Vagus-informed Therapy Creates Conditions for A Person to Heal from Trauma
The trauma field has seen a sharp increase in interest by researchers and clinicians alike within the past 25 years or so. Many factors contribute to the interest in trauma research. One factor may be the impact neurophysiology has had on trauma research. In an attempt to respond to biological naturalism which includes reductionism, emergent scientists like Dr. Porges, Schore, and van der Kolk claim that trauma should be acknowledged equally, while considering etiologies of psychological suffering, along with its biological and physiological substrates. Trauma has been shown to adversely impact the physiological properties of an organism. The main property that I plan to focus on, in this article, is the vagus nerve. Trauma continues to impact thousands of individuals in clinical and non-clinical populations. In this blog, I plan to do the following: firstly, I want a historical perspective on the vagus nerve; I discuss its evolutionary origins and its function inside an organism. Next, I provide an operational definition of the vagus nerve. Following this section, I discuss how the vagus nerve can be compromised when a person experiences trauma. Lastly, I close by sharing what clinical strategies focus on how to treat vagus nerve impairments in individuals who suffer from trauma symptoms.
A Small History Lesson Won’t Hurt!
Early psychophysiologists’ research assumed that peripheral autonomic measures provided sensitive indicators of arousal or activation. This view, according to Porges, is based on a rudimentary understanding of the autonomic nervous system in which changes in the electrodermal activity of the heart rate were assumed to be accurate indicators of sympathetic activity. Due to this, any organ influenced by sympathetic nerves was a potential indicator of limbic or cortical activity.
The autonomic and central brain structures have a relationship. Research continues to show that constructs do link central structures and peripheral organs (tissues that respond to a change in the environment, the body’s function at molecular levels). Darwin provides historical insight into the potential importance of the vagus in the bidirectional communication between the brain and the heart. Darwin speculated there were identifiable neural pathways that provided the necessary communication between specific brain structures and peripheral organs to promote patterns of autonomic activity associated with emotions. For Darwin, when a person experiences emotions, the beating of the heart changes, the change in the heart is caused by brain activity, and the brain stem structures via the vagus nerve stimulate the heart. How this occurred was not explained by Darwin, Porges explains, because he did not have access to neurophysiological research. For example, Darwin did not know that vagal fibers originate in the medulla oblongata; and he did not know that branches of the vagus nerve exert control over periphery organs through different feedback systems. What we can learn from Darwin’s insights here is that the afferent feedback from the heart to the brain, is independent of the spinal cord and the sympathetic nervous systems, and the vagus nerve.
What is the Vagus Nerve?
The vagus, the 10th cranial nerve, contains pathways that support the regulation of the internal viscera, including the heart. The vagus nerve comes from the medulla oblongata. The vagus nerve is composed of three main nuclei: the nucleus ambiguous (NA), the dorsal motor nuclei (DMNX), and the solitary nucleus (SN). The function of the vagus nerve includes the motor, sensory, taste, and chemoreception involving numerous organ systems of the body. The DMNX originates anterior to the base of the fourth ventricle in the medulla. The DMNX has general visceral efferent (nerve cells that conduct electrical impulses to send to muscles, neurons, and glands) fibers that send parasympathetic signals to the heart and lungs. The DMNX also regulates gastrointestinal smooth muscles and glands.
The vagal nuclei incorporate sensory, motor, and special sensory information from the facial nerve, the glossopharyngeal nerve (the nerve mainly helps raise part of your throat, enabling swallowing), vagus nerve, and cranial portions of the spinal accessory nerve. The vagal nuclei and their nerves stimulate nearly all muscles of the pharynx and larynx. These muscles receive nerve groups from the vagus nerve and the glossopharyngeal nerve. Many muscles that we have in our faces and neck are impacted by the health of all the nerves found that compose the vagus nerve, therefore. Not only are our visceral organs impacted by the dysfunction of the vagus nerve, but the evidence also above suggests that an organism as a whole is impacted significantly by the vagus nerve.
An important effector is the vagus nerve for the parasympathetic nervous system (PSN)- this is part of the autonomic nervous system (ANS) that helps an organism with “rest and digest.” The thoracic and abdomen cavity is impacted by the function of the vagus nerve; decreasing heart rate, bronchoconstriction, and increasing gastrointestinal activity are some of the activities that are impacted by the activity of the vagus nerve. Abdominal activity clearly is impacted by the working of the nerves found that compos the vagus nerve. Trauma disrupts the function of the vagus nerve(s) and can lead to dysfunction in other parts of our body.
Damage or displacement of the vagal nuclei may cause changes in the baroreceptor and chemoreceptor reflexes. Much interest lately has been placed on the brain-gut axis via communication through the vagus nerve. Stimulation of vagal fibers in the intestines influences monoaminergic brain function, which influences mood and anxiety disorders. Monoaminergic refers to neurons that create the neurotransmitters dopamine, norepinephrine, and serotonin. These neurons send messages through catecholamine (groups of dopamine hormones that help the body respond effectively to stress). In other words, the reward center is impacted by the type of stimulation the vagal nerve produces in the intestines. The mind-body interaction relationship is possible by the activity of the vagus nerve(s).
At this point, I want to summarize now main points from my discussion above:
- Messages we receive from outside of our body may impact our heart rate, i.e., trauma and complex trauma.
- Heart rate may decrease due to dissociation-a relationship may exist between the heart and dissociation symptoms.
- The content of a trauma memory may contribute to the heart decreasing to a harmful level, i.e., less than 60 beats per minute.
- Trauma memory leads sometimes to the production of excess stress hormones that lead to physiological effects (e.g., thyroid, gastrointestinal issues, and asthma symptoms).
- Environment cues impact physical reminders of safety (or lack of safety) for a patient.
Vagus-Informed Clinical Application
Deb Dana-influential trauma-informed therapist-suggests some of the following clinical strategies to help the vagal nerve “heal” from trauma. With eloquence, Deb puts it this way, clinicians must learn how to “…teach clients how to safely listen to their autonomic stories and shape their systems toward safety and connection.” The strategies I highlight below, I believe, target common issues patients report they experience when encountering a trauma memory. For example, reports of feeling trapped, powerless, and experiencing a death-like lived experience.
- First, suggest to the client to identify an image that gives her the feeling of controlling the dimensions of something.
- Second, ask the client to write a story describing the image and how you use it to increase energy and return to calm.
- Connect your image to a breath cycle; the cycle allows the heart to send messages to your brain that you are safe.
- Suggest to the client to visualize herself as the main operator of changing the dimensions of her image. Suggest to the client to try to feel herself adjusting it.
- If your client feels confident working through the steps above, work with the client to identify a slightly stronger challenge, e.g., the external image that may be triggering.
Porges and other trauma researchers do point out that the vagus nerve theory presented above is under heavy scrutiny by scientists and biologists alike currently. Although the debate is worth understanding, many clinical studies continue to appear in the literature that vagus-informed therapies are effective. In the future, I do plan to elaborate further on the vagus nerve theory in other articles. The time has come for clinicians to take the scientific leap into the world of neurophysiology, neuroscience, and neuroanatomy to help inform our work in therapy to help those suffering from psychological trauma.
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Clinical Complex Trauma Specialist (CCTS-1),
Certified Dialectical Behavioral Therapist (C-DBT),
Certified Alcohol & Drug Abuse Counseling (CADC)
this is a good post yet it is our symbolic relationship with the real world’s of words, other signs and behaviour where the impact hits…
Sure getting a handle on the Vagus, like the Amygdala, fosters a sense of relief but only as a socially constructed idea…
I find, after some treatments, that it is the inherent shame based attitudinal practice from both professionals and lay people which also trigger me…
I proffer that Julia Kristeva’s work called The Powers of Horror remain equally and critically important…
The object/subject debate is far from finished if only really properly starting…
The developments in neuroscience must not be ignored but most be seen as an integrative discipline with quite specific origins in the work on proprioception in the 80s and emerging from the gaps between the nature of causal explanations per se and especially in Psychology and Psychiatry….
Reality is not neat, stable and ordered the institutional organisation of life is where order is gained…
There is no knowledge without a perspective from which it is gained and the context of this gain…
The absence of an integrated sense of self, as with cptsd, is a beginning of the need for science too to lessen its objective need for the reification of self-reflection…
The negation of self will otherwise become compounded by the act of helping itself…
Thank you for the feedback. I appreciate your insights. I especially enjoyed reading about your insight on the impact CPTSD has on the self. Psychological fragmentation is crippling for someone’s identity, values, and self-validation.
Thank you again for your comments.
This was an article that finally gave me some hope.
When you tell a therapist that you can’t get something done because your brain literally freezes and goes blank and then they keep telling you that you just have to decide to do that thing, like its a choice or discipline… well you know they don’t actually understand the fundamental cause.
It is so difficult to find a therapist who truly knows how to treat trauma. I’m off to keep researching, thank you for the insights.