Rehab Kids

Polyvagal Theory
Pathways to Stillness
Deborah Dana, LCSW, LICSW

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Polyvagal Theory
Pathways to Stillness
Deborah Dana, LCSW, LICSW

Rehab Kids

ZNM059816
7/24
Copyright © 2024

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Rehab Kids
 Materials Provided By

Deb Dana, LCSW, LICSW, is a clinician and consultant specializing

in using the lens of Polyvagal Theory to understand and resolve
the impact of trauma and create ways of working that honor
the role of the autonomic nervous system. She developed the
Rhythm of Regulation Clinical Training Series and lectures inter-
nationally on ways Polyvagal Theory informs clinical work. She
is a founding member of the Polyvagal Institute, clinical advisor
at Khiron Clinics, and an advisor to Unyte.

Deb is the author of The Polyvagal Theory in Therapy: Engaging

the Rhythm of Regulation (Norton, 2018), Polyvagal Exercises
for Safety and Connection: 50 Client-Centered Practices (Norton,
2020), Befriending Your Nervous System (Sounds True, 2020),
Anchored: How to Befriend Your Nervous System Using Polyvagal
Theory (forthcoming from Sounds True), co-editor of Clinical
Applications of the Polyvagal Theory: The Emergence of Polyvagal-
Informed Therapies (Norton, 2018), and creator of the Polyvagal
Flip Chart (Norton, 2020).

To learn more, visit rhythmofregulation.com or

www.polyvagalinstitute.org.

For speaker disclosures, please see the faculty biography in activity advertising.

Materials that are included in this course may include interventions and modalities that are beyond the
authorized practice of certain professionals. As a licensed professional, you are responsible for reviewing
the scope of practice, including activities that are defined in law as beyond the boundaries of practice in
accordance with and in compliance with your profession’s standards.
 As required by several accrediting boards, speaker and
activity planning committee conflicts of interest
(including financial relationships with ineligible
organizations) were disclosed prior to the start of this
activity. To view disclosure information, please see
activity advertising.

Please note: Following links (including QR code scanning) in

this, or any, document may take the user outside of the
educational activity.
 Pathways to Stillness Disclosures
A Polyvagal Guide
The following organizations support my work.

Polyvagal Institute
W.W. Norton
Sounds True
PESI
UNYTE/iLS

Deb Dana, LCSW Khiron Clinics

Veterans’ Administration
rhythmofregulation.com
polyvagalinstitute.org

Polyvagal Theory was developed by Stephen Porges in the

1970’s and 1980’s and first presented to the clinical world
in the 1990’s. Since that time hundreds of peer reviewed
With gratitude to Stephen Porges for his
papers have referenced the theory and as we learn more development of Polyvagal Theory…
about the workings of the autonomic nervous system,
Polyvagal Theory continues to be relevant to our
understanding of our human biology.
The science of connection…
There is lots we don’t yet know about our human biology
and while we have many hypotheses, the coming years will
The science of feeling safe enough to fall in love with life…
bring additional research to guide the application of this
theory.
Porges S. W. (2023). The vagal paradox: A polyvagal solution. Comprehensive
psychoneuroendocrinology, 16, 100200. https://doi.org/10.1016/
j.cpnec.2023.100200
© 2024 Deb Dana, LCSW © 2024 Deb Dana, LCSW

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 Flow of the Workshop

Basics of Befriending

Wellcome Library London

The Biology of Stillness The autonomic nervous
Barriers and Benefits
system is at the heart of
our lived experience…
Pathways to Stillness

Stillness Practices

Becoming Safely Still

© 2024 Deb Dana, LCSW © 2024 Deb Dana, LCSW © 2022 Deb Dana, LCSW

Intervening Variable Befriending Your Nervous System

Co
nn n
ec tio
tio ec
ot
n Pr

Autonomic Neuroception - autonomic intuition

Response
Hierarchy - responding in service of safety and connection
Event
Co-regulation - wired for connection
© 2024 Deb Dana, LCSW © 2024 Deb Dana, LCSW

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 Neuroception
Neuroception is the word Stephen Porges coined to Tune in to Neuroception
describe the way the autonomic nervous system takes in
information without involving the thinking parts of the brain.

The autonomic nervous system responds to signals of

welcome and warning from:
Our responsibility is to tune into what happens in our own
• inside our bodies (embodied) nervous system…

• outside in the environment around us …and be curious about what is happening in another
(environmental) nervous system.

• in the relationships between us and others

(relational)
© 2024 Deb Dana, LCSW
© 2024 Deb Dana, LCSW

Find the pair of words that fits for your

A Dynamic Equation
nervous system.

Cues of Safety Cues of Danger

When cues of safety outweigh cues of danger, change is possible,

options appear, and new stories emerge.

When cues of danger outweigh cues of safety, survival strategies

activate and we get stuck in a survival story.

© 2024 Deb Dana, LCSW © 2024 Deb Dana, LCSW

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 Hierarchy of Response
Ventral Vagus safe and engaged
Parasympathetic Nervous System (supradiaphragmatic)
Ventral Vagus creates healthy homeostasis connect, communicate
system of safety and connection
divided at the diaphragm
health, growth, restoration
Dorsal Vagus
Sympathetic Nervous System (subdiaphragmatic)
survival response: move
system of mobilization daily function: healthy
protection through action out of awareness, out of
regulation of the digestive
connection, into collapse
system
Parasympathetic Nervous System
Dorsal Vagus
system of immobilization © 2024 Deb Dana, LCSW
© 2024 Deb Dana, LCSW protection through disappearing

The Sympathetic Nervous System Emergent Properties

Middle part of the spinal cord

(thoracic and lumbar)
daily function: helps regulate breath
• Our biology supports or restricts access to body

and heart rhythms and brings sensations, thoughts, feelings, behaviors, beliefs.
mobilizing energy
• The emergent properties of each state are only available
when we are in that state.
survival response:
fight and flight • When we move from state to state, we gain and lose
access.

© 2024 Deb Dana, LCSW © 2024 Deb Dana, LCSW

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 Ventral Vagal Oversees the System
All Systems Online
This is not a cognitive choice…it is a biological one.
navigate the world with safety and flexibility
Parasympathetic Nervous System explore options
Ventral Vagus see possibilities
connect
create

regulate blood flow and heart rate

energize to meet the demands of the day
Sympathetic Nervous System
mobilize in play
move with passion

Parasympathetic Nervous System digest

Dorsal Vagus rest
© 2024 Deb Dana, LCSW restore
© 2024 Deb Dana, LCSW

Emergent Properties of Ventral Sympathetic Nervous System Takes Over

co-regulate and self-regulate

connect to self, others, the world, Spirit Parasympathetic Nervous System
system offline
Ventral Vagus
tune into the moment and tune out distractions
resourced and resourceful
reach out for, and offer, support experience a sense of unease
lose cognitive abilities
compassion, self-compassion Sympathetic Nervous System move out of social engagement
explore options mobilize for fight and flight
feel the effects of cortisol and adrenaline
flexible, resilient
…a story of connection, hope
communication, and possibility Parasympathetic Nervous System
digestion out of balance
© 2024 Deb Dana, LCSW Dorsal Vagus
© 2024 Deb Dana, LCSW

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Emergent Properties of Sympathetic Survival Dorsal Vagal System in Charge
a polarized world
alarmed, hypervigilant Parasympathetic
attention on danger — miss and misread signs of safety Nervous System system offline
Ventral Vagus
disrupted connection from self, others, world, Spirit
…a story of an unsafe world

© 2024 Deb Dana, LCSW

and unsafe people system offline
Sympathetic Nervous System

zone out
shut down
dissociate
Parasympathetic disappear
© 2024 Deb Dana, LCSW
Nervous System collapse
Dorsal Vagus suffer with digestive problems

Co-Regulation
Emergent Properties of Dorsal Survival
body enters conservation mode
numb, foggy, collapsed
lost connection to self, others, the world, Spirit
disconnected, untethered, floating
alone, lost, abandoned
safety and hope feel unreachable

…a story of disappearing, disconnection, and despair

© 2024 Deb Dana, LCSW We are wired for connection…

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 A Biological Imperative
Trauma is a chronic disruption of connection.
(Porges) We are wired for connection…

We wish for connection…

We wait for connection…

How does the need for connection land in your system?

A story of friendship?
Porges S. W. (2022). Polyvagal Theory: A Science of Safety. Frontiers in integrative
neuroscience, 16, 871227. https://doi.org/10.3389/fnint.2022.871227 A relentless search?
A hopeless experience?
© 2024 Deb Dana, LCSW
© 2024 Deb Dana, LCSW

The Social Engagement System

An Ongoing Autonomic Conversation

Five cranial nerves joined in

the search for connection
The autonomic nervous system both sends and searches for through our…
cues of safety or danger.
eyes
We are continuously broadcasting and receiving.
ears
Our work is to stay tuned in to the autonomic conversation.
voice

© 2024 Deb Dana, LCSW

face and head movements
© 2024 Deb Dana, LCSW
Used with permission: copyright Kate White ppncenter.com

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 Parasympathetic Nervous System
The autonomic nervous system is Ventral Vagus
shaped and regulated through interactions with others.

Stillness
Sympathetic Nervous System

Through information sent from someone’s eyes, voice,

face, and gestures, we know if they are safe to approach Parasympathetic Nervous System
Dorsal Vagus
and can intentionally use these pathways to send an
invitation for connection.
© 2024 Deb Dana, LCSW © 2024 Deb Dana, LCSW

Safely Still Barriers to Stillness

The act of beginning to become quiet brings familiar cues

of danger and can overwhelm present moment awareness

Immobilization without fear becomes too big a neural

challenge for the autonomic nervous system

Individual beliefs about the meaning of action and inaction

Societal beliefs about the meaning of action and inaction

© 2024 Deb Dana, LCSW

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 Benefits of Stillness

Radun, J., Maula, H., Rajala, V., Scheinin, M., & Hongisto, V. (2021). Speech is
special: The stress effects of speech, noise, and silence during tasks requiring
Improves memory and cognition concentration. Indoor air, 31(1), 264–274. https://doi.org/10.1111/ina.12733

Bernardi, L., Porta, C., & Sleight, P. (2006). Cardiovascular, cerebrovascular, and
respiratory changes induced by different types of music in musicians and non-
Cardiovascular and respiratory stabilization musicians: the importance of silence. Heart (British Cardiac Society), 92(4), 445–
452. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1860846/

Stress reliever Kirste, I., Nicola, Z., Kronenberg, G., Walker, T. L., Liu, R. C., & Kempermann, G.
(2015). Is silence golden? Effects of auditory stimuli and their absence on adult
hippocampal neurogenesis. Brain structure & function, 220(2), 1221–1228.
Increased access to new ideas and perspectives https://doi.org/10.1007/s00429-013-0679-3

Lim R. (2018). Benefits of quiet time interventions in the intensive care unit: a
literature review. Nursing standard (Royal College of Nursing (Great Britain) :
An intentional act of restoration... 1987), 32(30), 41–48. https://doi.org/10.7748/ns.2018.e10873

© 2024 Deb Dana, LCSW © 2024 Deb Dana, LCSW

Stillness

Stillness is a complicated autonomic experience.

What happens when our biology doesn’t support stillness?

How do we move into a moment of feeling safety still

without activating survival states?

Stillness is… (from each state what do you hear?) Stillness Poetry
© 2024 Deb Dana, LCSW

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 Using Continuums
The Power of a Continuum

Draw a line to represent your stillness continuum. Let your

nervous system show you the shape.
• when we see both ends of something, we can see what
Name the two ends. Take time to find the words that
is in between
represent your experience of stillness and the absence of
stillness that takes you into survival.
• move out of all or nothing thinking
Travel from one end to the other marking several points
• see more than a point in time: see the progression of
along the way. Notice how your continuum takes you
steps along the way
along the hierarchy.

© 2024 Deb Dana, LCSW © 2024 Deb Dana, LCSW

Creating Your Stillness Continuum Safely Still

Moving
At Peace

Distracted
Spacious
Numb

Slow rhythm
Quiet
Disconnectiong
Not here Present

© 2024 Deb Dana, LCSW

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 Attending to Stillness Exploring Pathways to Stillness

Step 1: gather the information

listen to your nervous system
use neuroception as a guide
track your response via the hierarchy
• moving into stillness

Step 2: create a plan • breathing into stillness

• speaking the language of stillness

Exercise Worksheets:
An Exercise in Stillness • listening to the stories of stillness
Attending to Stillness
Exploring the Story of Stillness
© 2024 Deb Dana, LCSW © 2024 Deb Dana, LCSW

Connecting in Stillness

Bring moments of stillness into your clinical work.

Share a group experience of stillness.

Become safely still.

© 2024 Deb Dana, LCSW

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Exercise: Attending to Stillness

This exercise continues the exploration of autonomic experiences of

quiet with attention to exploring the conditions that support a client’s

ability to rest.

Background: Over the course of evolution, humans developed the ability

to become still as a way to rest and renew. Sometimes, instead of feeling

nurtured by stillness, the beginning of calm can bring cues of danger and

a sense of vulnerability. As your autonomic nervous system begins to

move from action to quiet, you might feel your sympathetic nervous

system reacting with mobilizing energy or you might feel pulled into

dorsal vagal collapse. Bring curiosity to identifying the elements that

add safety to your experiences of rest so you can find your way to the

places where you can receive the benefits of moments of quiet.

Steps:

1. Identify restful environments.

Many people label environments with lots of people, activity,

sound, and movement as restless. Workplaces and the daily

Polyvagal Exercises for Safety and Connection (Norton, 2020)

12
 commute are two environments that are often cited as mobilizing

and not restorative. In comparison, the natural environment and

at home are often identified as places to rest and renew.

- Identify environments at the two ends of your experience

—places that bring you a feeling of restlessness and

places that offer you the opportunity to rest.

- Attend to the qualities of the spaces that bring you a

rhythm of rest
location

size and shape of the space

colors, sounds, and textures

2. Decide if you want to be by yourself or with others (people or

pets).

3. Make a list of the combination of qualities you’ve identified. Go

out and find places that offer those.

4. Create a plan to regularly visit the places you identified as

offering the opportunity for rest.

5. Create your own space, incorporating qualities you identified that

support you in resting in a moment of stillness.

Polyvagal Exercises for Safety and Connection (Norton, 2020)

13
Tips: Stillness is a complicated autonomic experience and many clients

find sympathetic mobilization interrupts their ability to rest, or they get

pulled into dorsal vagal collapse when they begin to become quiet. By

helping your clients attend to the qualities of places that support safety

in quiet, this exercise helps them first identify where they can safely

experience stillness and then experiment with entering those places.

Polyvagal Exercises for Safety and Connection (Norton, 2020)

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 Exploring Stillness

Within you there is a stillness and sanctuary to which you can retreat at any time
and be yourself. Herman Hesse

Have you touched an experience of stillness? Do you wonder what new stories an

experience of being safely still might bring? Biologically, stillness is a blend of

autonomic states dependent on the actions of the vagus. The ability to become still

without stimulating shut down is a complicated and challenging physiological process.

The vagus with its two branches can bring us alive in joy, passion, ease, and calm, or

take us into a survival state of dissociation, numbing, and collapse. It is only when

these two vagal pathways, the ancient energy of immobilization and the new energy of

connection join together, that we can experience stillness without fear.

Experiencing safety in stillness allows us to be comfortable with silence, attune with

another person and meet them in wordless connection, gather information from self-

reflection, have restful sleep, and be present to the joy of intimate experiences.

Explore the following questions to discover where your moments of stillness can be

found.

✴ Who are the people in your life with whom you feel safe to be still? Which

relationships includes stillness?

✴ What are the qualities of places of stillness for you? Consider whether you are drawn

to quiet, a certain sound, being with another person or alone in solitude, inside or out

copyright Deb Dana 2020

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 in nature. Listen to your autonomic nervous system as you consider what brings you

to stillness.

✴ Where are the places in your everyday life you can find a moment to be safely still?

Is there a place in your home, in your neighborhood, a place you pass by regularly?

Is there a special place you visited that comes alive in your memory?

✴ When are the times when you can most easily find stillness? Is there a time of day

that invites you into stillness? Or a certain day of the week? Is there an activity you

engage in that offers time for stillness?

✴ How do you know when you are in need of a moment of stillness? What cues does

your autonomic nervous system send you?

Through practicing coming into stillness, you begin to shape your autonomic nervous

system in new ways and your capacity to be safely still deepens. As you learn to find

your way into a place of being safely still, it is time to turn inward and listen to the stories

that emerge.

In stillness the world is restored. Lao Tzu

copyright Deb Dana 2020

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 Exploring the Story of Stillness

Name It

Words offer a gentle entry into the autonomic experience. This top-down
experience of stillness is often the safe starting point for clients.

• Experiment with different words that describe the experience of being

safely immobile (e.g., still, quiet, inactive, at rest, embraced, held). For
each word, have your client notice their autonomic response and the
beliefs that accompany the state.

• Help your client find a word that brings safety into their experience of
stillness.

Observe It

Use of an observer state to consider an image is a way to titrate an

experience of exploration.

• Ask your client to describe a picture of stillness. What does a safe

moment of immobilization look like? Looking at the picture, can they hold
onto their sense of safety? What are the words that can anchor the
experience?

Imagine It

Guided imagery brings the experience alive through multiple senses and is
a way to experiment with embodying a state of immobilization without fear.

The Polyvagal Theory in Therapy (Norton, 2018)

17
• Have your client create richly detailed imagery of feeling safely
immobilized. Guide them into an embodied experience of the imagery. In
the beginning, inhabiting the image for a micro-moment might be the
client’s “just right” experience. Help your client engage in repeated micro-
moments and explore adding further cues of safety to support the ability to
prolong the experience of being safely still.

Experience It

Real-time experiments within the safety of the therapeutic relationship offer

opportunities for clients to use co-regulation to enlist their dorsal vagal
system in immobilizing without moving into protection.

• Have your client explore coming into physical stillness. Sequence slowly
from motion to rest while tracking autonomic state shifts. The autonomic
shifts may be strong or subtle, so it is important to attend to moment-to-
moment tracking. Ask your client to narrate the autonomic experience
and follow it with them.

• Find moments to sit together in silence during the therapy session. Move
into stillness through the linking of your own ventral and dorsal vagal
circuits and then encourage your client to sense the cues of safety your
stillness is sending. Support them in tracking their autonomic shifts. What
specific cues help your client find silence connecting and not life-
threatening? Play with subtle changes and track the state shifts and
accompanying stories.

The Polyvagal Theory in Therapy (Norton, 2018)

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Experiment with It

Finding ways to explore moments of safe immobilization in everyday life

takes the practice beyond the therapy hour, offering the “small and often”
opportunities needed to reshape autonomic response patterns.

• Help your client create a list of small experiments to try between sessions.
These may include identifying moments to practice stillness in social and
work situations; creating a plan to engage in brief moments of self-
reflection; allowing periods of silence in a conversation; practicing sitting
quietly next to a person; and finding a safe person with whom to explore
physical contact including holding hands and hugging.

The Polyvagal Theory in Therapy (Norton, 2018)

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 Your Personal Stillness Continuum

✴ Draw a line — let your nervous system show you the shape.

✴ Label the two ends of your stillness continuum. What word do you use to describe

stillness? Maybe you think about quiet, solitude, or presence. Find the word that fits

your stillness experience. Then, name the other end of the continuum. What word

represents your state when you aren’t able to find safety in stillness? Perhaps it is

fear, invisibility, or disconnection.

✴ Now begin to move between the two ends. Identify the micro-shifts in autonomic

experience. Name the small steps. What lies between? Where is the moment when

you move from the safety of stillness into an experience of distress?

With a stillness continuum you can track the moment-to-moment nuance of state shifts

that either support or challenge your moments of feeling safely still. And with the ability

to place yourself along the continuum, you can use that awareness to deepen into a

moment of stillness or to explore practices that bring safety back into the experience.

© 2024 Deb Dana, LCSW

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NOTES
NOTES