there are three neural circuits that evolved from reptiles to mammals, in which the oldest circuits respond to life threat by shutting down, to circuits that respond to danger by engaging in fight or flight, to circuits that are physiologically adapted to safety.

Therapists often observe these states in clients in sessions and work with them as part of symptom reduction and trauma therapy. Therapists often ask themselves, “How can I help my client get their body into a different physiological state that will support a more adaptive behavior?”

Everything that encompasses the therapeutic alliance is geared toward creating safety for the client, although many therapists or clients may not even be aware that the basic physiological states that are achieved through secure attachment impact a neurological system that is in a state of danger for the client.

How Our Bodies Respond to Risk

If our nervous system doesn’t detect risk, we can spontaneously engage with one another with reciprocity, or mutual dependence or influence.

If our nervous system does detect risk, it may move into fight or flight or immobilization behaviors, which remove benefits of the safety. If we can’t fight or flee, and our nervous system makes the decision there is no way out, our system will shut down and move into immobilization.

This is an ancient reaction that is prevalent in reptiles because, when they are under threat, immobilization enables them to reduce the metabolic demands so that they can, for example, hold their breath for longer periods of time or defecate in order to stop the metabolic demand required for digestion. This evolutionary survival strategy has been efficacious for reptiles, but for mammals, that is not necessarily the case.

As Dr. Porges’ work illustrates, the concept of immobilization with fear as a defense strategy is a missing concept in psychology and psychiatry. It should be noted, however, that forced immobilization (restraint) is a frequent feature of trauma and chronic abuse.

Polyvagal Theory provides one explanation for immobilization with fear. For example, we have all heard stories of the assault victim who was unable to move or defend themself during the assault. The idea that threat to the system can lead to immobilization and not just fight or flight is a noteworthy construct and critical to understanding the impact of trauma on human beings.

Again, unlike our reptilian ancestors, when the nervous system of human mammals shuts down, or immobilizes, it’s not as easy for the nervous system to recover.

Why the Social Engagement System Is So Important

At the heart of Polyvagal Theory is the concept of the social engagement system.

Connectedness is central to our biological functioning. Many studies have shown the negative impacts of social isolation or social deprivation at any stage of the lifecycle. In order to connect, we need to convey and perceive, both consciously and unconsciously, cues of safety. To connect with others, mammals need to signal that they are safe to approach or be approached. It is important to co-regulate through secure attachment.

The social engagement system supports the nervous system to maintain homeostatic functions. Homeostasis is the ability to maintain a relatively stable internal state despite external stressors.

When the social engagement system isn’t working, we see the effects in many psychopathology, including:

Lack of vocalizations that express positive emotional states
Difficulty with social communication
Poor eye contact
Facial expressions that are blunted
Challenges to regulate behavior, including hypervigilance, anxiety, distractibility, impulsiveness, tantrums, or hypoarousal
Difficulties in listening, following verbal commands, or speech-language delays
Sound sensitivities and no understanding of what people are saying
Oral motor defensiveness, including ingestive behavior alterations (e.g. not being able to eat or eat a wide variety of foods)

How the Pandemic Is Affecting Our Ability to Cope

To what extent are social engagement behaviors disrupted during the pandemic?

We are being confronted with chronic feelings of threat throughout the pandemic in one form or another, which does effect the way the nervous system can regulate or co-regulate with others.

In general, any type of trauma shifts our autonomic nervous state, distorts social awareness, displaces social engagement behaviors with defensive reactions (fight/flight or immobilization [dissociation]), interferes with healthful reciprocal “co-regulation” of state, and disrupts neurophysiological regulation.

Safety is based on social connectedness providing a “neural” expectancy, which promotes both mental and physical health. True experiences of “feeling” safe keep the nervous system out of states of defense. Feeling safe optimizes homeostasis, while being threatened compromises homeostasis.

There are some predictable health consequences of threat disrupting the nervous system function, as it can only support “health, growth, and restoration” when it is not being used for defense. Loss of social engagement system results in a neurophysiological state that supports defensive behaviors and, when chronic, promotes mental and physical disorders.

Medically unexplained symptoms (MUS) — for example, IBS or fibromyalgia — are frequent co-morbidities of trauma and chronic stress. These symptoms are manifestations of the nervous system no longer operating in a homeostatic way. The organs are not getting the neurofeedback they need for optimal functioning because they have been shifted to react to external threat.

The ongoing stress of the pandemic is producing a similar impact to our physiological states. Many people may be having more symptoms as a result, which is one explanation for why not only are individuals seeking mental health services to a greater degree, but couples also have increased distress.

Polyvagal Theory also looks at how efficient our bodies are at responding to threat once traumatized through the concept of vagal efficiency. Research has shown that people who have undergone traumatic experience are less likely to cope productively and maintain homeostasis in the face of new threat.

If people have more traumatic experiences in their history, they are being more autonomically reactive during the pandemic.

How to Get Help

If you are experiencing increased physiological disruption, anxiety, depression, or other medically unexplained symptoms, psychotherapy can be very helpful during this time.

Like many other aspects of the pandemic, silver linings can appear as clients may be pushed to treat old problems when the pandemic escalates old symptoms to new states of dysregulation that are no longer sustainable.

Therapists are co-regulators. The physiological state is very important in the therapeutic realm; it is an intervening variable between the stimulus and the response — the experience and the reaction.

When the therapeutic alliance can serve as a mechanism to co-regulate a client’s physiological state, they may be able to reprocess many of the experiences that have led to traumatic reactions.

Explore Our Mental Health Services

Looking for more pandemic coping resources to help you stay calm and regulated? Check out the COVID-19 resource center from Integrated Listening Systems (or any of the other blog posts in our own pandemic resource hub!).