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simon dubois

Polyvagal Theory and Practice Essentials with Simon DuBois

simon dubois

Polyvagal Theory and Practice Essentials

Today, we are welcoming Simon DuBois, clinical director and psychologist at The Health Lodge to the podcast.   Join us as we talk about the polyvagal theory and what psychologists can do to help people who have got disruptions with their vagal system.

Tune in to this truly fascinating episode as we delve deep into nervous system regulation, discussing physiology, dorsal and ventral aspects, the polyvagal ladder and of course treatment options.

About Simon DuBois
Simon DuBois is the Clinical Director and psychologist at The Health Lodge Medical Centre in Byron Bay. Simon works with traditional psychological treatment therapies such as Cognitive Behaviour Therapy, Schema Therapy and Mindfulness.

He is also trained in Eye Movement Desensitisation Therapy (EMDR) for the treatment of trauma-based distress and also works with depression and pain through the use of Transcranial Direct Current Stimulation (tDCS). Simon is an advocate for working collaboratively with doctors, naturopaths and other allied and complementary therapies to improve wellness results for patients.

Connect with Simonwww.thehealthlodge.com.au

Transcript

Introduction

Andrew: This is “Wellness by Designs.” And I’m your host, Andrew Whitfield-Cook. Today, we are welcoming Simon DuBois, clinical director and psychologist at The Health Lodge. And we’ll be discussing today part one of a two-part series on polyvagal theory. Now the next part will be done by Reine DuBois, Simon’s wife. She’ll take on the natural therapies. Today, we’ll be talking about the theory and what psychologists can do to help people who have got disruptions with their vagal system. Welcome to “Wellness by Designs,” Simon. How are you?

Simon: Thank you very much. I’m really well, thank you, and thanks so much for having me.

Andrew: It’s an absolute pleasure. Now, I have to ask because I’ve known Reine for quite some time and she is the calmest, floating, but there’s this true expert in her. You are a science, obviously, you’re a nice guy, or else you wouldn’t have been drawn to such a beautiful woman, but where did the meeting of the mind, there’s the psychologist, which is normally quite medical in thinking, and there’s the naturopath. Where was that meeting of the minds?

Simon: Well, the meeting of the minds happened 22 years ago. It’s our wedding anniversary today. And the meeting of the minds happened in West End, but I’m not sure that we really quite appreciated how well suited the meeting of those two minds would be. But something that we’ve really come to appreciate in our clinical work is that the nervous system is such a fundamental and important part of our whole health system that we need to have a shared and common language to work around and work with.

Now, you did mention, and I think you’ve described Reine nervous system very well. It is incredibly regulated and I’m really not sure how she’s such a regulated person, but I’m trying to work it out and getting my nervous system to emulate that as well. But just bringing it back to the task at hand today, one of the great things about polyvagal theory, what Reine and I have been able to do as a couple in our personal lives, and then as a couple in a therapeutic setting, and then as a team at The Health Lodge, is really use polyvagal theory as a language which helps us to describe and understand the workings of our nervous systems and our patients’ nervous systems, and then how we can go about supporting and treating them.

Andrew: Right. Well, like, I’ve spoken to a few practitioners about vagus nerve stimulation, but there’s a lot more that you talk about. Can we first go into polyvagal theory and even discuss some of the evolution, because I find this fascinating. I’ve never learned this before. You sent me a PowerPoint, our viewers, our listeners won’t know this, and I didn’t know this. So can we discuss this, please?

Simon: Yes, absolutely. So one of the key components of the development of polyvagal theory and Stephen Porges is an imminent psychiatrist that many of us would know about now. And he proposed this theory back in 1994. And just as a sort of little bit of context here, the work that I’ve been able to draw upon is from Deb Dana, and really, she has been instrumental in translating Stephen Porges’ work. Which, if you delve into the preliminary books, are highly complex and actually very difficult to decipher. And she has brought his work into the applied setting in particular for psychologists, but more specifically for any practitioner. Because when we’re working with patients and clients, their nervous system comes into the room and that nervous system has to be regulated as does our own before we can even start the treatment process.

So, we’ll touch on that a little bit more as well because the regulation of ourselves and our client in the therapeutic setting is absolutely paramount for the important information that we have for them and their healing journey. So back to your interesting reflection though, because evolutionary theory was very much a part of Porges’s understanding of the development of the nervous system and why it does what it does. And, you know, it’s not too unfamiliar with this, that we, you know, all beings on this planet started out as very simple organisms and we became more and more complex, but there was a point in our evolutionary journey as an animal and an organism where we decided that being a herd animal, being a pack animal, functioning as a group of animals was much better for us for our survival, and our health, and our wellbeing.

So our nervous systems developed not only the capacity to recognize danger, but also to recognize safety and support from our fellow humans. So this is very much, you know, a very important part of the theoretical understanding that the nervous system, our autonomic nervous system does two principle things. Yours and mine are doing it right now and it’s just surveying our internal environment and our external environment for a sense of safety and a sense of threat.

So kinda right at this moment, I’ve got both going on. I mean, with my initial connection with you, my autonomic nervous system is going, there’s, you know, Andrew is a safe guy, he’s got a nice time, you can connect with him. It’ll be okay. While at the same time, I can also feel a sense of kind of threatened danger in my sympathetic nervous system, which is going, okay, we’ve got a task to do here and we want to get it right. And if we get it wrong, you know, we could be ejected from the tribe and that’s it. So, this is a fundamental understanding that our autonomic nervous system, when it’s functioning well, can pick up accurately and effectively, what our internal and external environment has to offer in terms of safety and in terms of threat, and then organize our whole system for that.

Andrew: You know, one of the things I found fascinating in the evolutionary development of the various segments of the autonomic nervous system is that the first part that was developed 500 million years ago. So we’re talking pre-trial about, we’re talking really, really early on. And it was basically chill, dude, it’s okay. Just think about your internal environment, about food, and that’s it. But there was no escape mechanism, the fright or flight. I hope I got that wrong. That came later. So it was basically the first part was to die, then the next one was to survive or fight, and then it took millions of years further to be able to learn how to prosper in a community. That to me is fascinating for life on earth.

Simon: Yeah, absolutely. And so, I mean, let’s segue from there to the polyvagal ladder, because you’re starting to kind of describe the autonomic nervous system. And what Deb Dana has done extremely well is provide a simple but really effective way for us to be able to check-in and notice where our nervous system is at. So we know the nervous system is made up of a sympathetic nervous system, and we know that that relates to the fight-flight-freeze response. So it’s a very activated, it’s a very readying kind of response and generally to an idea or sense of threat. And then we have the parasympathetic nervous system, which is a part of the nervous system which will interestingly, and let’s get back to evolution, Andrew, that this parasympathetic nervous system acts as a brake and has a way of acting as a brake on the sympathetic nervous system.

We’re generally primed in our nervous system to be slightly sympathetic all of the time because as you readily point out and is incredibly fascinating for most of our lives as an organism and as a human, we’ve been out in an environment where we’ve had to keep an eye out for threat all of the time. I don’t know why, but I always think of the kangaroo. There’s all sorts of animals you can think of, but I always have a picture of the kangaroo, that’s kinda, you know, it’s nibbling on the grass, but there’s, you know, there’s one ear out and, you know, he’s just kinda looking around, just keeping an eye on things. And that’s fine and that’s important, but given that we, as human beings have decided that being a pack animal, being a herd animal, being together creates a great sense of safety, we have to be able to depress that sympathetic mode so that we can relate to who we are around.

So, for example, if I was still a bit stuck in a sympathetic mode right now and my ventral vagal system, part of my parasympathetic system, wasn’t able to go, “Hey, sir, things are safe, mate. You’re okay, let’s connect in with this situation,” if that wasn’t happening, if that brake wasn’t on my sympathetic system, you’d kinda see something like this, I’d be fiddling with my notes. You’d be talking to me, I’d be looking at my PowerPoint, but my capacity to engage would really be compromised. And this is where, you know, this is where the impact of trauma on a nervous system is quite disastrous because the person’s natural ability to just depress that sympathetic mode, which is always slightly on, notice cues of safety and then engage with other people is really compromised. Because their sense of threat is constant, even in environments of safety.

Andrew: Right. Can I just backtrack a little bit, and forgive me for doing this, but we’re gonna backtrack a little bit into anatomy and physiology, and that is you were mentioning the ventral vagal system. There’s the dorsal vagal system as well, and this is something I knew nothing about until last night. Can you explain to us what they are and how they differ, please, Simon?

Simon: Yes. Thank you. Because I went off on a little tangent and I left my polyvagal ladder way behind. So we’re going back to the shed, get the ladder back out, and think about this polyvagal ladder. So correct. As part of our whole autonomic nervous system, there’s the sympathetic strand and then there’s the parasympathetic strand. Sympathetic activating, parasympathetic down-regulating. So there’re two parts to the parasympathetic system. There is the ventral vagal, and if you are thinking about yourself riding along on a bicycle and that bicycle is kinda heading down the hill kinda pretty fast, you’re in sympathetic. You ventral vagal system can switch on and just slightly brake that bike, slow things down. Ah, that’s better, I’m just heading down the hill, kinda nice and gently, just taking it easy, I can smell the roses.

Now, the other part of the parasympathetic system is the dorsal vagal. So we’ve got our ladder, we’ve got ventral vagal safe and social, sympathetic, activating fight and flight, and then parasympathetic underneath that, which is the dorsal vagal. And the dorsal vagal is a much more complete shutdown of the overall system. We kind of relate that to the mouse that by no choice of its own plays dead in front of the cat. In all intensive purposes, it looks like that mouse is well and truly out. But as soon as that cat turns its head, that mouse springs into life, and off it goes.

So the dorsal vagal will usually activate when we’re in a felt or sensed situation where it feels like there are just no options. There is a great threat and there are no options. And this takes us back to our evolutionary beginning where the only defence mechanism we had was just to close up and shut down. So you think of the turtle, the mollusk, it’s all about just closing in. In our everyday experience, a dorsal vagal response would feel like a depressive shutdown response. Interestingly, when this talk was presented to me as an option and we were making some times, and it was fairly rapid. It was very interesting that I noticed I went into a dorsal vagal state and kinda a feeling of overwhelm. And then you’ll be pleased to know, Andrew, I pulled myself out fairly rapidly.

Andrew: But that’s an interesting thing about that dorsal activation and the closing off. It’s almost like, I remember the hunching over, the giving up the withdrawn person who presents to you in clinic like that, the lower self-esteem person. And then you’ve got that sympathetic more activation, the standing upright, the alert, that sort of thing. So I get the issue about this balance. Can I go back though, forgive me for doing this, once again to anatomy and physiology when we’re talking about the origins of the vagal system in what is it, the medulla oblongata. So is that part of, I wonder how relevant this is. I’m just wondering about the alertness, about standing up and being able to visualize things, but then that doesn’t talk about mollusks, does it? Is there an important aspect to the dorsal vagal system with the origins in the medulla oblongata, or does it happen later on from an anatomic physiological perspective?

Simon: I might be answering this in obscure way and not particularly based in neurophysiology, because I’m an applied guy, not a details guy. But something that you’ve flicked to me which is an important consideration is that the dorsal vagal state isn’t a problem in and of itself. The sympathetic state isn’t a problem in and of itself. Our aim is not to be in ventral vagal and safe and social 24/7. What we’re seeking to be able to do on a healthy autonomic system is firstly, that that system identifies level and threat and safety accurately, but secondly, if we do move into dorsal vagal or sympathetic, whether the threat is real or not your presentation today wasn’t a real threat, but I decided to do a little bit of a sympathetic dorsal vagal dance, I was able to move through those systems fairly fluidly. And people who have had trauma exposure, for example, can experience getting stuck in those states of their autonomic system longer than they need to. And that’s very distressing.

Andrew: Right. Now, you’ve got, obviously, what I spoke about before, the depressed patient hunched over that sort of person, then you’ve got the PTSD person who’s a sympathetic dominant, they react, overreact because of a prior threat that’s just set hardwired that they’re constantly hyper-vigilant. So teaching people about moving through those aspects of their autonomic system, particularly, I guess, somebody who let’s say, you know, abusers, domestic violence, I’m thinking here of what is a dialectical behavior therapy. I spoke to a therapist once and she was talking about having the person who was initiating the violence, so the affected person, I guess, in that sense to try and splash some water on their face. And I thought, how do you do that when you’re in a fit of rage? How do you get a patient out to move between those states? So the question for you is, how do you indeed get a patient certainly out of that dorsal phase where they’ve just got low self-esteem they want to raise up, but also if they’re hyper-vigilant, how do you get them to calm down or indeed to move up into being socially safe?

Simon: You like to ask simple questions that you.

Andrew: Yeah, I know. You spoke about an obscure answer. I like to ask the obscure questions that have got 20 parts to them. Sorry, Simon.

Simon: So something I like about your reflection in this space is noticing that you’re very acutely aware of the state of each of these parts of the autonomic response. So, again, we’ve got the polyvagal ladder and at the top, we have ventral vagal, which is safe and social. And so the first part of our process, and I’m thinking from a therapist standpoint in whatever modality they’re in, but a client is moving into their space to engage with them. We’re asking ourselves the question, “Hmm, where am I on the ladder?” Oh, I’ve just come out from tea break, and I just got the coffee and I was belting through a couple of emails. Oh, I’m slightly sympathetic. And where’s that person at? Oh, okay. So, yeah, they’re deflated. It looks more dorsal vagal for them. There’s not a lot of action. They look a bit stooped and they’re a bit slumped.

So having that polyvagal ladder on your wall somewhere until it becomes etched in your mind is a great thing. And some of the GPs here have actually, doing this very actively, where they ask their patient because there’s been an educative process, “Where are you on the ladder at the moment?” And it’s a great way to begin a dialogue. And that can just set off a train for that person to go, “Hey, yeah, yeah. I’m in dorsal vagal. And there’s, you know, we tend to kind of correct ourselves a bit and go, okay, where am I? Okay. I’m at Dr. Such and such’s place and that’s right, we’re gonna have a talk about that part of my health, and we reregulate.

So, you know, the very beginnings of the more complex question that you ask, when somebody’s been through a significant traumatic process or they’re in a middle of a very reactive process like you talked about, you know, a domestically violence situation. I mean, that’s all things firing. How on earth does a polyvagal ladder and awareness of your nervous system creep into something that’s so gross and intensive in its manifestation? And it starts with these little drops of water of, ah, right, nervous system. How do I understand this as a, you know, a thing in my body? It’s all a bit abstract. It’s all these kind of like wires. Well, let’s think about it like a ladder and you move up and through that ladder, depending on what you are exposed to.

Sometimes your nervous system will react in a situation where something isn’t there. So you can learn to catch that and reregulate yourself into a more ventral vagal state. So I think, you know, the answer I’m rounding to, Andrew, is having a model and having a simple model that people can apply rapidly. And you can start to practice using that within the clinical setting or with yourself at home. Yes, there’s a, I think a more direct answer.

Andrew: Well, to me, it’s actually the first practical, visual signal, if you like, a tool for mindfulness. Because most people think of mindfulness as, oh, it’s 10:00, I must do my breathing, you know? Oh, you know, now I must do that. There’s a time set. It’s like exercising, it’s then. Whereas the ladder diagram is something you can visualize in your mind to go, oh, hell, I’m here. Or, oh, I’m here at the moment. To me, it was this initial bang, probably one of the best clinical tools I’ve ever seen. I’ve gotta give it to you, it was fantastic. And then you can use further tools.

Simon: It’s a lot of fun to play with. We use it at home at the moment because it’s all a bit rough at the moment for everybody. And we’ve got a daughter in year 12 and she finds herself sitting at home, studying on her own with exams delayed. So it’s all pretty miserable for her. Reine and I are both busy and there’s a clinical load of people who are really having an autonomic tough time through the COVID process, and we’ve stuck three ladders up in our kitchen. And when the moment takes us, we’ll check-in and just ask each other where we are on the ladder. It’s a great way to practice and then it gets you into practice at work as well.

Just adding to this, something I really like about polyvagal theory, the autonomic nervous system, the polyvagal ladder, understanding our state in three fundamental parts. Ventral vagal, safe and social, sympathetic, fight or flight, or dorsal vagal, shutdown, is that it’s simple. And I really can’t express this enough is that when we are having a tough time, complexity is not…it’s not a good time for it. So a simple way to understand something and to relate to where we’re at and how we’re feeling I think is fundamental. And I think it beholds psychologists, in particular, you know, I’m psychoanalytic in my orientation and training as well. But there’s a time and a place for a psychoanalytic approach to treatment. And there’s a time where just having something that is much more direct and much more simple, particularly in times of difficulty that you can use for your health.

Andrew: So with regards to therapy, there’s, you know, like I’ve spoken to people about gurgling, singing, the auricle of the ear, vagal nerve stimulation, there’s the medical implants that have been used. There’s an interesting one, but what other things do you employ? What other tools and practices do you employ to help with vagal nerve stimulation, if you like? One of the ones that interests me is the, and forgive me, I don’t know the name of it. A friend of ours has done it. The eye movement? Has that got to do with vagal polyvagal therapy? Can you take us through that, please?

Simon: AMDR. All right. Now you’re getting me excited.

Andrew
: But has that got to do with polyvagal therapy, or is that another aspect?

Simon: I would say it’s another aspect. But what I will do is answer your question in terms of treatment approaches that come out of Deb Dana’s work, and what our listeners will appreciate is there’s a great sense of commonality with mindfulness. So, you know, they’re not unknown, but they are couched within the context of polyvagal theory. So I’ve got two favourites. Generally speaking, it’s healthy and good for us to practice being in a ventral vagal state. Again, particularly within the context of our current environment, we’re getting a good dose of sympathetic distress which has a tendency for us when things are bigger, an overwhelming tendency towards shutdown. So practising ventral vagal capacity and the fluidity that the ventral vagal space gives us between the different parts of the ladder is pretty good going.

So, Deb Dana has one exercise called glimmers and glowers, and this exercise is about noticing and catching a glimmer. And a glimmer or the definition of a glimmer is when you have a ventral vagal moment. So possibly, Andrew, this morning, you know, when you’re hopping up or maybe you were in the kitchen with your family, there was a moment that you just caught something just really lovely. And Deb Dana’s exercise is to bring conscious aware to that, to catch it, and then to give it a glow, the glow being to accentuate your experience of that. So I guess that’s like, ah, hang on. Oh, that was a nice ride. Let me just hold myself in that space for a bit longer. The example I tend to give, we’re pretty lucky in Byron Bay because there are lots of glimmers coming at us left, right, and centre.

But a very impressionable glimmer I had was when surfing and there wasn’t much surf, but I was just sitting out the back and the sun was at that angle with the ocean where there were just all of those shimmery bits of light that were bouncing off. You know, it was like a, I mean it was like a whole little glimmer show out there. But I just read the catching glimmers and really noticed that, and then just held myself in that space. So that’s glimmers and glowers. The other great exercise that Deb Dana has is called anchoring. And again, it’s not an unfamiliar exercise couched in different ways within psychology, and reviews, and other practices, but anchoring is knowing what a ventral vagal state is and what would usually encourage a ventral vagal state.

And that’s usually identifying, you know, and quite commonly, a people that we value or environments that we really love, tuning in with that environment, and that space, creating that ventral vagal experience. And then if we’re having a rough time, we can anchor ourselves in that rough time by taking ourselves to that ventral vagal environment. So, again, for me, that would be let’s say, yeah, so, you know, last night I’m trying to put together 100 things in my head for this catch-up today, getting a little bit overwhelmed, you know, really interestingly, my daughter picked up on it and she said, “Let’s go for a lighthouse walk tomorrow.” And she put me in a ventral vagal environment and you know, really supported my system to move out of sympathetic. So this is the other thing about the autonomic nervous system. When it’s offline, it affects others and into you. It was very interesting to watch my daughter notice, you know what it’s like, oh, dad’s in one.

Andrew: But she was attuned to that. So she’s obviously feeling at the top of the ladder, she’s safe, she’s connected with her social and she’s aware at that point. Yeah?

Simon: That’s right, correct. I’m keen to just let listeners know a little bit about the organizing principles of polyvagal theory. I think they’re good to have on awareness of, and I just, something I really love about understanding the autonomic nervous system and what it really likes, is thinking about the essential elements for safety and regulation. We need to talk about regulation and dysregulation at some point because this is a part of our health that if we find because of health distress, we dysregulate easily, we become emotionally overwhelmed or distressed easily. And it’s an extremely distressing part of a person’s health picture.

I get depressed more than I would like. That’s dysregulation. I get anxious more than I want, or I need to, that’s dysregulation. I think about things too much and I start to catastrophize, that’s dysregulation. And a lot of the therapeutic work that we all do from our respective modalities is bringing regulation back to our system. So what are the essential elements for safety and regulation? I’ll talk about them. This is what our autonomic nervous system really likes. It likes context, it likes the sensed awareness of what’s going on. It likes choice, it likes freedom to move, you know, especially when there’s doubts. If there’s doubts, the autonomic nervous system, it likes there to be choices. And thirdly, it likes connection. It’s built to find connection with others and with people that are safe around us. And again, thinking from an evolutionary perspective, it’s all been designed to help us not only survive but thrive.

So, Andrew, I’d like you to think about what happens in a horror movie. And this is really, really interesting. The car that the people are in is driving along, and where does it break down? Of course, it breaks down in the middle of the dark forest. So all of a sudden context is out the window, this dark forest. I don’t know anything about dark forests but what I do know is that they’re not very nice. Then what happens? Well, their freedom to move is taken away by those three people in the dark forest, because not only do they lose the keys, but the battery goes flat and a tire goes down. And then last but not least, to top it all off, they decide in all their wisdom to split up and go into the forest to look for help. And so the connection is broken. And we notice what, I mean, I don’t watch horror movies very often because I can’t bear what it does to my autonomic nervous system, but our autonomic nervous systems respond in spades and they completely dysregulate. And some people do that for fun.

Andrew: Well, that’s an interesting point.

Simon: Tell me what’s interesting about it.

Andrew: Well, just the thrill-seekers, you know, there’s that gene, what do you call it? The warrior gene and that sort of thing, but I’m taking over, forgive me, you continue, Simon.

Simon: No, problem. So we’ll go into the organizing principles and then we’ll have some more interesting discussion. I keep coming back to the traumatic impact because I guess it’s my bread and butter, but this is what’s a bit devastating about the impacts of trauma because the nervous system is then primed to look for threat, and in seeking threat, it often makes that capacity to understand context, choice, and connection readily and easily. And then often what people do is they’ll isolate which takes them away from the very fundamental thing that’s good for their overall system, which is connection, and connection with other people.

So there are some principle, well, some organizing principles that were incorporated into this theory by Stephen Porges. And one of those is about the principle of co-regulation. And so our autonomic nervous systems are shaped early in life by our early relationships. So this is where the importance of co-regulating parents and regulating parents is so important because they support the development of an autonomic nervous system that can read safety and threat easily and effectively.

Neuroception is a term that people will see more as they go into polyvagal theory, and something I’ve found really interesting because, you know, polyvagal theory has been around since ’94. Deb Dana’s book came out in 2019. I’m still really kind of heartened and fascinated that it’s still a really strong interest area that people want to understand more about and feel like they haven’t got a grasp on it yet. So I’m really hoping this talk is buoying people into the space. And, you know, it’s not a particularly complex or academic space either, but as a framework, so, so helpful.

So neuroception, was a term that Stephen Porges actually developed himself. And this is a term that describes the autonomic nervous system’s response to cues of safety and danger inside the body or outside in the environment. So we are being neuroceptive as we speak. And we are, again, just constantly looking for and seeking cues of safety and cues of danger. And so, we can be neuroceptively accurate where our nervous system tends to read things correctly, or we have a neuroceptive mismatch, and that’s where things get tricky. And through our health modalities, we are trying to support people’s nervous systems to be more neuroceptively accurate.

And then last but not least, and I think this seems to be an area of the theory that you’re most interested in, Andrew, is the autonomic hierarchy, and understanding that that ladder and our nervous system development happened over time, beginning with dorsal vagal and the parasympathetic. So when we had to protect ourselves, I think we looked very different back then. I think we’re a much simpler organism to danger, where dorsal vagal shutting down and protecting. We then had the development of the sympathetic nervous system and the sympathetic response, which was much more active and external. And then finally, the final part of the ladder, also part of the parasympathetic system, but a gentle breaking as opposed to a hard breaking of the sympathetic system and closing it all down as the ventral vagal.

The ventral vagal system, again, just allows us to just gently shut that sympathetic down. You know, if it was a conversation, I think it was sort of something like, “Hey, it’s cool, relax. You know, we’re around good people and, you know, all the tigers have already had a feed. Don’t worry about it.” Here is a space and an opportunity to connect and form important relationships with your community because the formation of those relationships is important to your overall being and survival.

Andrew: You know, you’ve given me a few things to think about there. One of them was the glimmers and glows. To me, this is a perfect example of practising gratitude. And the funny thing about it for me is the word gratitude is over there whereas grateful is here. So do you ever use things like, you know how people like positive self-talk you gave some negative self-talk examples before, but do you ever use positive self-talk in the way that I am grateful for, you fill in the rest, please? I am grateful for this. Like, you’re talking about glimmers, and I was going through some photos this morning of, and I saw the orchids that just grow in our garden because I couldn’t grow them inside, so I threw them in the garden and they bloomed. Yeah.

Simon: Yes, I do. And it’s a little bit more by stealth. What it will look like is a way to get a ventral vagal response, particularly if I can see a patient or a client has come in a sympathetic or a dorsal vagal. And my favourite around here I did it yesterday, with… Byron Bay is a surfing mecca. So I have a, you know, have a few patients who surf and they actually surf to survive emotionally and psychologically, but the best way to get a ventral vagal response is ask them, what was your best wave this week?

Andrew: Right. Okay. I’ve got a flip for you. I’ve got a flip for you here. This is a really weird one. So I’ll call this guy a patient, he wasn’t. But anyway, I once had somebody tell me that parachuting was the only thing that kept them from topping themselves. How? How does that work in with this ladder?

Simon: Okay. So I think this is akin to some surfers I know who if they’re not in the water and they’re not busy, then it can be very tough for them. So I suspect that these are people that generally speaking, sit in a sympathetic or dorsal vagal state kind of generally, and that’s a pretty tough place to sit within yourself and your body. Let’s take the sympathetic state, which would mean you are generally feeling quite anxious and overwhelmed a lot of the time. How on earth would, you know, surfing Nazare, or jumping off a cliff and parachuting suit that at all? Well, the way that it would work is, you know, in a fundamental sense, it’s a distraction. So there isn’t a focus on the nervous system and that part of your nervous system. But these are environments where these people have developed mastery and capacity.

So, I think they’re very involved because it is a very fixed activity. And it also tends to be activities that don’t involve other human beings, which is very complex and highly dysregulating. So you involve yourself in activities, which generally you’re on your own. You’re doing them with yourself. They require a high degree of concentration. But then within that place of mastery people experience flow states, they experience environments that are absolutely amazing and I think supports them to have quite peaked ventral vagal experiences. But if I was to kinda have my best guess, I think where nervous system dysregulation can occur and where autonomic nervous systems, particularly ones that have a mismatched to its environment experience threat is with other people. So there is a tendency to be involved in activities which are activities that are on your own, that require a high degree of concentration. So it’s a high degree of distraction away from how you are feeling and sensing in your body, but then you get a ventral vagal blast when you do catch that 6-foot wave or jump off the cliff.

Andrew: Gotcha. Just one last quick question. I know we are running outta time, but I need to ask this. You are a multimodality clinic. So when you have team meetings, this is gonna be one of those obtuse questions, I’m so sorry, but with regards to inter referral, like there’s gotta be times when you’re dealing with a patient who has, you know, suicidal ideation, and signs of major depressive disorder. There’s gotta be that time where you think, look, it’s appropriate that you see the doctor here and that it’s probably appropriate that you’re put onto an antidepressant for a while, at least, and then we can work with whatever, you know, you want to work with. How do you inter-refer with the other modalities in your clinic? Because it’s quite diverse, right?

Simon: Correct. So we have team meetings on a Tuesday and a Friday morning. So there’s an opportunity to talk about cases. And often those cases will be difficult cases. So we can develop an understanding of what other modalities might fit and support. I mean, there are other ways that we can communicate within our practice whether that’s the, you know, internal messaging system. And of course, there’s the famous but not to be disregarded tea room conversations, which are, you know, a particularly important way of getting a sense of who else can assist and support. Again, thinking around that with the polyvagal theory and having a polyvagal framework on the nervous system, what we’ve found over time. And it’s almost become a bit of a mantra when we’re dealing with a complex health condition, we often find that there is a trauma history in its background.

Now, it’s a little bit cheeky on it because it can either be trauma within that system because of traumatic events, adverse childhood events that indeed occurred and then that whole system over time, as we know, trauma impacts have a significant impact on overall health and a big contributor to chronic health conditions. But of course, when you’ve lived with a chronic health condition for a long time, that’s also traumatizing to lose the sense of freedom and agency, and hope, for guilt for being, you know, a felt sense of being such a liability on others.

So we feel very fortunate that we’ve got a language where we can describe where somebody’s nervous system seems to be sitting. And it’s become a common language now, which is really great. One of our GPs also went off and did a Deb Dana online course, which is over a kind of a three or four-month period. So it’s an immersive process in referencing your own nervous system and learning how to recognize and regulate, and then supporting your patients in that process as well. So he always brings that framework back to the table. But you’re absolutely right, Andrew. You know, when people experience dysregulation frequently, it’s highly distressing, highly distressing. To be, you know, dorsal vagal depressed state is a very, very difficult place to be.

Just to kinda finish on that, and it’s important to stress because it is a mistake that people can make. Dorsal vagal in and of itself isn’t a problem per se. Moving into a dorsal vagal state, highly important. If you find yourself in a life-threatening situation, it will get the body to respond in the most appropriate way. Dorsal vagal is also important just to find a place of rest one way or another. Dorsal vagal is a problem if it’s neuro receptively mismatched to what the world can actually give and provide. And it’s also a problem if we have trouble coming out of it once it’s done what it needs to do. So getting stuck in these states is also a challenge.

Andrew: Well, I’ve gotta say, with your permission, I’m going to print that ladder and I’m gonna frame it and I’m gonna have it up on my wall so that I can constantly check it. I think, dead serious, this is probably one of the most practical, simple, important infographics I’ve ever seen that anybody and everybody can hang in their clinics and check-in even multiple times during a consult to say where are you at now? Anyway, it’s blown my mind. Thank you so much, for taking us through the polyvagal system today, Simon. I can’t thank you enough for the future of many naturopaths who are gonna be using that ladder thing to help their patients. Thank you so much for joining us today on “Wellness by Designs.”

Simon: My pleasure.

Andrew: And thank you for joining us today. Of course, you can get all the show notes. We’ll put up some of the information and definitely the Deb Dana online course, the information for that, on the Designs for Health website. So thanks so much for joining us. I’m Andrew Whitfield-Cook, and this is “Wellness by Designs.”