Category: Polyvagal Theory

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How to be a Soothing Presence: Keeping Nothing Between

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The essence of working with another person is to be present as a living being. And that is lucky, because if we had to be smart, or good, or mature, or wise, then we would probably be in trouble. But, what matters is not that. What matters is to be a human being with another human being. – Eugene Gendlin, The Primacy of Human Presence

 

How best to accompany those suffering from grief, extreme stress or trauma? It’s a question that has been coming up a lot in my life and work. It seems as though many of us are searching for just the right technique, or thing to say in the face of deep suffering, and feeling unequal to the task. I believe it’s part of being human to experience a mix of joy and suffering, and that we are all capable of helping those in pain.

In a recent group I host for the Polyvagal Institute, we had a conversation about how to help those experiencing the effects of trauma and dysregulation. While there are lots of excellent and well-known techniques, like slowing the breath or orienting to inner and outer resources, our conversation led to something more important, beyond technique. Underlying all the suggestions you may have to soothe a person who is suffering, the most valuable thing you can offer is simply your presence.

 

We are designed to co-regulate

There are some practical ways to cultivate a sense that we are safe to others. If we can embody and convey a sense of calm and reassurance, this is contagious. As mammals, we are designed to pick up cues of safety, so when those around us feel comfortable enough, we can settle in a sense of safety too.

However, the ability to co-regulate is not something that can be falsely manufactured. What if I don’t feel all that safe and settled, and I still want to be a source of help and comfort? This is where a powerful idea from psychologist/philosopher Eugene Gendlin can help. In his lovely piece on ‘Keeping Nothing Between’, he suggests we don’t need to be anything other than who we are in the moment, our fallible human self. Our very willingness to be open and vulnerable is an invitation to trust.

I am sharing an excerpt here, from Gendlin (You and I – The Person in There), hoping you find it as inspiring as I do:

“In a restaurant a little girl in the next booth turns to look at you. It is an open look, direct from her – to you. She doesn’t know that strangers are not supposed to connect. She does not put this knowledge between herself and you. There is nothing in between. You look back. Her parents make her sit down and face forward. But then, when they all leave, she turns around at the door, to look again. After all, you and she have met therefore she wouldn’t just leave.

In first grade the children look at the teacher searchingly, openly, reachingly. They put nothing between. The teacher is concerned with the eight levels of reading ability, and does not look back.

Do only little children keep nothing between? Or can adults do that too? We can, but for us it is a special case.

If you came to see me now, I would not look at you like that, nor would I notice if you looked. You would find me in a certain mood in my private struggles. I am also preoccupied with writing this paper. If you suddenly walked in, a third cluster would come: The social set for greeting someone properly. I would respond to you out of that set. Or if you are an old friend, I would respond from the familiar set of the two of us. If you then wanted to relate in some fresh, deep way, it would take me a minute to put our usual set aside, to put my concern about my chapter away, and to roll my mood over so that I am no longer inside it. Then I would be here without putting anything between. But it would be easier to remain behind all that, and depend on my automatic ways.

If I really want to be with you, I keep nothing in front of me. Of course I know I can fall back on the automatic ways. If need be, I can also defend myself. I have many resources. But I don’t want all that between us.

If I keep nothing between, you can look into my eyes and find me. You might not look, of course. But if you do, I won’t hide. Then you may see a very insufficient person. But for contact, no special kind of human being is required. This fact makes a thick peacefulness.”

Wishing you and yours a ‘thick peacefulness.’

 

For those interested in learning more about Gendlin’s gentle somatic art of Focusing, I have a short introductory course on my web site under Products. I am also offering a live 4-class course via the Jung Platform starting Jan. 23, 2024 — which will be available as a recording after this. Here is the link: https://jungplatform.com/store/focusing-accessing-the-bodys-wisdom/partner/frxszk/

 

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The Vagal Paradox: A Current Summary of Polyvagal Theory

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Porges’ recent article has two main purposes: first, to set out a clear, complete description of the Polyvagal Theory in accessible language to clear up confusion and misconceptions among those who apply and describe it; second, to systematically address criticism of PVT in the literature. This is a summary of the former, especially as it relates to the mental health professions.

Porges never dreamed that when he introduced the Polyvagal Theory (PVT) in 1994, it would attract both intense interest among trauma therapists, and also persistent criticism from some scientists. He wrote The vagal paradox: A polyvagal solution (2023) to correct some of the many misconceptions and misrepresentations about PVT in the literature. He takes pains to express the PVT as clearly as possible, aware that those without education in the foundational sciences required to understand the complexities of this cross-disciplinary theory will continue to apply it and describe it to their colleagues. He notes that “misunderstandings can become misinformation in the digital world.”

The ‘vagal paradox’ paper carefully describes the foundations of the theory, what it covers and does not. It is the clearest, most complete description of PVT to date. The following is a summary of the main ideas Porges presents about PVT, in particular what is new in how he describes the theory and what is of highest relevance to mental health professionals. It does not cover the sections where Porges tackles specific detractors of PVT, most often pointing out why their argument is irrelevant to PVT or shows a lack of understanding of its scope and foundations.

Porges devotes about half of the article to addressing his critics — the main point is that PVT is a respected and testable theory. It has been cited in more than 15,000 peer-reviewed journals. PVT has also been enthusiastically adopted as a non-pathologizing way for therapists to help those with a history of trauma to make sense of their body’s responses to threat, and to recover. As trauma therapists, we can use PVT with confidence that it rests on a solid academic foundation.

 

The vagal paradox

Much of the description of PVT is unchanged and will be familiar to those who have studied it. The theory came about as a solution to the ‘vagal paradox’ that the vagus nerve in mammals could be both health-promoting and lethal. Porges observed this paradox in his research with preterm infants, for whom the vagus, usually associated with helpful calming, could also stop the heart.

The vagus, a cranial nerve that travels from the brain stem to many organs, is the primary neural pathway of the parasympathetic nervous system. It is primarily sensory, with 80% of its fibres carrying information up from the organs to the brain. The other 20% are inhibitory motor fibres that can act as a brake on the heart and stimulate the gut.

How can the same nerve help or kill? Because it splits into two branches, emerging from the dorsal and ventral areas of the brain stem, and each function very differently. The PVT describes the anatomy, development, evolutionary history, and function of the two (poly) vagal systems.

The PVT had a focus on how the vagus nerve evolved differently in mammals (although modern reptiles and mammals share a common, ancient reptilian ancestry). Porges describes how in mammals, some of the cardioinhibitory neurons migrated from the dorsal to the ventral branch of the vagus to form part of the ‘ventral vagal complex.’ This allowed for down-regulation of threat responses necessary for nursing, co-regulation and attachment, which are distinctly social, mammalian features.

Porges describes how respiratory sinus arrhythmia (RSA) can be used to track the impact of the two vagal pathways through early development. The myelinated cardioinhibitory fibers from the ventral vagal nucleus have a detectable respiratory rhythm. Research has shown RSA has lower amplitude in preterm infants, whose ventral pathways are not yet fully developed, and that this both improves as the infant matures and can be increased further through social engagement. By contrast, when bradycardia (slowed heart rate) is observed in preterm infants, this appears to be mediated mainly by dorsal vagal pathways (though further research is needed to determine if ventral pathways are also recruited).

 

Dissolution: Evolution in Reverse

An important key to understanding PVT is the Jacksonian principle of dissolution, the observation that evolutionally-newer circuits inhibit older ones except under stress or injury, when changes happen in reverse of this sequence. PVT extends this principle, originally applied to the brain, to include the autonomic nervous system (ANS). Our nervous system develops in this hierarchical fashion: older autonomic circuits (dorsal vagal and sympathetic nervous system) develop first, followed by the newer (ventral vagal, parasympathetic) circuits. It makes sense to Porges that older circuits “would sequentially be disinhibited to optimize survival… under challenge there is a progression that could be characterized as either evolution or development in reverse.”

Porges felt it important to note that the dorsal vagus has beneficial functions, especially related to digestive processes. “PVT proposes that when the ventral vagus is optimally managing a resilient autonomic nervous system both the sympathetic and dorsal vagus are synergistically coordinated to support homeostatic functions including health, growth and restoration. However, when ventral vagal influences are diminished… the sympathetic and dorsal pathways are poised to be sequentially recruited for defense.”  These steps are more commonly known as fight/flight and then collapse/immobility responses in the popular descriptions of PVT. In the body, these steps are observed as increased heart rate and suppression of the dorsal vagal calming of gut and heart. This sympathetic state is metabolically demanding. To reduce demands, the dorsal vagal influence may surge, lowering blood pressure, reducing heart contractility and clearing the bowel (dorsal vagal collapse).

 

Ventral Efficiency: A Dynamic Measure

The ventral vagus acts as a brake on the heart, which has an intrinsic rate of 90 beats per minute. “PVT specifically assumes that the vagal brake is mediated primarily through the myelinated ventral vagus and can be quantified by the amplitude of RSA.” Porges introduces a new measure, that of ventral vagal efficiency (VE), to account for the fact that the vagal brake functions in a dynamic manner in response to the environment. This involves evaluation of short sequential shifts or ‘epochs’ to capture the dynamic relationship between RSA and heart rate. Porges lists several studies using VE as a measure, including his own preliminary research showing lower VE for those with a history of maltreatment, which in turn mediated increased symptoms of anxiety and depression.

Porges suggests that VE reflects a disruption in feedback between the heart and brainstem that could lead to body numbness and index autonomic regulation to stressors and psychiatric symptoms. “Blunted VE may be a mechanism through which maltreatment induces mental health risk and interventions aimed at promoting efficient vagal regulation may be promising for improving resilience and wellbeing in trauma survivors.” He suggests VE could be a “powerful, low cost, easily quantifiable and scalable measure” for screening for low ventral vagal efficiency.

 

PVT: Five Key Principles

In order to understand PVT, Porges suggests there are five key principles. Most of them have already been described in this summary, but they will be explicitly listed below. PVT has evolved since its introduction 30 years ago, in part due to the intense interest and interaction with trauma therapists and survivors who found PVT to be a helpful and liberating explanation for their own embodied experiences. For example, many understood for the first time why they were unable to fight or flee when under attack.

In the process of developing PVT and interacting with the research and clinical communities that have embraced it – the notion of the vagal complex as a process not measurable through standard cause-and-effect principles has emerged. Porges describes PVT as a neural algorithm in which testing by traditional randomized controlled trials does not apply.

Instead, Porges envisions an index of autonomic signatures describing autonomic responses to specific situations. “Perhaps the most informative aspect of such an algorithm would be to identify the autonomic pathways that would support the ability to down regulate threat to enable mobilization and immobilization to occur with trusted others and not trigger defense… It is this process of functionally liberating mobilization and immobilization from defensive threat driven strategies that PVT hypothesizes to have supported the emergence of social behavior and cooperation in species of social mammals.”

This leads naturally to the first principle:

  1. Autonomic state functions as an intervening variable

This principle stresses the capacity of the ANS to dynamically respond, adapt, process and recover from challenges. “PVT emphasizes an important perspective missed by correlational research – how the ANS is part of an integrated response, not a covariate.” This notion transforms how research would be conducted since it emphasizes integration of autonomic, cortical and somatic systems, shifting research targets from correlation to all of the parameters that mediate such integration. Porges said this could curb the tendency to generate faulty causal inferences from high correlations that can lead to inappropriate treatments and poor outcomes.

  1. Three neural circuits form a phylogenetically ordered response hierarchy that regulate autonomic state adaptation to safe, dangerous and life-threatening environments.

This is the cornerstone of the PVT, and well documented in this and other polyvagal literature, however Porges continues to refine his description. The PVT emphasizes there are three neural circuits that regulate and shift autonomic state in response to signals of safety, danger and life threat. PVT describes the mammalian response hierarchy in terms of biobehavioural scripts initiated.

“The phylogenetic sequence is initiated by a dorsal vagus, followed by a spinal sympathetic system, and finally with the ventral vagus. By identifying the biobehavioural scripts of each of these circuits, we become appreciative of the efficiency of the three neural circuits in an attempt to optimize survival,” Porges wrote.  These scripts help us to identify when the system in a safe or threatened state, and if the latter is fight/flight or immobilization. PVT shows how in a safe (ventrally-mediated) state, the system supports health, growth, restoration and sociality.

  1. In response to challenge, the ANS shifts to states regulated by circuits that evolved earlier consistent with the Jacksonian principle of dissolution, a guiding principle in neurology.

This has been described above.

  1. Ventral migration of cardioinhibitory neurons leads to an integrated brainstem circuit (ventral vagal complex) that enable the coordination of suck-swallow-breathe-vocalize, a circuit that forms the neurophysiological substrate for an integrated social engagement system.

The ventral migration of cardioinhibitory neurons became integrated in the regulation of the striated facial muscles used in ingestion and expression. This led to the formation of a social engagement system in mammals that enables a shift from states of defense to those of connection through co-regulation. The PVT describes how the presence of trusted others, especially if they project calm and safety through voice and gesture, can help a person shift into a calmer state. Such features can also be incorporated into trauma therapy.

  1. Neuroception: reflexive detection of risk triggers adaptive autonomic state to optimize survival.

Porges coined the term ‘neuroception’ to emphasize that the scripts initiated by the ANS in response to perceived safety and threat operate outside of awareness and are not under cognitive control. Because these are survival responses, the time it takes to assess and think about a response might be too long, hence these processes are reflexive, “unimpeded by intentionality and cognitive appraisal.”

 

In conclusion…

This article has not only offered a complete, and accessible summary of the development and current state of the PVT, but has also shown that it rests on a firm academic foundation. In addition, it paves the way for future research, and prescribes a significant shift in how such research ought to be conducted to faithfully capture the dynamic and integrative nature of the ANS. Most importantly for clinicians, PVT offers a humane and hopeful path for those who have suffered severe trauma – both a way of understanding symptoms, and a supportive path toward healing.

 

Reference:

Porges, S. W. (2023). The vagal paradox: a polyvagal solution. Comprehensive Psychoneuroendocrinology, 100200.

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Experiential Dreamwork: Adding depth, creativity and transformation of trauma memory for you and your clients

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Over time, dreams appear to help take the emotional charge out of challenging memories while enabling us to retain the information we need to make more adaptive decisions in the future. Engaging with dreams can augment and strengthen this process.

By Dr. Leslie Ellis

Paying attention to dreams adds richness, creativity and depth to inner process. Bringing experiential dreamwork into clinical practice also increases the likelihood that clients will experience deep and lasting change. In my recently-published book, A Clinician’s Guide to Dream Therapy (Routledge, 2020), I offer many reasons for therapists to engage in dreamwork, both for themselves, and with clients. I close the book with a chapter on how neuroscience and dreamwork can combine to bring about transformation of core emotional patterns and beliefs. In this article, I offer a summary of these highlights from my book.

 

Why work with dreams?

“Clinicians who do not pay attention to their clients’ dreams are missing an opportunity to add a compelling dimension of depth, meaning and emotional authenticity to the therapy process. Because dreams often speak the language of metaphor, even the most seemingly-mundane content may carry important meaning that is outside of the dreamer’s immediate awareness. For example, a client who regularly brings dreams to therapy told me in one session that she had lots of dreams the previous night, but nothing important. Her dogs were in the dream, doing what they always do: the younger one pestering the older one who was, in the dream, getting to the point where she simply couldn’t take it anymore and was ready to snap. While acknowledging the dream snippet was literally true, the simple query: “Is there anything in your life like that, anything that you are completely fed up with?” opened up a whole avenue of process for her that was aptly represented by the dogs and may well have been left unexplored had she not mentioned her dream.

 

In addition to turning our attention to deeper matters, the benefits of working with dreams in clinical practice include the fact that dreams are creative and engage clients in the therapy process. They point to our most salient emotional concerns. They bypass our internal editing process and normal defenses, and so are unflinchingly honest representations of our life situation. Dreams can bring a new and wider perspective on a situation that seems otherwise stuck. They provide diagnostic information and can be indicators of clinical progress. They help to regulate our emotions, and working directly with the feelings dreams engender may strengthen this positive effect. They can be a safe pathway to working with trauma. The ‘big’ dreams we occasionally experience can literally change our lives, and dream therapy can facilitate and integrate this transformation.

 

Much of what we know about how clinicians use dreams in their practice is captured in a handful of studies that were reviewed by Pesant and Zadra (2004) with the goal of making clinicians aware that integrating dream work into their practice is both beneficial and accessible. The researchers found that while most therapists do work with dreams at least occasionally in their practice, the majority are not comfortable doing so because they feel they lack expertise or the necessary specialized training. In fact, it is most often the clients, not the therapists, who initiate dream work. The review also found evidence that dream work helps increase clients’ self-knowledge and insight, and increases their commitment to therapy, which can be a predictor of good therapy outcomes” (from chapter 1, A Clinician’s Guide to Dream Therapy).

 

Dreamwork informed by neuroscience can lead to transformation

We will now skip ahead to the final chapter which brings much of the preceding information together. I map a process that touches on how dreams are implicated in the updating of our emotional memories. The following is an abbreviated version of the last chapter: Transformation: Applying neuroscience to dreamwork.

 

“It used to be thought that emotional memories were not malleable, but the discovery of the processes behind emotional memory reconsolidation (Lane et al., 2015) has changed this view. Current evidence suggests the brain is more resilient and capable of changing and healing than previously thought, even later in life. This is a cause for optimism because now that we know something about the specific mechanisms of change, we can attempt to engineer our therapy processes to engender such changes. The beauty of this kind of change, which can take place in basic neural structures (at the synaptic level), is that once it has taken root, the test of success is that clients maintain the changed behavior automatically and without effort. This is not the white-knuckling kind of change that reverts back to its former patterns under stress.

 

Implicit emotional patterns are malleable, and can permanently transform into more up-to-date responses, but only under the right circumstances. It used to be thought that long-term emotional memory was indelible because it was stored in synapses, in the basic structures of the brain. But Lee and colleagues (2004) have shown that if certain conditions are met, the synapses will destabilize, making revision of fear memory possible without reinforcing the original memory. According to Ecker, Ticic and Hulley (2012), the keys to unlocking the emotional brain involve clear, repeatable steps that involve juxtaposing a deeply-felt experience of an outdated emotional belief with something that feels true in current life, but opposite. This creates instability in the memory, and if the new experience is reinforced in a timely way, it will not just cover over or compete with the old information, but will actually replace it. Ecker and colleagues state that the resulting change will be transformational, rather than incremental. In my experience, this can be the case, but when beliefs arose in different contexts, transformation may take place over time, with repetitive experience of how the new experience contradicts the older paradigm.

 

Do not treat the trauma itself, but the beliefs that arise from it

This research highlights something important to keep in mind when working with trauma. The traumatic events themselves are not the important focus. The process, and an open curiosity should be directed to the beliefs that arose out of the traumatic events with the understanding that fear generalizes. For example, people who suffered from chronic neglect in childhood often develop the belief that no one is ever there for them. Feeling deeply into the experience of having even one person consistently show up for them has the potential to shift this long-standing emotional pattern. This is why falling in love can be transformational. Implicit emotional beliefs are not generic, however, but quite specific. They must be experienced in the body rather than speculated about with the mind for the change process to initiate.

 

Such beliefs and their opposites are often referred to in dreams. Jung was the first to notice this pattern. He found it so pervasive that he developed his theory of dreams as compensation around this idea. Although many early theories about dreams have been successfully challenged, this one persists and is incorporated into many current theories that suggest dreams bring new information and have the potential to transform our long-held emotional beliefs based on current experience. Therefore, dream material can be a rich source of experiential information to use as a base for facilitating memory reconsolidation.

 

Doing what dreams do, only better

This section describes how we can take a dream and by focusing on it, assist in the very processes that dreams are implicated in – those of emotional memory reconsolidation and emotional regulation. Over time, dreams appear to help take the emotional charge out of challenging memories while enabling us to retain the information we need to make more adaptive decisions in the future. Dreamwork can augment and strengthen this process. And it can kick-start a ‘failed’ dreaming process that is not working as it should, as is the case with recurrent nightmares of those suffering from posttraumatic stress disorder (PTSD).

 

One of the challenges of trying to engender emotional memory reconsolidation is that it can take quite a bit of detective work to uncover an outdated emotional belief that was formed implicitly. Ideas about the nature of the world are often formed in childhood based on experiences from one’s family of origin, and early beliefs are rarely explicit or called into question. Having no other frame of reference as very young children, we see our environment as simply how the world works, and the beliefs we pick up are a way of adapting to the emotional and relational world we found ourselves in. Dreams, however, can bring our emotional beliefs to life as metaphorical images we experience directly. They often represent novel information that contradicts what we believe. Such images are the keys that can unlock the process of emotional memory reconsolidation, updating and transforming how we respond to life situations in light of current experience.

 

Those who consistently work with dreams as part of their practice of psychotherapy already have an intuitive understanding of how to work with dreams to bring about therapeutic change. Most invite their clients into a deeply experiential sense of the dream, a critical ingredient in the process. Dreams often have within them contrary elements that can be juxtaposed. Inviting the dreamer to deliberately hold this ‘tension of the opposites’ (Jung) can bring about deep and durable emotional shifts.

 

In my book’s final chapter, I am suggesting that armed with a basic understanding of the role of dreaming in emotional memory consolidation, we may be able to explore the dreams that clients bring to therapy in a way that facilitates or strengthens the helpful processes that dreams are already a part of. Well-considered current theories suggest that: dreams are implicated in the process of reducing the emotional charge of memories that have current relevance; and dreams play a part in updating our store of memories to include current experience, better preparing us for what’s next. This could also serve as a definition of what happens in psychotherapy. Not just the dreams themselves, but the dreamwork process within therapy can facilitate these emotional and memory updating processes. In addition, nightmare treatment research has shown that by using what we know about dreams in specific and thoughtful ways, we can repair sleep-dream-memory processes that are not working well, helping healthy dreaming to resume.

Clinical examples of transformational dreamwork

What I have noticed about the process of memory reconsolidation is that theories of psychotherapy incorporated its basic elements well before the neuroscience underlying the process was discovered. The trend in dreamwork toward greater experiential practices is an example of how therapists intuit and/or learn by experience to use methods that engender change. In addition, Jung’s notion that dreams are compensatory, and Gendlin’s bias control are two ways dreamwork brings about an experiential juxtaposition that can cause significant shifts in the dreamer’s store of emotional memory.

 

An example of memory reconsolidation at work is shown in the dreamwork with the Grateful Dead dream earlier in this book. Initially, the dreamer is terrified of being shot by ‘Jack’, the man who in waking life had been abusive and was now aware of where the dreamer worked. In the dreamwork, this fear was juxtaposed by the feelings of safety I encouraged her to sink into very deeply. There were at least two safe places in the dream to draw from: memories of her first love, and also being with a group of like-minded people on the bus who prevent Jack from harming her. In a later part of the session, I ask the dreamer to ‘be’ Jack for a minute, another form of juxtaposition; she feels how hollow and sick he is, before we move on to the part of the dream where she is safe on the bus.

 

There is a palpable release of tension in the course of working with the dream, and this is sustained, which is the hallmark of a successful memory reconsolidation process. The dreamer reported that prior to the dreamwork, she felt very anxious in general, and especially going to work. After the dreamwork, the fear was no longer present. She said, “I’m not holding the charge anymore.” She could walk into work without her usual worried pausing at the threshold, and this was not a conscious, but an effortless, automatic action reflective of a structural change in the nature of her fear memories. Interestingly, in her subsequent dream, she confronts Jack and he apologizes, which is further evidence of change. I believe such dream changes are significant and authentic reflections of clinical change because they happen without conscious volition.  The dreamwork also shifted the way the dreamer holds the memories about Jack, with more of a focus on her friends coming to her rescue and her desire to cultivate community in her life.

 

The ‘new was’

In the preceding example, the client arrives at a new vantage point. From there, she views the past differently, but also, paradoxically, with a sense that it has always been that way.  Gendlin (1984), called this the “new was.” He viewed feelings, thinking, actions and words all primarily as lived experience in the body, and each bodily event as implying what comes next. He called this ‘carrying forward’ and said, “In therapy we change not into something else, but into more truly ourselves. Therapeutic change is into what that person really ‘was’ all along… it is a second past, read retroactively from now. It is a new ‘was’ made from now.”  From this new was, steps come that change one’s conception of the past entirely. The change is not just a current one, but a shift that ripples through our entire store of memory, revising many things accordingly.

 

There is room here to think about state-dependent memory, something I encounter frequently in working as a psychotherapist. To play with the above example, when the client feels afraid, the memories of Jack feel much more ominous and she recalls the worst ones. When she is less afraid, she may recall better times, such as her earlier relationship with her first love.  This fear bias colors her perception of the world in general, and of relationships specifically. I believe that the elements of this dream were particularly salient and powerful tools for engendering lasting change in her sense of relational safety. It can be a challenge in psychotherapy to create deeply-felt juxtapositions necessary to revise emotional memory, but dreams provide ready-made and highly relevant material for this powerful transformation process.

 

 

Dr. Leslie Ellis is an author, teacher, researcher and therapist with an abiding interest in inner life. She teaches therapists how to work with embodied experience, trauma and dreams, and offers on-line courses in dreamwork and focusing. She has a PhD in Clinical Psychology with a somatic specialization. Shen has conducted award-winning research in treating nightmares of refugees using embodied dreamwork techniques. For more information, go to https://www.drleslieellis.com or contact her at leslie@drleslieellis.com.

 

References

Ecker, B., Ticic, R. & Hulley, L. (2012). Unlocking the emotional brain: Eliminating symptoms at their roots using memory reconsolidation. New York: Routledge.

Ellis, L. (2019). A Clinician’s Guide to Dream Therapy: Implementing Simple and Effective Dreamwork. New York & London: Routledge.

Gendlin, E. T. (1984). The client’s client: The edge of awareness. In R. L. Levant & J. M. Shlien (Eds.), Client-centered therapy and the person-centered approach. New directions in theory, research and practice, pp. 76-107. New York: Praeger.

Lane, R. D., Ryan, L., Nadel, L., & Greenberg, L. (2015). Memory reconsolidation, emotional arousal, and the process of change in psychotherapy. Behavioral and Brain Sciences, 38.

Lee, J. L., Everitt, B. J., & Thomas, K. L. (2004). Independent cellular processes for hippocampal memory consolidation and reconsolidation. Science, 304, 839-843.

Pesant, N. & Zadra, A. (2004). Working with dreams in therapy: What do we know and what should we do? Clinical Psychology Review, 24, 489–512.

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Dreams as a picture of the nervous system

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Dreams as a picture of the nervous system, and an avenue for state shifts

It’s beginning to dawn on me that not just nightmares, but all dreams can be seen as an expression of the nervous system. They are images direct from the body, far less filtered by our internal censor than waking thoughts — they are more image-based, more visceral and fluid. Spending time with our dream images in a calm and curious way can be inherently regulating, and I am beginning to suspect why this is so.

The late Ernest Hartmann, a celebrated dreamworker and researcher, said two things that I want to follow up on in this context. The first is, “The nightmare is the most useful dream.” This is not meant to dismiss the real distress and terror that our worst dreams can bring. It’s that nightmares represent an extreme state, and as such, one that we can learn the most from.

Linking nightmares and the nervous system

I’ve spent the last couple of years investigating the link between nightmares and the autonomic nervous system (ANS) through the lens of polyvagal theory. Although I think the implications of this for nightmare formation and treatment are still largely unexplored, I started this ball rolling with the recent publication of an article with the optimistic title, Solving the Nightmare Mystery in which I imply that the role of the nervous system is a missing link in our understanding of how to treat nightmares (Ellis, 2022).

I have been sitting with those who experience deeply disturbing dreams for many years now, one of the main things I do to help is facilitate the search for, and embodiment of, cues of safety that help alter their perception and experience of these dreams. They tell me this embodied process of dreaming their dreams forward (called ‘rescripting’ in modern nightmare treatment literature), changes how they hold the dream in their body. Typically, the memory remains, but the charge dissipates, after a successful session.

Nightmares are dramatic, and there is clear autonomic activation during sleep state shifts for those who experience them frequently. Nightmares are easily recalled and their impact is tangibly felt, as is the relief one experiences when they begin to fade or shift into a more benign form. This is useful because when a phenomenon is loud and colorful, we can more easily see it.

Dream images as nervous system state and shifts

However, in a recent class I teach on the clinical use of dreams, a dreamer brought an image of a dark, still woman in a tub that had sat so long the water had gone cold. Her impulse, in dreaming this forward, was to turn on the hot water faucet, to bring some warmth to the bath and to the woman’s body. Entering the dream further, she noticed the tub itself, and it was older, more ornate and beautiful than the one is her current bathroom, where the dream was set. Her own demeanor changed in this process or warming the bath, her face coloring and smiling as she described making the bath a sanctuary, adding scent and oil and dipping into the enjoyment of it. Later, she told me the shifts continued in the coming days: “I continued to experience “mini shifts” in the following days and was able to access and carry the felt sense of the warmth and beauty of the bath into many areas of my daily life. I noticed I feel more present when I bring a sense of aesthetics, in the form of a little beautifying and warming detail, when I have to tackle some of the mundane daily tasks and responsibilities, which were weighing me down lately.”

This entire dream process could be seen as an image of the nervous system as it shifted from a cold, immobilized (dorsal vagal) state, into one of connection and animation that was clearly visible on her face. Her fellow classmates remarked on the change, as her physiology demonstrated a clear shift into a state of social engagement and warmth (ventral vagal). This kind of shift is typical in working with dreams. The images from nightmares are clear representations of autonomic states. Activation or fight/flight – being chased or engaged in a battle – are some of the most prevalent nightmare themes. The leap I have made is simply that nightmares are the most obvious expression of what happens in all dreams. They are our bodies expressing in image and sensation our fluctuating internal state. They are doorway into its expression, particularly valuable for those who have trouble hearing what’s going inside.

Dreamwork as a way to metabolize and regulate emotion

This brings me to another of Hartmann’s famous statements: that dreams are a ‘picture-metaphors’ for our most salient emotional concerns. Sometimes our most pressing feelings are repressed, historic or fleeting enough that we don’t think about them during the day. But our dreams have an uncanny way of picturing what matters most, even if we have repressed it. Our bodies carry the charge of feelings and memories that are unmetabolized, and these find expression in our dreams.

My sense, which is shared with many dreamworkers and researchers, is that a purpose of dreaming about emotion is not to upset us but to help us process and shift such feelings. Sometimes, the dreams do this all on their own, like a nocturnal therapist, and sometimes it really helps to have another person process the dreams with us. One idea that attention to the nervous system and polyvagal theory has taught us is that we humans (and all mammals) function better together than alone. Sharing our dreams and bringing them into company and the light of day helps them do their job better. And more and more, I’m beginning to think that a large part of their job is expressing and regulating the state of our nervous system.

 

References

Ellis, L. A. (2022). Solving the nightmare mystery: The autonomic nervous system as missing link in the aetiology and treatment of nightmares. Dreaming.

Hartmann, E. (1999). The nightmare is the most useful dream. Sleep and Hypnosis, 1(4), 199-203.

Hartmann, E. (2010). The dream always makes new connections: the dream is a creation, not a replay. Sleep Medicine Clinics, 5(2), 241-248.

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Terror and excitement are not so far apart

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Nervous system hybrid states and how they show up in dreams 

Not all dreams are pure fight/flight, but much like our complex nervous systems they can express hybrid states. We are all familiar with the nightmares of being chased (flight response) or weighed down with helpless immobility (dorsal vagal response). These are fear-based dreams, but they take on a very different tone when imbued with a sense of safety.

At its most basic level safety allows for social engagement, a sense of being at home in the company of those we love and trust. There are also hybrid states, where how safe we feel can mediate how our nervous system responds. When we are immobilized with safety, this allows for stillness, intimacy and bonding. When we are activated with safety, this allows for excitement, sport and play.

The genius of the polyvagal theory developed by Dr. Stephen Porges is that it takes us beyond the simple categorization everyone rattles off without much thought – the well-known fight/flight/freeze paradigm. When naming and understanding our autonomic state, Porges puts safety first.

A neuroception of safety is automatic, not intellectual

What does Porges mean by safety? His polyvagal theory is referring not to literal safety, but rather, bodily-sensed safety. Many who experience activated nervous systems, fear responses and nightmares are not in any real, physical danger, but there is no way to convince them of this, at least not by simply saying so.  Porges’ model stresses the neuroception of safety, that full-body sense which happens automatically, beyond conscious control, that allows our system to relax and repair.

When we are not experiencing rejuvenating embodied safety (a ventral vagal state), our dreams come as nightmares, as being chased or in aggressive encounters (fight/flight) or as helplessness immobility (often called freeze, those this word is not quite accurate). When our bodies feel safe, we dream of social encounters, of intimacy, adventures and play. Our dreams depict how safe or endangered we feel. As such, they can be a doorway to shifting these states at a deep level.

Autonomic state shifts are common — our nervous systems are always working to balance the need for safety and self-protection with those of social engagement, healing, digestion and the achievement of homeostatic balance. When our system perceives threat, things like digesting food or making love are luxuries our bodies senses we can’t afford… whether or not this is actually true.

Our sense of safety or danger is not always accurate

How do our bodies get this wrong? Much of the mismatch comes from early programming, from chronic exposure to neglect or trauma that creates nervous system responses that are either too sharp, too dull or a mixture of both. Those with complex trauma histories, for example, can perceive danger where none exists, or be blithely unaware of actual threatening situations and walk into danger without knowing it. Our dreams can provide both clues and solutions as they reflect our unconscious ANS responses.

During typical sleep, we shift states many times, alternating periods of deep restorative sleep with progressively longer period of dream-rich rapid-eye movement (REM) sleep. In these state shifts, we are most likely to become aware of our dreams and to be awakened by those that are particularly intense. Nightmares can disrupt sleep and affect mood, but they can also open the door to autonomic state shifts that can be lasting.

If we approach our dreams with curiosity, and begin to cultivate mastery and degrees of lucidity, we may be able to shift our dreamscape from a pervasive sense of threat to one of safety, changing our whole experience of the dreaming. This is easier to do that one might think. One chronic nightmare sufferer I worked with was able to turn a face her pursuers and discovered they were far less threatening than expected, and this changed the nature of her dreams. The chase dreams still visit at times, but now they have taken on more of an adventurous feel, one of excitement rather than terror – a similar activated state, but with more of a sense of safety.

Hybrid states show us that the programming our nervous systems received early in life may be tenacious, but it is also malleable. Change is possible, and dreams are one pathway to understanding and altering our habitual responses.

For more on this topic, join Dr. Leslie Ellis for a workshop on Nightmares and The Nervous System October 13, from 9:30-noon (Pacific)

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Nightmares and the nervous system: How the content of your nightmares can guide recovery from disturbed dreaming

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The content of our dreams offers clues about the state of our nervous system. As we know from current research on recurrent dreams, these often depict being chased, feeling helpless or, if positive, represent ways of being socially engaged. Anyone familiar with the polyvagal theory will recognize these states as the some of the main expressions of different states of autonomic nervous system (ANS): being chased is fight/flight, helplessness is immobility and social engagement corresponds with the ventral vagal state the body enters when feeling safe.

A new wave of somatically-oriented trauma therapies has swept through the field of trauma treatment as a result of what we now know about the nervous system. I love that these new approaches view ANS responses as adaptive rather than pathological. I am also impressed at how neatly such constructs map onto dream content. Clinicians can use this information from dreams to inform diagnosis and treatment, and to map clinical progress. For example, when recurrent dreams change, this is can indicate clinical progress as it coincides with increased well-being.

My upcoming journal article, Solving the Nightmare Mystery: How Polyvagal Theory Updates Our Understanding of the Aetiology and Treatment of Nightmares, takes Porges’ polyvagal theory and the nervous system into account when considering the causes and treatment of nightmares; it is in the final stages of production for APA journal Dreaming. The article articulates both a theory and treatment approach that I will cover in more detail in my upcoming workshop on October 13 (participants will receive an advance copy). One of the practical take-aways is the matching of dream content with autonomic states. Here is an excerpt from my article:

“It is possible to map the hierarchy of threat responses onto the content of nightmares. Virtually all fear-based nightmares contain material that represents either an activated fight/flight response or a helpless immobilized response in the face of threat. A recent study to determine the main themes in nightmare content (n = 1216) points to a strong, though not perfect, correlation between most common nightmare themes and the polyvagal response hierarchy. In order, the most frequent nightmare themes identified by Schredl and Goritz (2018) were failure or helplessness (immobility), physical aggression (fight), accidents, being chased (flight), illness or death (immobility), and interpersonal conflict (fight).”

In my doctoral research, I conducted a related qualitative study (Ellis, 2016), looking at changes in recurrent nightmare content after treatment using a protocol that is a precursor to the Nightmare Relief protocol I now use and teach.  The recurrent nightmares of study participants changed after treatment toward more empowered responses, moving up the polyvagal hierarchy of threat responses — from immobility to flight to fight. Also, the dreams that came after treatment began to weave in current settings and characters from the dreamer’s life shifting away from a focus in past trauma. The progression of dream content from replicative and recurrent toward dreams with strange twists and temporal anomalies (ie more normal dreaming) often coincides with trauma recovery.

Relevant to polyvagal theory, I also noticed that the dreams post-treatment tended to move toward greater social engagement: “When dreamers were asked to rescript their dream endings, they almost invariably imagined ‘home.’ The quality of home is similar to Porges’ ventral vagal state: not necessarily a literal place (especially for those whose actual homes were unsafe), but rather a sense of safety in the company of trusted others.” This is a clue about how to help with nightmares – assisting dreamers to reimagine their dreams in ways that feel safer can shift them, and reduce the aversion nightmare sufferers tend to have toward sleep and dreams.

In my upcoming seminar, I will present the most salient aspects of this material and focus mainly on introducing the Nightmare Relief protocol. I will be able to offer more detail, clinical examples, demos and experiential practices than are covered in the academic paper. I would like those who take this workshop to be able to put these ideas into practice right away with clients who suffer from nightmares and disturbing dreams.

To sum up, I have arrived at the idea that the nervous system is deeply implicated in nightmare suffering, and that using newer embodied trauma treatment methods that instill a sense of safety and connection are the starting points for treatment. I have incorporated what I learned in my doctoral research, and also what I have learned from existing evidence-based treatment to develop an individualized, embodied approach to treatment. This is described in my paper and upcoming workshop. I do hope you’ll join me.

 

Workshop: Nightmares and the Nervous System: How to treat disturbed dreaming
October 13, 9:30 to noon Pacific
LIVE online via Zoom, recording available to registrants
Cost: 140 (plus GST) = $147 USD