If you’ve been looking for therapy that focuses on regulating your nervous system, chances are you’ve come across the vagus nerve and polyvagal theory. Polyvagal therapy incorporates these ideas into a form of psychotherapy that aims to target your biological stress response.

“Polyvagal therapy” isn’t a formally certified therapeutic approach in itself, so you won’t yet find specialized “polyvagal therapists” – but you might find plenty of therapists integrating polyvagal theory into their practice (we’ll refer to them as polyvagal therapists going forward).

Polyvagal therapists often incorporate neuroscience with talk therapy to assist their clients with understanding their symptoms, which are often associated with trauma and stress. We’ll dive deeper into polyvagal theory and its role in psychotherapy in this article, as well as explore how to find polyvagal therapists and how to decide whether polyvagal therapy could be right for you.

The Origins of Polyvagal Theory

Polyvagal theory was first developed in 1994 by Dr. Stephen Porges, an American psychologist specializing in trauma and cranial (brain) nerve responses¹. He proposed that the vagus nerve, which is the longest nerve in the autonomic nervous system and directly influences several bodily functions, adapted in humans to respond to social and danger cues.

The vagus nerve is impacted by both our immediate sense of safety and social cues; if we don’t have those available, or our vagus nerve is not functioning as it should, we might find it difficult to feel calm and relaxed.

“The heart of the theory is a simple yet transformative idea: our ability to feel safe and connect with others is biologically embedded in the structure and function of our autonomic nervous system.“¹

According to Porges, the vagal system has three primary states that support different types of behavior.

The Three Primary Neural Pathways in Polyvagal Theory

Safe and social: the ventral vagal complex: The ventral (which simply means “towards the abdomen”) vagal complex is active when we feel calm and safe¹. These moments of calm and safety are sometimes referred to as glimmers. It inhibits automatic defence reflexes and enables us to interact with others from a place of security. This system keeps the other two in balance. If severe stress or trauma compromises the ventral vagal complex, we can have a difficult time moving between states of peace and alertness.

Fight or flight: sympathetic nervous system: When we sense danger, our sympathetic nervous system activates and overrides the ventral vagal complex. This gives us adrenaline and cortisol to motivate us to react – either by fighting or fleeing from the threat.

Shutdown/freeze: the dorsal vagal state: If we can’t overpower or run from the danger, the dorsal (meaning “towards the back”) vagal complex activates our freeze or shutdown response. This protects us by minimizing harm.

Polyvagal Theory and Attachment

Polyvagal theory is, maybe surprisingly, deeply interwoven with attachment theory. Our early attachments shape our vagus nerve development, which is responsible for an infant’s reflexes and co-regulation with the caregiver.

When our caregiver is responsive and attuned to our needs, not only do we develop a secure attachment to them, but polyvagal theory suggests that we build “vagal flexibility”. This means we can shift easily between the three vagal states, developing emotional resilience and regulation skills. Some studies have suggested that people with insecure attachment styles do have weaker vagal activity⁴, ⁵.

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How Does Polyvagal Theory in Therapy Work?

Polyvagal theory suggests that when we’re experiencing extreme stress or trauma, our ventral vagus complex can be inhibited. This leaves us stuck between the sympathetic and dorsal vagal responses – or fight, flight, and freeze.

This once served an evolutionary purpose, but living in these states now can make it difficult to get on with daily life. Since the vagus nerve is involved in a number of bodily functions, including digestion, pain sensation, and energy release, problems with the vegas nerve can manifest physically as well as cognitively and emotionally¹.

Polyvagal theory therefore takes a “bottom-up” approach – the difficulties we experience might be down to our physiological responses, rather than a disruption of thoughts and emotions. To restore a sense of safety, then, we would have to start from the bottom-up – only when the body feels safe can we start to feel safe and connected emotionally. To do this, we give the body safety cues.

What Is Polyvagal Therapy?

Polyvagal therapy isn’t a standardized form of therapy in itself, but you can find therapists who integrate polyvagal theory into their work. These polyvagal therapists use a combination of psychoeducation, or learning about our psychological responses, and neuroscience to bring the body back into its calm ventral vagal state.

Since it’s not its own type of therapy, polyvagal therapy could look different with different therapists. For example, a polyvagal therapist specializing in somatic (body-based) therapy could spend much more time focused on the body itself, compared with a polyvagal therapist specializing in talking therapy, who might spend more time discussing how your experiences might relate to polyvagal theory.

Since its focus is on the body’s stress response, polyvagal therapy is most strongly implicated in PTSD, depression, and anxiety, and may also improve symptoms of OCD².

How Does Polyvagal Therapy Work?

By incorporating polyvagal theory into therapy work, therapists aim to restore the body’s baseline sense of calm and natural transitions between states of rest and alert.

They primarily do this by implementing “cues of safety” through neural exercises, with the understanding that safety is a feeling, not just the state of being danger-free. Polyvagal theory says that we need 3 things to feel safe³:

1. The nervous system needs to be relaxed, not prepared for imminent danger.
2. The ventral vagal system needs to be activated to keep the sympathetic and dorsal vagal systems in balance.
3. Cues of safety, such as positive expressions from others, need to be detected.

Polyvagal therapists might teach and help you to practice ways to achieve these 3 conditions for feeling safe. It can take time for your body to adjust, but practicing these techniques in and out of therapy is thought to restore your vagus nerve to normal function over time. From this place of safety, you might be able to better understand your thoughts and feelings and work towards other therapy goals.

Techniques in Polyvagal Therapy

Polyvagal therapists might use a range of techniques to restore the function of the ventral vagus complex. A few examples might be:

• Listening protocols – listening is vital for social engagement, so, according to polyvagal theory, listening can activate our ventral vagus complex. These protocols use sound frequencies in the range of human speech to activate safety cues³.
• Rhythmic breathing – using conscious breath control can stimulate the vagal complex and reduce sympathetic activation by providing an internal safety cue.
• Biofeedback techniques – biofeedback involves controlling your bodily functions, like heart rate, by receiving feedback when they’re out of a desired range. For example, a machine that beeps when your heart rate becomes too high can help you learn to slow down.
• Movement therapy – movement therapies, such as dance therapy, can help to provide safety cues through co-regulation.

Different techniques are right for different people – it’s normal to try a few different therapies or therapists before you land on one that resonates with you.

What Are the Benefits of Polyvagal Therapy?

Returning the body to a state of calm could be the goal of polyvagal therapy, but it could also be just the first step.

In order to successfully learn, evaluate, create, connect, and process information, we need to be calm. All of these things are important components of recovering from trauma and other mental health difficulties – without returning the body to a state in which it’s ready to learn and process, we can’t effectively move forward.

Polyvagal therapy can therefore provide a sense of safety that may go on to be the basis of future therapy work. For some people, just restoring that sense of safety is enough – your therapy goals are unique to you, and your therapist can help you to clarify yours.

How to Find a Polyvagal Therapist

If you’ve decided to try polyvagal therapy, look for a therapist whose focus is on trauma, somatic processing, or the nervous system. They might mention polyvagal theory in their professional bio, but if not, you can always ask them whether they work with polyvagal theory. Therapists will usually start with an intro session – this is your chance to ask them more about how they work and discuss whether they think polyvagal therapy would suit you.

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Final Words on Polyvagal Therapy

Until we have further evidence, polyvagal theory is just a theory – but it can be a useful framework for understanding your nervous system and how it responds to your experiences. Some people find comfort in the idea that their thoughts and feelings result from dysregulation in the nervous system, rather than the other way around.

Although the jury’s still out on polyvagal theory, we do have plenty of evidence to suggest that the controlled breathing and meditative practices that polyvagal therapy uses can be very helpful². If you’re interested in trying polyvagal therapy, look for a therapist who uses polyvagal-informed practices in their area.

References

1. Porges SW. Polyvagal Theory: Current Status, Clinical Applications, and Future Directions. Clinical Neuropsychiatry. 2025 Jun;22(3):169.
2. Poli A, Gemignani A, Soldani F, Miccoli M. A systematic review of a polyvagal perspective on embodied contemplative practices as promoters of cardiorespiratory coupling and traumatic stress recovery for PTSD and OCD: research methodologies and state of the art. International Journal of environmental research and public health. 2021 Nov 10;18(22):11778.
3. Porges SW, Dana D. Clinical applications of the polyvagal theory: The emergence of polyvagal-informed therapies (Norton series on interpersonal neurobiology). WW Norton & Company; 2018 Jun 12.
4. Diamond LM, Hicks AM. Attachment style, current relationship security, and negative emotions: The mediating role of physiological regulation. Journal of Social and Personal Relationships. 2005 Aug;22(4):499-518.
5. Abtahi MM. Attachment and emotion regulation: Changes in affect and vagal tone during stress. Kent State University; 2016.