Deb Dana, LCSW- Guest
Deb Dana, LCSW is a clinician, consultant and author specializing in complex trauma. Her work is focused on using the lens of Polyvagal Theory to understand and resolve the impact of trauma, and creating ways of working that honor the role of the autonomic nervous system. She is a founding member of the Polyvagal Institute, consultant to Khiron Clinics, and advisor to Unyte. Deb is the developer of the signature Rhythm of Regulation Clinical Training Series and is well known for translating Polyvagal Theory into a language and application that is both understandable and accessible for clinicians and curious people alike. Deb’s clinical work published with W.W. Norton includes The Polyvagal Theory in Therapy: Engaging the Rhythm of Regulation, Polyvagal Exercises for Safety and Connection: 50 Client Centered Practices, the Polyvagal Flip Chart, and the Polyvagal Card Deck. She partners with Sounds True to bring her polyvagal perspective to a general audience through the audio program Befriending Your Nervous System: Looking Through the Lens of Polyvagal Theory and her print book Anchored: How to Befriend Your Nervous System Using Polyvagal Theory. Deb can be contacted via her website www.rhythmofregulation.com |
W. Keith Sutton, Psy.D. - Host
Dr. Sutton has always had an interest in learning from multiple theoretical perspectives, and keeping up to date on innovations and integrations. He is interested in the development of ideas, and using research to show effectiveness in treatment and refine treatments. In 2009 he started the Institute for the Advancement of Psychotherapy, providing a one-way mirror training in family therapy with James Keim, LCSW. Next, he added a trainer and one-way mirror training in Cognitive Behavioral Therapy, and an additional trainer and mirror in Emotionally Focused Couples Therapy. The participants enjoyed analyzing cases, keeping each other up to date on research, and discussing what they were learning. This focus on integrating and evolving their approaches to helping children, adolescents, families, couples, and individuals lead to the Institute for the Advancement of Psychotherapy's training program for therapists, and its group practice of like-minded clinicians who were dedicated to learning, innovating, and advancing the field of psychotherapy. Our podcast, Therapy on the Cutting Edge, is an extension of this wish to learn, integrate, stay up to date, and share this passion for the advancement of the field with other practitioners. |
Dr. Keith Sutton, Psy.D: (00:22)
Welcome to Therapy on the Cutting Edge, a podcast for therapists who want to be up to date on the latest advancements in the field of psychotherapy. I'm your host, Dr. Keith Sutton, a psychologist in the San Francisco Bay Area, and the Director of the Institute for the Advancement of Psychotherapy. Today I'll be speaking with Deb Dana, a licensed clinical social worker, who is a clinician, consultant, and author specializing in complex trauma. Her work is focused on using the lens of polyvagal theory to understand and resolve the impact of trauma and create ways of working that honor the role of the autonomic nervous system. She's a founding member of the Polyvagal Institute, consultant to Chiron Clinics, and advisor to Unite. Deb is a developer of the Signature Rhythm of Regulation Clinical Training series and is well known for translating polyvagal theory into a language and application that is both understandable and accessible for clinicians and curious people alike. Deb's clinical work published with WW Norton includes The Polyvagal Theory of Therapy, Engaging The Rhythm of Regulation, Polyvagal Exercises for Safety and Connection, 50 Client-Centered Practices, The Polyvagal Flip Chart, and The Polyvagal Card Deck. She partners with Sounds True to bring her polyvagal perspective to a general audience through the audio program, Befriending Your Nervous System, looking through the lens of polyvagal theory and her print book Anchored: How to Befriend Your Nervous System Using Polyvagal Theory. Let's listen to the interview. Hi, Deb. Welcome. Thanks for joining us today.
Deb Dana, LCSW: (01:51)
It's nice to be here. Nice to meet you.
Dr. Keith Sutton, Psy.D: (01:53)
Yeah, nice to meet you. So, I've heard a lot about the work that you've been doing. A number of clinicians in my practice have talked about polyvagal theory and, a lot of the folks in the trauma community particularly. So I got really interested in this work and have been wanting to learn more and got to listen to some of your talks. So I'd love to hear about your work and polyvagal theory, but first, before we even get there. I always like to hear kind of how people got to do and what they're doing, kind of the evolution of your thinking as it kind of went along to get where you are here.
Deb Dana, LCSW: (02:25)
Yeah. It's a lovely way to start sort of reflecting on how I ended up at this moment in time. I've been doing a lot of that recently because I will be 70 this coming year, and it seems like a time of reflecting and looking back and looking ahead. So it's interesting, you know, Steve and I. I read his book when it came out, and then we met in 2013, he came to Maine to do a workshop for the group practice I was in. And I had already started playing around with polyvagal theory, bringing it into clinical practice, because the theory made so much sense to me. I've always loved understanding the brain and the body as a social worker and I just think we should understand and help our clients understand.
Deb Dana, LCSW: (03:19)
And so I had already started playing with, what do I do to bring this into my work? Because it was so brilliant to theory and yet a little complicated. Okay, but how do you make this work in a session with the client? So, he came and we had a lovely time just sort of talking about his work and my work and how it fits together, and that was a moment in time when my life changed. I didn't know it at the time because, you know, I lived in Maine at the time. I still do live in Maine, half the time.
Deb Dana, LCSW: (03:58)
I was sitting in my room over the garage creating this stuff and from there to here at this moment feels like a life-changing journey that I've been on because now people really ask me to talk to them about polyvagal theory to translate. I guess I've translated Steve's work into a sort of clinical language and everyday language. I talked with Steve the other day and I said, “I cannot imagine what my life, where my life would've gone without this. And reading your book and having you come to Maine and setting off on this journey.” There was a moment in time when there was a workshop or a presentation that he couldn't do and he asked me if I would fill in for him. And it was that moment when I thought, really Steve Portis wants me to fill in for him, and it was in Italy no less.
Deb Dana, LCSW: (04:51)
So, and from that it was like, oh, I love this. I love doing this. So, you know, we have these moments and we don't know where they're gonna send us. And so I look back on, you know, it's been almost a decade now and it's like, wow, who would ever have known, I never could have predicted where I am now. And, so I guess that's my invitation for everybody to sort of, you never know, you just never know, right?
Dr. Keith Sutton, Psy.D: (05:27)
Well, it's great. And it sounds like you're following your passion too, to really finding helpful and, and digging into it, and then kind of things evolved from there. And is Steve a psychologist, a therapist, or a researcher?
Deb Dana, LCSW: (05:43)
He's a research psychologist. He's always been in the lab. He's run labs. He's in academia, so I needed his theory to make some sense of what I was seeing with my clients. And then he said, “I depend on you to then translate it for the clinical world”, so it's a lovely partnership. And I have to say, if you haven't listened to him talk find a way to do that. He is a brilliant scientist, and also a very down-to-earth, humble, kind human being, which is a really special combination.
Dr. Keith Sutton, Psy.D: (06:22)
So tell me about what is the polyvagal theory.
Deb Dana, LCSW: (06:29)
So, the polyvagal theory is a theory of how our autonomic nervous system is organized and I think about it in with three basic principles. And, before we talk about those, I just wanna say that the autonomic nervous system is at the heart of our daily experience. We think our brains are running the show, but in fact, it's our nervous system that begins everything. And so, for therapists who are listening, no matter what model of therapy you've been trained in, you're in fact working with your client's nervous system. You may not bring that into explicit awareness, but you're working with your client's nervous system. And that's where I began thinking, okay, I should understand it and my clients should understand it. Because I think part of what we're doing as therapists is helping clients have skills and tools, and understand how to find their way to regulation.
Deb Dana, LCSW: (07:28)
And the nervous system is the pathway there so the reason, I guess for understanding how your nervous system works I like to say we're helping our clients become active operators of their nervous systems. That's really what this is about. So we have three principles that guide polyvagal theory, neuroception hierarchy, and co-regulation. And those are three words that are not in the common vocabulary, but I think at some point they probably will be because they are the sort of vocabulary of your nervous system. So you want to look at those one at a time.
Dr. Keith Sutton, Psy.D: (08:09)
Yeah, and I want to understand too what you're saying about working with the nervous system. Because emotions are really connected and really kind of is the nervous system, right? That when we feel these various things in our body, we can kind of connect that to anxiety or feeling sad and so when we're working with emotions we're working with the nervous system.
Deb Dana, LCSW: (08:36)
Yeah, and it's interesting because we give a label, right? The nervous system underneath that is having a response and then the brain puts a label on it. The brain's job is to make sense of what's going on in the body. And so the brain gives it a label, right? So a client might come in and say, you know, I've had a really sad week so they've put a label of sadness on it, but it doesn't tell me what happened in the nervous system. So we wanna go underneath the label, under the symptom to see where did it come from.
Deb Dana, LCSW: (09:12)
So that's really, I think when we think about working with the nervous system we're looking underneath the symptoms our clients are bringing to us. To find where did they emerge from because when I know where they emerged from, it directs the clinical choice I make about treatment.
Dr. Keith Sutton, Psy.D: (09:30)
It's kind of like the same physiological experience can be labeled as anxiety or excitement, you know, those kinds of pieces. And then looking at kind of what is maybe triggering that nervous system response that's kind of leading to them, the labeling in a particular emotion.
Deb Dana, LCSW: (09:50)
And for our trauma survivor clients, you know, that their heart begins to race a bit and their autonomic automatic pathway is towards anxiety because that's been a familiar pathway they've traveled. So part of our job is to slow it down and say, let's look at all the options for a heart that is speeding up, you know, getting ready to move, passionate, excited, worried, anxious, there's a whole range of things that come to out of this. And if we can anchor in a place of regulation, we then have a chance to make a choice.
Deb Dana, LCSW: (10:31)
Not simply be taken down a survival pathway, which we need those survival pathways. They were built for a reason. It's just that when we have traveled them so easily and so often we lose that aspect of choice. We end up on that pathway without even knowing how we got there.
Dr. Keith Sutton, Psy.D: (10:52)
Well, it's helping the client move from being reactive, or responsive, and having an experience to, how I want to respond to that experience.
Deb Dana, LCSW: (11:00)
And we can't be responsive unless we are anchored in some autonomic regulation. Soon as we end up in a survival state, we're reactive, not reflective or responsive. So again, we come back to, “can we help begin to regulate the state?” And what the research is beginning to show us is that as clients begin to have a more regulated nervous system, their symptoms reduce or even resolve sometimes both physical symptoms and psychological ones because it's all one, mind and body are all one. So, it's interesting, no matter what your client brings to you as they're presenting problem you really want to help them come into a place where they feel more regulated, more access to regulation in their nervous system. And then everything begins to look different.
Dr. Keith Sutton, Psy.D: (11:49)
Perfect, so let's start by going through those three.
Deb Dana, LCSW: (11:55)
So we'll start with neuroception. And neuroception is this beautiful word that Steve created to describe how the nervous system takes in information and then makes a choice about safe or unsafe. There wasn't a word because perception uses the cortex and the nervous system, although it does connect with the cortex in the limbic, which is a brains stem originating system. So it's a subcortical system. So he created the word neuroception, which I love and think is a great word. And everybody should have that word as part of their vocabulary. Use it on your Scrabble or, maybe it will end up in Wordle someday, who knows? But, neuroception uses three pathways to take in information. There's an inside, outside, and in-between pathway. So there's the embodied pathway where it's always listening. It would be that pathway we were just talking about, heart rate, lungs, digestion, and viscera, it listens there to see what's going on whether safe or unsafe.
Deb Dana, LCSW: (12:50)
Then an outside, an environmental pathway listens into the world around us to get cues of welcome or warning. And then the between pathway, which is the one that I think is so important for us as clinicians between two nervous systems. It's always listening below the level of conscious awareness to get cues from another nervous system. Is this safe or not safe? Do I approach or not approach? So that's neuroception and what we know is that the cues of safety have to outweigh the cues of danger in order for us to feel safe enough to move forward in whatever way.
Dr. Keith Sutton, Psy.D: (13:38)
I was gonna say, so the embodied, that's kind of like in our interception, kind of our experience of our physical sensation internally, what's going on in the environment. And between nervous systems, do you mean between your nervous system and my nervous system kind of getting a sense of your energy or where you're at, or if you're feeling on edge? And kinda my nervous system attuning peers.
Deb Dana, LCSW: (14:01)
Exactly, and that in-between is so fascinating because you may have a certain way of moving or you may have a certain tone of voice or a certain look that is a familiar cue of danger from my past. And then will activate in the present and take me out of connection when it really has nothing to do with you. It has to do with a cue from the past that's come alive in the present. The same is true for the environment and the embodied pathway. But it's really interesting when we're working with clients and we kind of have this moment of something just happened, but I don't know what it was. Neuroception has neuro septic, a queue of danger, and has shifted that equation so that the cues of danger now outweigh the cues of safety and you can feel it when that happens, everything stops. And then if you're working, you know, through a nervous system level your curiosity is “Wow, what just came in and shifted the balance? What was it?” Sometimes, we look away, we look at the clock or we look down. You know, neuroception of danger to another nervous system is not intentional at all.
Deb Dana, LCSW: (15:18)
However, it gets sent as a warning out there into the world. And my client does this. They pull back, and they disconnect. So it's interesting to track those because it gives us a way to come back into connection and a way to understand what are the deceptive cues that really bring a sense of safety. Because I want to bring more of those into my work with that client. What are the cues that bring danger? Maybe, we can reduce some of those.
Deb Dana, LCSW: (15:50)
And, what we've discovered is neuroception, we might call them the passive cues because they're just going on in the background all the time. Those passive cues have to be weighted toward safety n order for us to use the active experiences that we want to bring to therapy. If the neuroception is one of unsafety, it doesn't matter how brilliant you are as a therapist you can't engage your client in therapy because their nervous system says this is not safe.
Dr. Keith Sutton, Psy.D: (16:22)
So they're kind of not able to access that. We kind of need that safety first to be able to do that work.
Deb Dana, LCSW: (16:28)
Exactly, and we often make stories up and label our clients as non-compliant, not trying hard enough, or too needy. And if we can look across and say, “unsafe”, it changes the equation because non-compliant, I don't know what to do with non-compliant, but unsafe.
Deb Dana, LCSW: (16:46)
Of course, I know what to do with unsafe. And that's really what we're seeing. We're seeing a nervous system that doesn't feel enough neuroception of safety to be able to, not unwilling, but able to come into connection. So that's the lovely part of the polyvagal theory. It's so nonjudging, non-shaming, non-blaming, and non-pathologizing. It's simply the nervous system doing what it knows how to do, trying to keep you safe.
Dr. Keith Sutton, Psy.D: (17:18)
That's interesting. It makes me think of motivational interviewing when I think about that, or the idea of resistance that sometimes that's due to what the therapist is doing, not necessarily something within the client. And that sometimes the therapist gets ahead or the client's not feeling seen. And once we get back to that place where they feel like we understand, oftentimes there's that regulation and that big head noob like you're doing right now. Then we can move forward again.
Dr. Keith Sutton, Psy.D: (17:44)
But framing that as unsafe is I think a helpful way of thinking about it.
Deb Dana, LCSW: (17:47)
Yes, and I often with my clients, I actually get out a piece of paper and write down what are the cues of safety. What are the cues of un of unsafety at this moment? Because we want to concretely identify them, therapy is about bringing the implicit into explicit awareness.
Deb Dana, LCSW: (18:04)
This is the same thing we're doing in the nervous system, all this implicit neuro-deceptive experience. We're bringing explicit awareness so that we can work with it. You know, you were talking about head nods and head nodding and turning and tilting is wired into your biology to send a queue of safety to another nervous system.
Dr. Keith Sutton, Psy.D: (18:28)
Another one, I'm supervising her, so I'm looking for that big head nod when I got the head then I know we can kind of move forward. I don't want that like kind of shrugging shoulder, as we wanna really look at like, we're on the same page now we can forward together.
Deb Dana, LCSW: (18:42)
So your brain is looking for certain cues for a reason. Your nervous system is also looking for those cues to feel like, oh yes, we're in a connected co-regulating moment.
Deb Dana, LCSW: (18:55)
Yeah, so if we take neuroception and understand it then leads to hierarchy, which is the next organizing principle, because as your neuroception makes a judgment about safer or unsafe, it then activates one of your states. And we can talk about three states. We've got a lot of blended states too. But if we just talk about three, ventral which is regulated, connected, organized, and safe enough. The state that we long to be in, and I think our nervous system inherently knows how to get to it.
Deb Dana, LCSW: (19:33)
So that's where we're helping our clients get that. Then we have two survival states. The first one is sympathetic, which most people know the fight and flight.
Deb Dana, LCSW: (19:42)
Then the other survival state is dorsal, which is collapse, shut down, and disconnect. And that was Steve's brilliant work in illustrating polyvagal theory. He was working with premature babies in the NICU and It was the dorsal discovery really that the vagus nerve, which we had just thought was parasympathetic. We had sympathetic parasympathetic and with his work, we now know parasympathetic has both ventral which is regulated and connected. And dorsal which is shut down, collapsed, and disconnected.
Deb Dana, LCSW: (20:23)
And, for our trauma survivor clients, we see that all the time.
Deb Dana, LCSW: (20:27)
We see that disconnect, associate float away fuzzy experience. That's their dorsal vehicle system.
Dr. Keith Sutton, Psy.D: (20:36)
Oh. This is a kinda hypo arousal kinda dissociation, like kinda the survival response of like playing dead.
Deb Dana, LCSW: (20:44)
Yeah, and just a slight flavor of it. It's that experience I think most of us have had of going through the motions, but not really being present there doing it or going through the motions, but not having the energy to really care. Dorsal is draining of energy. The body, you know, goes into conservation mode. We just don't have energy and the psychology around it is some sort of, you know, hopelessness, giving up, and despair. Whereas sympathetic is that overwhelming, disorganized, chaotic energy that mobilizes us. So they're the opposite experiences, both survival responses. And what Steve really outlined is this hierarchy which is so helpful for us as humans, but especially us as therapists, because it means that you travel from ventral to sympathetic to dorsal in that order. And then in order to get back to the ventral, you have to leave the dorsal, come through some energy from the sympathetic, and arrive back in the dorsal. So, you know, we can help clients understand that pathway down and back.
Dr. Keith Sutton, Psy.D: (21:57)
Yeah. Sometimes when working with clients when dissociation is coming up I sometimes move forward with them, “how is it protecting you?” And oftentimes it's protecting from that sympathetic, “I'll be so overwhelmed,” or “I'll have a panic attack”, or whatever it might be. And so oftentimes kind of using some heart's work to be able to look at when they handle that because oftentimes it's the emotional flashback that's kind of the same. That's dangerous, now you can't handle this.
Deb Dana, LCSW: (22:26)
And isn't that a brilliant way our nervous system protects us?
Deb Dana, LCSW: (22:30)
You know, and that's one of the Dorsal jobs is to rescue us from sympathetic from that overwhelming, that intensity. And then sympathetic, one of its jobs is to pull us out of dorsal because dorsal is probably the most challenging place to be because we're untethered floating, and we sort of disappear in that place. And so sympathetic tries to pull us back, but it does it with that overwhelming energy. So it's an interesting loop. We see many of our clients get in. Sympathetic, dorsal, sympathetic, dorsal back and forth, because sympathetic brings a bit of energy, but it feels too big, too scary, too much. The system goes right back to the dorsal.
Deb Dana, LCSW: (23:14)
And then it peaks its head out again and it's too much and back again. So, the key to working with how to get clients to move back from sympathetic to ventral is to not go through the survival pathway of sympathetic but to go through the mobilizing pathway. We don't want to go to fight and flight, but we want to use some of the mobilizing energy of sympathetic to bring energy back into the system and continue on up to the ventral.
Dr. Keith Sutton, Psy.D: (23:46)
So, that kind of energy that more kind of motivates us or the gas in the car that gets us kind of going, to kind of address whatever the issue is or the helpful part.
Deb Dana, LCSW: (23:59)
The energy of movement rather than the energy of survival. Because sympathetic does both in its everyday role. It brings us the energy to do what we're doing. We're moving, we're sitting up, sympathetic brings the energy to do that, but it's under the management of ventral. And so when ventral is overseeing your nervous system, the sympathetic brings you that energy, and the dorsals everyday job is to run your digestion in a healthy way.
Deb Dana, LCSW: (24:31)
So our states, you know, work together in this beautiful way. It's only when ventral gets overwhelmed by the world and we enter into sympathetic survival that we have this fight and flight. And, that HPA access, hypothalamus, pituitary, and adrenal access gets revved up then and we get flooded with cortisol and adrenaline. And that's what's so terrifying to our clients' nervous systems. That feeling of danger that comes, it's a neuroception of danger.
Dr. Keith Sutton, Psy.D: (25:03)
And back to what you were saying with the dorsal and the digestion. Can you talk more about that? That kinda rest and digestion.
Deb Dana, LCSW: (25:11)
Dorsals everyday role when the ventral is again, overseeing the system, dorsal brings nutrients to nourish us. It runs our digestion in healthy ways. And if we think about our clients, so many of our clients have digestive issues and this is because their system is out of regulation. And as soon as the ventral can no longer run the system digestion gets impacted. When you're in sympathetic digestion is impacted, when you are in dorsal digestion is impacted. And we have many clients who come to us with, you know, digestive problems they want to work with. I'm not a medical social worker, and yet what I can tell my clients is as we find the way to more regulation that is going to change.
Deb Dana, LCSW: (25:59)
You know, happy to work with medical providers, and let's build a team that is willing to help us regulate your nervous system and see what happens.
Dr. Keith Sutton, Psy.D: (26:10)
So there's the hierarchy there that you're talking about, the neuroception and then the hierarchy, and then that goes into the regulation.
Deb Dana, LCSW: (26:25)
Co-regulation is the third organizing principle. And, co-regulation is what we call a biological imperative. Meaning it's something we have to have in order to survive. We come into the world and we do not survive without another human to help us. And the interesting thing is that co-regulation is a lifelong need. And if you think about that how so many of our clients who come to us with the belief, you know, wired in the nervous system, belief people are dangerous.
Deb Dana, LCSW: (26:59)
And so when we begin to understand that, you also have to find self-safe people to come into connection with in order to fully experience wellness. It's terrifying for many of our clients, right? So co-regulation, the ability to connect to safe others is essential for us as humans. And in fact, in the developmental trajectory is that we all learn somewhere in our training we co-regulate first. And from a foundation of safe co-regulation, we then move off into the world and learn to self-regulate
Deb Dana, LCSW: (27:42)
For many of our clients, even for many of us, we weren't met with a regulated nervous system. We didn't come into the world in an environment that was regulated and safe. So in order to survive, we had our basic needs met by another human but we had to self-regulate for survival because there was no unsafe, predictable present to co-regulate with so it works. We did survive but when we self-regulate for survival, we don't feel nourished by it.
Deb Dana, LCSW: (28:17)
And you might think of clients who come to you who are highly successful, and yet they're suffering because there's no satisfaction. There's this drivenness to seek, seek, seek, which is sympathetic. That never can feel satisfied and good about it, which is ventral.
Dr. Keith Sutton, Psy.D: (28:35)
The way I think about it is when the baby's little, the parent picks them up, they're crying, they soothe them, they're co-regulating, and they're internalizing that ability to soothe. And that's, you know, I also do emotionally focused couples therapy. And so that's one of the ideas, right? In adults that we still have those attachment systems and we're co-regulating. And when we don't have that responsiveness, we go into a panic. So that idea, you know, really resonates about that. That we really need that co-regulation. So in part, you're saying that when we don't have that co-regulation growing up, especially like in complex PTSD where there are prolonged states of experiences of fight or flight, that then the person is learning to regulate themselves. But they have a hard time kind of getting to that sense of safety that is satisfying. Say more about that. Why is that? Is that cause they're waiting for the next thing to happen, or they're feeling like they can't trust the environment?
Deb Dana, LCSW: (29:44)
All of that really, it's the neuroception is one of unsafety and so their wiring will not allow them to feel safe and co-regulating because the nervous system learns. It's a system that learns from experience. That's how it's shaped and that's why therapy works too because it's reshaped. I mean, that's the brilliance of this. It's shaped every moment. So as we are having this conversation, our nervous systems are being shaped. Every moment it's being shaped by what's happening. And you know, you were talking about growing up in an unsafe world or even an unpredictable world where a parent is unpredictably present for whatever reason. We build a pathway, a survival pathway and some of us build a pathway to a sympathetic fight. And others of us build a pathway that takes us further and disappear into dorsal and you see this in your clients. Some tend more towards dorsal collapse and others tend more towards sympathetic bigness. And that's simply how the nervous system learns like my nervous system learned growing up, that dorsal was the safe place, to be invisible, and fly under the radar. So, you know, even though I don't go there as often now. I've done a lot of work.
Deb Dana, LCSW: (31:18)
When push comes to shove, my system takes me right down to the dorsal. And other people, stay much longer in the sympathetic. Sympathetic is a place where being big and getting attention or running away. You know, acting out was the way to be safe. And again, there's no right or wrong here. There's just the way of each nervous system and so that gets shaped by our experience and by the people around us. And what I tell my clients all the time is, you know, we get to know how your nervous system was shaped and how is it being shaped now. That's equally as important and how might we shape it going forward? Because many of our clients are still living in situations that feel unsafe so it's still being shaped that way.
Dr. Keith Sutton, Psy.D: (32:08)
And I'm wondering in that hierarchy that maybe growing up the person had to spend a lot of time on the dorsal end because it wasn't safe. I'm wondering if later in life when maybe it is safer the person spends more time in the sympathetic because it's not necessary of being, and they kind of like didn't get that ability to kind of be in that sympathetic place. Like you're saying kind of in a hierarchical kind of framework. Is that somewhat necessary or somewhat like it?
Deb Dana, LCSW: (32:35)
Well, you know, it's interesting because some people will tell me they're home. I call it a home away from home. I say, we all have a home in the ventral. Every human has a home in the ventral waiting for us. And I truly believe that, and that's a lovely thing for clients to know. It exists inside you. We just have to uncover the pathways and help you get there. And we have a home away from home, which means one of those two survival states where we tend to end up more often. And people's homes away from home can change. Mine has predictably stayed dorsal, which is fine, except I have noticed recently, I have a lot more moments of sympathetic, which is interesting to me. It's like, ooh, I wonder what's going on.
Deb Dana, LCSW: (33:21)
I had a client who came in one week she had been really dorsal for years and years and years. And, you know, could function in the world going through the motions. She came in one week and she said, “Deb, you're gonna be so proud of me” I said, “Ooh, why?” She said, “because I screamed at my boss this week.” And I said, “yay, you came up to the sympathetic. Don't think we wanna stay there, but yay. For coming up to that place.” And she had a boss who understood and was fine with it, but that was something to celebrate. We need to remember that with our clients. That mobilizing, even though it's messy and mobilizing out of dorsal through sympathetic is often messy and yet it is a sign they are moving up towards ventral regulations.
Dr. Keith Sutton, Psy.D: (34:08)
Things you think about too, like clients that couldn't fight back as a child, but as an adult, you know, if somebody messes with them, they're ready to stand up for themselves or stand up for others. Because maybe they, again, weren't safe enough to be in that sympathetic place. Although maybe it's not as developed, I guess the ability to kind of, as you were saying kind of uses it as active rather than reactive. Maybe not having as much time there or using that in a way that we utilize for functionality.
Deb Dana, LCSW: (34:45)
it's interesting because we can have a lot of sympathetic in our system, and yet if we're anchored in the ventral if the neuroception is one of safety. We can use that energy so beautifully for purpose, passion, and forthrightness. Stand up for what I believe in all of those things that take energy, strength, and power. And as long as ventral is there, I do not automatically become a cue of danger to the people around me because there's a thought that they may be able to stay in connection with me. But if I'm in a sympathetic fight I automatically become a cue of danger to the people around me and they will then have their own response. And if we think about the world today and we don't have enough people who have some ventral going on to be able to have these courageous conversations then people just are in survival responses. And we can't, our prefrontal cortex goes into hypoactive mode as soon as we go into either sympathetic or dorsal. And so we don't have the benefit of our thinking brain while we're trying to change the world in some way unless we're anchored in ventral.
Dr. Keith Sutton, Psy.D: (35:58)
So to understand, I'm thinking like, if somebody's in a difficult conversation, maybe with a partner or something like that, if they have enough ventral and feel safe in that connection. They might be able to talk about something they're really angry about or scared about with them and so on. Because there's that kind of, like EFT, that secure attachment or that sense of safety versus if we don't feel safe. Then that anger and so on may come out in more of a less vulnerable way and more of a kind of self-protective way.
Dr. Keith Sutton, Psy.D: (36:35)
That might trigger the other person's kind of nervous system to react, to protect themselves also.
Deb Dana, LCSW: (36:41)
I mean, you do couples work and so you can see how two nervous systems can dysregulate so easily together. They may go in opposite directions, one sympathetic, one dorsal, or they may go in the same direction. But you know what I like to say when I'm teaching, you know, therapists, is there has to be at least one ventral regulated system in the room. And as a therapist, it better be mine.
Deb Dana, LCSW: (37:07)
Because I need to be helping this experience. I need to help my clients find their way back to the ventral so they can continue the conversation. We, think about the emergent properties of each state and the emergent properties of ventral are what you were just talking about. We can be vulnerable. We can be curious. We can communicate difficult things. We can have self-compassion and compassion. These are all the things that are only available to us in the ventral. And when we get pulled out of ventral into survival, we no longer have access to those. So it's not like the person I'm working with doesn't want to listen to their partner. They're no longer able.
Deb Dana, LCSW: (37:52)
And, that I think is also really helpful for people to understand, you know what I'm looking at my partner who's doing this crazy thing, and somebody reminds me their nervous system has just taken them away. They cannot, they're unable to be with you. It's like, oh, that makes a difference. It's not that they want to do this, it's that they're now taken into a survival state that helps.
Dr. Keith Sutton, Psy.D: (38:16)
I do a lot of work with children in adolescents and families too, with oppositional defiance. And, the way we oftentimes think about it is that your average kid, gets their hand caught in the cookie jar, they feel some anxiety, and they learn at that moment. Or a kid that's oppositional, feels backed into a corner, and sometimes can be like a pit bull with their jaw locked. And so that co-regulation piece, particularly on the parent's part, because like you're saying. If a parent is dysregulated and kind of going at the kid, they can either go to dorsal and just kind of submit, or they can go into a fight and kind of fight back. Then they get into this kind of oppositional pattern. So that means somebody that's can be kind of regulated is so important.
Deb Dana, LCSW: (39:02)
Yeah, and that is so hard when we're in those situations with kids, with partners, with friends. Anywhere to hold onto our regulation in the face of somebody's big dysregulation because again, we feel it and it feels unsafe in our system. And then I have to, you know, use my skills to say stay anchored because my brain is giving me some very different story.
Deb Dana, LCSW: (39:29)
And with parents and kids, we off often get they're just doing this to you know, get to me. All the brain stories and again, if we can look over and go, so dysregulated. The guiding question that, that I always use, is what does my nervous system need at this moment? How do I find my way to the ventral and anchor there? And then I can look over at somebody else and go, what does their nervous system need?
Deb Dana, LCSW: (40:02)
It's a very different way of looking at it and it gives me a better chance of being able to stay regulated in the face of somebody who is just having a meltdown.
Dr. Keith Sutton, Psy.D: (40:16)
And tell me about the, I've heard about the different exercises. I've seen some little YouTube videos about the kind of, you know, turning certain ways and so on. Can you say a little bit about that and how that kind of plays into this resetting or kind of shifting from different states?
Deb Dana, LCSW: (40:32)
You know, it's interesting. There are so many people who are finding ways to bring more ventral regulation, which really is the goal for all of us. And, I would like to say the goal is not to be regulated all the time. That's never a goal for any of us. Our survival states are needed. We all move, you know, down the hierarchy and back up many times a day in small ways. Like you might have dipped a toe in sympathetic or dorsal already today. In big ways sometimes when the world is just too challenging. So, the goal is to have a flexibility of response to know, oh, I am being pulled out and how do I reach for regulation and get back? And, you know, there they're basic categories of ways to do that.
Deb Dana, LCSW: (41:22)
Breath is one way because breath is a nervous system experience. Your nervous system is what helps you breathe. And so we can directly change our breath to help bring a different state alive to bring more regulation. I will say breath is both a powerful regulator, but also a powerful activator. So we want to be very careful and experiment with people around, just notice your breath, and let's be very gentle in what we do because it can bring a huge response as we just change some simple aspect of breath movement. Movement is another big category. When you're in the sympathetic, the movement is disorganized and chaotic, and we don't want people to calm down that's never helpful. But let's use this energy, this movement, and organize it in some way.
Deb Dana, LCSW: (42:18)
Because once it begins to become organized and purposeful, we move to ventral, you know, dorsal to begin the movement back up the hierarchy. A very gentle movement. You know, just a gentle swaying back and forth or even, moving your hands. It's just bringing some gentle energy back in. And then when you're in ventral, what are the things you wanna do? How do you wanna move to stay there? Go for a walk, because we don't wanna forget when we're in the ventral, we wanna deepen that. We wanna enjoy that. So, you know, we've got movement, we've got breath, we've got nature, Nature is a brilliant way to begin to feel more regulated. You know, art, music, I often have my clients create musical playlists. So, you know, what are the songs that really bring your sympathetic well alive?
Deb Dana, LCSW: (43:13)
And you can be with safe music. The research says music has that paradoxical effect. You can be with intense emotions safely and even enjoy them. So, you know, what music brings your anger and anxiety alive? What music brings that place of hopelessness, you know, alive and you can be with, and you feel not alone. In those places, which is the other thing, you know, when you think about co-regulation, when we are dysregulated, when we're in a survival state, we're usually alone. Our trauma survivors, their experience is alone. And so even me being anchored in ventral and being with my client as they remember that moment, or we travel together to a moment that is held in a survival state. The experience changes because they're not alone. They're with a regulated other being.
Deb Dana, LCSW: (44:12)
And there's a real brilliance in that and not a lot of work that has to be done. It's simple, I have to stay regulated and we can go be with, and something pretty magical happens then. Because of the autonomic experience, it's a missing experience, right? So that you're giving the nervous system a disconfirming experience, which is beautiful. Rather than from the brain down, you're going from the nervous system up and things change. But back to, you know, resources. What I really invite people to do is, is play around with all the ways that they feel a bit of regulation and then create a menu, their own menu. Because your menu and mine might look very different. And so it really is about finding what are the ways that you anchor in the ventral or you find your way back to the ventral.
Deb Dana, LCSW: (45:02)
Places help, remembering places that brought you a moment so the Imagery. Remembering a person who, when you were around them, you felt welcomed. So, we can bring it to life, because if we've had that experience, it's wired into our biology.
Dr. Keith Sutton, Psy.D: (45:27)
It reminds me of an EMDR when we do the resource installation of a safe place or a nurturing figure and helps the person connect with that kind of neurological experience of feeling.
Deb Dana, LCSW: (45:40)
And the thing that I love about, you know, I do some similar things. I do savoring and sifting and anchoring, and the thing that I am always careful with my clients is to have it be something that they have actually experienced. Because I found sometimes with a safe place when you bring in things that you would like, but haven't actually had, it can get a little tricky. But if you stick with what your nervous system already has experienced, it's wired in there.
Dr. Keith Sutton, Psy.D: (46:12)
That safe place in the EMDR is often like thinking of a memory of a time when you felt safe. Kinda that oftentimes can evoke that kinda neurological memory of the absolutely effective affective state. And then the turning up, turning that up with the EMDR.
Deb Dana, LCSW: (46:33)
Objects, you know, we have objects that we each attach to in certain ways. You know, and if you have an object that reminds you of ventral and brings it alive as you look at it or hold it. You know, I love the beach, it's my place. And so I collect beach stones and I have them all over the place, and some days it just feels like it's gonna be a challenging day and I'll put a beach stone in my pocket.
Deb Dana, LCSW: (47:01)
Something as easy as that. It's because it reminds me the ventral is possible. That's all we're trying to bring in. Ventral exists and it's possible. And it may be a long reach for me today, but it's possible. And I have this thing that reminds me of it.
Dr. Keith Sutton, Psy.D: (47:19)
It makes me think about too, with like emotional flashbacks, you know, because when the person has been triggered and they're feeling some of those unprocessed emotions and sensations. And sometimes even though all the work they've done and all the cognitive and so on, that when that flip and switches flipped. They have a hard time being able to even recognizing that there is this triggering of this emotional flashback and if they're safe in the present or whatever it might be, and all the other stuff kind of goes out the window. Thoughts on that about kind of, like you're saying, you're trying to help the client bring awareness to the cues and also bring awareness to what their experience is that they're in the states.
Deb Dana, LCSW: (48:06)
It's fascinating because when you're pulled into a survival state like that hopefully, someone around you is able to then help you come back to regulation, and then you can reflect on what happened. Because when you're in it, it's really hard to do anything.
Deb Dana, LCSW: (48:28)
But I can reflect on it. I have a discernment question that I have people write on cards and put somewhere where they can find it easily. Because again, we don't find things, we don't locate things when we are dysregulated. So, you know, and the discernment question is, at this moment, in this place with this person or these people, is this response or is this intensity of response needed? And we often have to do that on reflection because we can't do it at the moment. If I'm slightly activated, I can do it at the moment but when I'm in a flashback experience there is no way. But I can then return to it afterward and sort of think about that with somebody else. And then if the answer that, you know, I usually get for myself is, Ooh, probably not needed.
Deb Dana, LCSW: (49:16)
Then you can say, is that a familiar response? Yes, and let's begin to think, when did your nervous system learn that this was the way to keep you safe? And so we can begin to get the information about what happened because those flashback experiences live in the sympathetic and dorsal. Our survival stories live in dysregulated states. They don't live in the ventral, but when we're anchored in the ventral, we can revisit them. We can listen to them, we can be informed by them. Because, again, the ventral brings enough safety so that I can reenter a moment safely and begin to experience it differently.
Dr. Keith Sutton, Psy.D: (49:58)
Like that dual awareness, I'm safe here now, but I'm looking at this memory where felt unsafe. And what you're talking about too, also makes me think a little bit about, like with some of my clients to talk about like when we're feeling so bad sometimes thinking. I probably don't have to be feeling this bad right now unless, you know, it's like it was a car accident or something, you know, and kind of using some of that cognitive therapy. To look at, is there a way that I'm thinking about this? Or, you know, doesn't mean emotional avoidance, but sitting with that emotion that kind of uses like acceptance commitment therapy and just kind of being with that experience, but also kind of noticing. That probably, this is not as extreme as I'm feeling at this moment. There might be a different way that I could be experiencing it.
Deb Dana, LCSW: (50:39)
When I do a simple practice, I call it notice, name, turn toward, and tune in. So you notice, oh my gosh, you know, if this feels a little not helpful or not needed. Name the state. Ooh, I have a lot of sympathetic activation. Turn toward it rather than running away. Turn toward and listen for just a moment, what is the nervous system? What does that state try to do at this moment? What does it need you to know?
Deb Dana, LCSW: (51:09)
Because it's always acting in service of our safety and survival. You know, it can look irrational. It can look crazy, but on a nervous system level because the nervous system doesn't assign motivation or meaning to make moral meaning. It's simply acting in response. So if I can tune in and my nervousness, like the other day, I was having a really challenging day. And, I went to that sympathetic place and I said, “oh, for goodness sake. Okay. What is it you need me to know? Because this is crazy. And I got the message really clear.” If you don't get out of the house on a regular basis you're gonna go crazy. I thought, oh, well that's good to know. I'm a caregiver for my husband. There's all that going on. But it was a clear message which you would think I could get from a ventral place of rational thinking. My sympathetic had to really get big and loud to have me pay attention and give me this message and it was like, oh, okay. Thank you. Now I can do something with that. But it's the turning toward and listening. That we can be so afraid to do. It's so hard to do that.
Dr. Keith Sutton, Psy.D: (52:24)
Well, especially too if you've been dysregulated so dysregulated in the past. It makes me think of temperature drawn kind of holding that emotion in your hand and seeing what it has to tell you and being curious about it. And taking that opportunity rather than just trying to get rid of it or cut it out or push it away. Well, there’s so much wonderful stuff here. I could keep on going forever, but actually, we're nearing the end of our time. I really appreciate your time and this is really helpful to kind of wrap my head around polyvagal. Because it's a complex theory, but I think we've broken it down so nicely to kind of help it be really tangible and useable, so thank you so much. I really appreciate the time today.
Deb Dana, LCSW: (53:07)
It's been a lovely conversation, hasn't it? A lovely back-and-forth.
Dr. Keith Sutton, Psy.D: (53:13)
Thank you for joining us. If you're wanting to use this podcast or continuing education credits, please go to our website at therapyonthecuttingedge.com. Our podcast is brought to you by the Institute for The Advancement of Psychotherapy, providing in-person and remote therapy in the San Francisco bay area. IAP provides training for licensed clinicians through our in-person and online programs, as well as our treatment for children, adolescents, families, couples, and individual adults. For more information, go to SFIAP.com or call 415-617-5932. Also, we really appreciate the feedback. If you have something you're interested in, something that's on the cutting edge of the field of therapy, and think clinicians should know about it, send us an email or call us. We're always looking for advancements in the field of psychotherapy to help in creating lasting changes for our clients.
Welcome to Therapy on the Cutting Edge, a podcast for therapists who want to be up to date on the latest advancements in the field of psychotherapy. I'm your host, Dr. Keith Sutton, a psychologist in the San Francisco Bay Area, and the Director of the Institute for the Advancement of Psychotherapy. Today I'll be speaking with Deb Dana, a licensed clinical social worker, who is a clinician, consultant, and author specializing in complex trauma. Her work is focused on using the lens of polyvagal theory to understand and resolve the impact of trauma and create ways of working that honor the role of the autonomic nervous system. She's a founding member of the Polyvagal Institute, consultant to Chiron Clinics, and advisor to Unite. Deb is a developer of the Signature Rhythm of Regulation Clinical Training series and is well known for translating polyvagal theory into a language and application that is both understandable and accessible for clinicians and curious people alike. Deb's clinical work published with WW Norton includes The Polyvagal Theory of Therapy, Engaging The Rhythm of Regulation, Polyvagal Exercises for Safety and Connection, 50 Client-Centered Practices, The Polyvagal Flip Chart, and The Polyvagal Card Deck. She partners with Sounds True to bring her polyvagal perspective to a general audience through the audio program, Befriending Your Nervous System, looking through the lens of polyvagal theory and her print book Anchored: How to Befriend Your Nervous System Using Polyvagal Theory. Let's listen to the interview. Hi, Deb. Welcome. Thanks for joining us today.
Deb Dana, LCSW: (01:51)
It's nice to be here. Nice to meet you.
Dr. Keith Sutton, Psy.D: (01:53)
Yeah, nice to meet you. So, I've heard a lot about the work that you've been doing. A number of clinicians in my practice have talked about polyvagal theory and, a lot of the folks in the trauma community particularly. So I got really interested in this work and have been wanting to learn more and got to listen to some of your talks. So I'd love to hear about your work and polyvagal theory, but first, before we even get there. I always like to hear kind of how people got to do and what they're doing, kind of the evolution of your thinking as it kind of went along to get where you are here.
Deb Dana, LCSW: (02:25)
Yeah. It's a lovely way to start sort of reflecting on how I ended up at this moment in time. I've been doing a lot of that recently because I will be 70 this coming year, and it seems like a time of reflecting and looking back and looking ahead. So it's interesting, you know, Steve and I. I read his book when it came out, and then we met in 2013, he came to Maine to do a workshop for the group practice I was in. And I had already started playing around with polyvagal theory, bringing it into clinical practice, because the theory made so much sense to me. I've always loved understanding the brain and the body as a social worker and I just think we should understand and help our clients understand.
Deb Dana, LCSW: (03:19)
And so I had already started playing with, what do I do to bring this into my work? Because it was so brilliant to theory and yet a little complicated. Okay, but how do you make this work in a session with the client? So, he came and we had a lovely time just sort of talking about his work and my work and how it fits together, and that was a moment in time when my life changed. I didn't know it at the time because, you know, I lived in Maine at the time. I still do live in Maine, half the time.
Deb Dana, LCSW: (03:58)
I was sitting in my room over the garage creating this stuff and from there to here at this moment feels like a life-changing journey that I've been on because now people really ask me to talk to them about polyvagal theory to translate. I guess I've translated Steve's work into a sort of clinical language and everyday language. I talked with Steve the other day and I said, “I cannot imagine what my life, where my life would've gone without this. And reading your book and having you come to Maine and setting off on this journey.” There was a moment in time when there was a workshop or a presentation that he couldn't do and he asked me if I would fill in for him. And it was that moment when I thought, really Steve Portis wants me to fill in for him, and it was in Italy no less.
Deb Dana, LCSW: (04:51)
So, and from that it was like, oh, I love this. I love doing this. So, you know, we have these moments and we don't know where they're gonna send us. And so I look back on, you know, it's been almost a decade now and it's like, wow, who would ever have known, I never could have predicted where I am now. And, so I guess that's my invitation for everybody to sort of, you never know, you just never know, right?
Dr. Keith Sutton, Psy.D: (05:27)
Well, it's great. And it sounds like you're following your passion too, to really finding helpful and, and digging into it, and then kind of things evolved from there. And is Steve a psychologist, a therapist, or a researcher?
Deb Dana, LCSW: (05:43)
He's a research psychologist. He's always been in the lab. He's run labs. He's in academia, so I needed his theory to make some sense of what I was seeing with my clients. And then he said, “I depend on you to then translate it for the clinical world”, so it's a lovely partnership. And I have to say, if you haven't listened to him talk find a way to do that. He is a brilliant scientist, and also a very down-to-earth, humble, kind human being, which is a really special combination.
Dr. Keith Sutton, Psy.D: (06:22)
So tell me about what is the polyvagal theory.
Deb Dana, LCSW: (06:29)
So, the polyvagal theory is a theory of how our autonomic nervous system is organized and I think about it in with three basic principles. And, before we talk about those, I just wanna say that the autonomic nervous system is at the heart of our daily experience. We think our brains are running the show, but in fact, it's our nervous system that begins everything. And so, for therapists who are listening, no matter what model of therapy you've been trained in, you're in fact working with your client's nervous system. You may not bring that into explicit awareness, but you're working with your client's nervous system. And that's where I began thinking, okay, I should understand it and my clients should understand it. Because I think part of what we're doing as therapists is helping clients have skills and tools, and understand how to find their way to regulation.
Deb Dana, LCSW: (07:28)
And the nervous system is the pathway there so the reason, I guess for understanding how your nervous system works I like to say we're helping our clients become active operators of their nervous systems. That's really what this is about. So we have three principles that guide polyvagal theory, neuroception hierarchy, and co-regulation. And those are three words that are not in the common vocabulary, but I think at some point they probably will be because they are the sort of vocabulary of your nervous system. So you want to look at those one at a time.
Dr. Keith Sutton, Psy.D: (08:09)
Yeah, and I want to understand too what you're saying about working with the nervous system. Because emotions are really connected and really kind of is the nervous system, right? That when we feel these various things in our body, we can kind of connect that to anxiety or feeling sad and so when we're working with emotions we're working with the nervous system.
Deb Dana, LCSW: (08:36)
Yeah, and it's interesting because we give a label, right? The nervous system underneath that is having a response and then the brain puts a label on it. The brain's job is to make sense of what's going on in the body. And so the brain gives it a label, right? So a client might come in and say, you know, I've had a really sad week so they've put a label of sadness on it, but it doesn't tell me what happened in the nervous system. So we wanna go underneath the label, under the symptom to see where did it come from.
Deb Dana, LCSW: (09:12)
So that's really, I think when we think about working with the nervous system we're looking underneath the symptoms our clients are bringing to us. To find where did they emerge from because when I know where they emerged from, it directs the clinical choice I make about treatment.
Dr. Keith Sutton, Psy.D: (09:30)
It's kind of like the same physiological experience can be labeled as anxiety or excitement, you know, those kinds of pieces. And then looking at kind of what is maybe triggering that nervous system response that's kind of leading to them, the labeling in a particular emotion.
Deb Dana, LCSW: (09:50)
And for our trauma survivor clients, you know, that their heart begins to race a bit and their autonomic automatic pathway is towards anxiety because that's been a familiar pathway they've traveled. So part of our job is to slow it down and say, let's look at all the options for a heart that is speeding up, you know, getting ready to move, passionate, excited, worried, anxious, there's a whole range of things that come to out of this. And if we can anchor in a place of regulation, we then have a chance to make a choice.
Deb Dana, LCSW: (10:31)
Not simply be taken down a survival pathway, which we need those survival pathways. They were built for a reason. It's just that when we have traveled them so easily and so often we lose that aspect of choice. We end up on that pathway without even knowing how we got there.
Dr. Keith Sutton, Psy.D: (10:52)
Well, it's helping the client move from being reactive, or responsive, and having an experience to, how I want to respond to that experience.
Deb Dana, LCSW: (11:00)
And we can't be responsive unless we are anchored in some autonomic regulation. Soon as we end up in a survival state, we're reactive, not reflective or responsive. So again, we come back to, “can we help begin to regulate the state?” And what the research is beginning to show us is that as clients begin to have a more regulated nervous system, their symptoms reduce or even resolve sometimes both physical symptoms and psychological ones because it's all one, mind and body are all one. So, it's interesting, no matter what your client brings to you as they're presenting problem you really want to help them come into a place where they feel more regulated, more access to regulation in their nervous system. And then everything begins to look different.
Dr. Keith Sutton, Psy.D: (11:49)
Perfect, so let's start by going through those three.
Deb Dana, LCSW: (11:55)
So we'll start with neuroception. And neuroception is this beautiful word that Steve created to describe how the nervous system takes in information and then makes a choice about safe or unsafe. There wasn't a word because perception uses the cortex and the nervous system, although it does connect with the cortex in the limbic, which is a brains stem originating system. So it's a subcortical system. So he created the word neuroception, which I love and think is a great word. And everybody should have that word as part of their vocabulary. Use it on your Scrabble or, maybe it will end up in Wordle someday, who knows? But, neuroception uses three pathways to take in information. There's an inside, outside, and in-between pathway. So there's the embodied pathway where it's always listening. It would be that pathway we were just talking about, heart rate, lungs, digestion, and viscera, it listens there to see what's going on whether safe or unsafe.
Deb Dana, LCSW: (12:50)
Then an outside, an environmental pathway listens into the world around us to get cues of welcome or warning. And then the between pathway, which is the one that I think is so important for us as clinicians between two nervous systems. It's always listening below the level of conscious awareness to get cues from another nervous system. Is this safe or not safe? Do I approach or not approach? So that's neuroception and what we know is that the cues of safety have to outweigh the cues of danger in order for us to feel safe enough to move forward in whatever way.
Dr. Keith Sutton, Psy.D: (13:38)
I was gonna say, so the embodied, that's kind of like in our interception, kind of our experience of our physical sensation internally, what's going on in the environment. And between nervous systems, do you mean between your nervous system and my nervous system kind of getting a sense of your energy or where you're at, or if you're feeling on edge? And kinda my nervous system attuning peers.
Deb Dana, LCSW: (14:01)
Exactly, and that in-between is so fascinating because you may have a certain way of moving or you may have a certain tone of voice or a certain look that is a familiar cue of danger from my past. And then will activate in the present and take me out of connection when it really has nothing to do with you. It has to do with a cue from the past that's come alive in the present. The same is true for the environment and the embodied pathway. But it's really interesting when we're working with clients and we kind of have this moment of something just happened, but I don't know what it was. Neuroception has neuro septic, a queue of danger, and has shifted that equation so that the cues of danger now outweigh the cues of safety and you can feel it when that happens, everything stops. And then if you're working, you know, through a nervous system level your curiosity is “Wow, what just came in and shifted the balance? What was it?” Sometimes, we look away, we look at the clock or we look down. You know, neuroception of danger to another nervous system is not intentional at all.
Deb Dana, LCSW: (15:18)
However, it gets sent as a warning out there into the world. And my client does this. They pull back, and they disconnect. So it's interesting to track those because it gives us a way to come back into connection and a way to understand what are the deceptive cues that really bring a sense of safety. Because I want to bring more of those into my work with that client. What are the cues that bring danger? Maybe, we can reduce some of those.
Deb Dana, LCSW: (15:50)
And, what we've discovered is neuroception, we might call them the passive cues because they're just going on in the background all the time. Those passive cues have to be weighted toward safety n order for us to use the active experiences that we want to bring to therapy. If the neuroception is one of unsafety, it doesn't matter how brilliant you are as a therapist you can't engage your client in therapy because their nervous system says this is not safe.
Dr. Keith Sutton, Psy.D: (16:22)
So they're kind of not able to access that. We kind of need that safety first to be able to do that work.
Deb Dana, LCSW: (16:28)
Exactly, and we often make stories up and label our clients as non-compliant, not trying hard enough, or too needy. And if we can look across and say, “unsafe”, it changes the equation because non-compliant, I don't know what to do with non-compliant, but unsafe.
Deb Dana, LCSW: (16:46)
Of course, I know what to do with unsafe. And that's really what we're seeing. We're seeing a nervous system that doesn't feel enough neuroception of safety to be able to, not unwilling, but able to come into connection. So that's the lovely part of the polyvagal theory. It's so nonjudging, non-shaming, non-blaming, and non-pathologizing. It's simply the nervous system doing what it knows how to do, trying to keep you safe.
Dr. Keith Sutton, Psy.D: (17:18)
That's interesting. It makes me think of motivational interviewing when I think about that, or the idea of resistance that sometimes that's due to what the therapist is doing, not necessarily something within the client. And that sometimes the therapist gets ahead or the client's not feeling seen. And once we get back to that place where they feel like we understand, oftentimes there's that regulation and that big head noob like you're doing right now. Then we can move forward again.
Dr. Keith Sutton, Psy.D: (17:44)
But framing that as unsafe is I think a helpful way of thinking about it.
Deb Dana, LCSW: (17:47)
Yes, and I often with my clients, I actually get out a piece of paper and write down what are the cues of safety. What are the cues of un of unsafety at this moment? Because we want to concretely identify them, therapy is about bringing the implicit into explicit awareness.
Deb Dana, LCSW: (18:04)
This is the same thing we're doing in the nervous system, all this implicit neuro-deceptive experience. We're bringing explicit awareness so that we can work with it. You know, you were talking about head nods and head nodding and turning and tilting is wired into your biology to send a queue of safety to another nervous system.
Dr. Keith Sutton, Psy.D: (18:28)
Another one, I'm supervising her, so I'm looking for that big head nod when I got the head then I know we can kind of move forward. I don't want that like kind of shrugging shoulder, as we wanna really look at like, we're on the same page now we can forward together.
Deb Dana, LCSW: (18:42)
So your brain is looking for certain cues for a reason. Your nervous system is also looking for those cues to feel like, oh yes, we're in a connected co-regulating moment.
Deb Dana, LCSW: (18:55)
Yeah, so if we take neuroception and understand it then leads to hierarchy, which is the next organizing principle, because as your neuroception makes a judgment about safer or unsafe, it then activates one of your states. And we can talk about three states. We've got a lot of blended states too. But if we just talk about three, ventral which is regulated, connected, organized, and safe enough. The state that we long to be in, and I think our nervous system inherently knows how to get to it.
Deb Dana, LCSW: (19:33)
So that's where we're helping our clients get that. Then we have two survival states. The first one is sympathetic, which most people know the fight and flight.
Deb Dana, LCSW: (19:42)
Then the other survival state is dorsal, which is collapse, shut down, and disconnect. And that was Steve's brilliant work in illustrating polyvagal theory. He was working with premature babies in the NICU and It was the dorsal discovery really that the vagus nerve, which we had just thought was parasympathetic. We had sympathetic parasympathetic and with his work, we now know parasympathetic has both ventral which is regulated and connected. And dorsal which is shut down, collapsed, and disconnected.
Deb Dana, LCSW: (20:23)
And, for our trauma survivor clients, we see that all the time.
Deb Dana, LCSW: (20:27)
We see that disconnect, associate float away fuzzy experience. That's their dorsal vehicle system.
Dr. Keith Sutton, Psy.D: (20:36)
Oh. This is a kinda hypo arousal kinda dissociation, like kinda the survival response of like playing dead.
Deb Dana, LCSW: (20:44)
Yeah, and just a slight flavor of it. It's that experience I think most of us have had of going through the motions, but not really being present there doing it or going through the motions, but not having the energy to really care. Dorsal is draining of energy. The body, you know, goes into conservation mode. We just don't have energy and the psychology around it is some sort of, you know, hopelessness, giving up, and despair. Whereas sympathetic is that overwhelming, disorganized, chaotic energy that mobilizes us. So they're the opposite experiences, both survival responses. And what Steve really outlined is this hierarchy which is so helpful for us as humans, but especially us as therapists, because it means that you travel from ventral to sympathetic to dorsal in that order. And then in order to get back to the ventral, you have to leave the dorsal, come through some energy from the sympathetic, and arrive back in the dorsal. So, you know, we can help clients understand that pathway down and back.
Dr. Keith Sutton, Psy.D: (21:57)
Yeah. Sometimes when working with clients when dissociation is coming up I sometimes move forward with them, “how is it protecting you?” And oftentimes it's protecting from that sympathetic, “I'll be so overwhelmed,” or “I'll have a panic attack”, or whatever it might be. And so oftentimes kind of using some heart's work to be able to look at when they handle that because oftentimes it's the emotional flashback that's kind of the same. That's dangerous, now you can't handle this.
Deb Dana, LCSW: (22:26)
And isn't that a brilliant way our nervous system protects us?
Deb Dana, LCSW: (22:30)
You know, and that's one of the Dorsal jobs is to rescue us from sympathetic from that overwhelming, that intensity. And then sympathetic, one of its jobs is to pull us out of dorsal because dorsal is probably the most challenging place to be because we're untethered floating, and we sort of disappear in that place. And so sympathetic tries to pull us back, but it does it with that overwhelming energy. So it's an interesting loop. We see many of our clients get in. Sympathetic, dorsal, sympathetic, dorsal back and forth, because sympathetic brings a bit of energy, but it feels too big, too scary, too much. The system goes right back to the dorsal.
Deb Dana, LCSW: (23:14)
And then it peaks its head out again and it's too much and back again. So, the key to working with how to get clients to move back from sympathetic to ventral is to not go through the survival pathway of sympathetic but to go through the mobilizing pathway. We don't want to go to fight and flight, but we want to use some of the mobilizing energy of sympathetic to bring energy back into the system and continue on up to the ventral.
Dr. Keith Sutton, Psy.D: (23:46)
So, that kind of energy that more kind of motivates us or the gas in the car that gets us kind of going, to kind of address whatever the issue is or the helpful part.
Deb Dana, LCSW: (23:59)
The energy of movement rather than the energy of survival. Because sympathetic does both in its everyday role. It brings us the energy to do what we're doing. We're moving, we're sitting up, sympathetic brings the energy to do that, but it's under the management of ventral. And so when ventral is overseeing your nervous system, the sympathetic brings you that energy, and the dorsals everyday job is to run your digestion in a healthy way.
Deb Dana, LCSW: (24:31)
So our states, you know, work together in this beautiful way. It's only when ventral gets overwhelmed by the world and we enter into sympathetic survival that we have this fight and flight. And, that HPA access, hypothalamus, pituitary, and adrenal access gets revved up then and we get flooded with cortisol and adrenaline. And that's what's so terrifying to our clients' nervous systems. That feeling of danger that comes, it's a neuroception of danger.
Dr. Keith Sutton, Psy.D: (25:03)
And back to what you were saying with the dorsal and the digestion. Can you talk more about that? That kinda rest and digestion.
Deb Dana, LCSW: (25:11)
Dorsals everyday role when the ventral is again, overseeing the system, dorsal brings nutrients to nourish us. It runs our digestion in healthy ways. And if we think about our clients, so many of our clients have digestive issues and this is because their system is out of regulation. And as soon as the ventral can no longer run the system digestion gets impacted. When you're in sympathetic digestion is impacted, when you are in dorsal digestion is impacted. And we have many clients who come to us with, you know, digestive problems they want to work with. I'm not a medical social worker, and yet what I can tell my clients is as we find the way to more regulation that is going to change.
Deb Dana, LCSW: (25:59)
You know, happy to work with medical providers, and let's build a team that is willing to help us regulate your nervous system and see what happens.
Dr. Keith Sutton, Psy.D: (26:10)
So there's the hierarchy there that you're talking about, the neuroception and then the hierarchy, and then that goes into the regulation.
Deb Dana, LCSW: (26:25)
Co-regulation is the third organizing principle. And, co-regulation is what we call a biological imperative. Meaning it's something we have to have in order to survive. We come into the world and we do not survive without another human to help us. And the interesting thing is that co-regulation is a lifelong need. And if you think about that how so many of our clients who come to us with the belief, you know, wired in the nervous system, belief people are dangerous.
Deb Dana, LCSW: (26:59)
And so when we begin to understand that, you also have to find self-safe people to come into connection with in order to fully experience wellness. It's terrifying for many of our clients, right? So co-regulation, the ability to connect to safe others is essential for us as humans. And in fact, in the developmental trajectory is that we all learn somewhere in our training we co-regulate first. And from a foundation of safe co-regulation, we then move off into the world and learn to self-regulate
Deb Dana, LCSW: (27:42)
For many of our clients, even for many of us, we weren't met with a regulated nervous system. We didn't come into the world in an environment that was regulated and safe. So in order to survive, we had our basic needs met by another human but we had to self-regulate for survival because there was no unsafe, predictable present to co-regulate with so it works. We did survive but when we self-regulate for survival, we don't feel nourished by it.
Deb Dana, LCSW: (28:17)
And you might think of clients who come to you who are highly successful, and yet they're suffering because there's no satisfaction. There's this drivenness to seek, seek, seek, which is sympathetic. That never can feel satisfied and good about it, which is ventral.
Dr. Keith Sutton, Psy.D: (28:35)
The way I think about it is when the baby's little, the parent picks them up, they're crying, they soothe them, they're co-regulating, and they're internalizing that ability to soothe. And that's, you know, I also do emotionally focused couples therapy. And so that's one of the ideas, right? In adults that we still have those attachment systems and we're co-regulating. And when we don't have that responsiveness, we go into a panic. So that idea, you know, really resonates about that. That we really need that co-regulation. So in part, you're saying that when we don't have that co-regulation growing up, especially like in complex PTSD where there are prolonged states of experiences of fight or flight, that then the person is learning to regulate themselves. But they have a hard time kind of getting to that sense of safety that is satisfying. Say more about that. Why is that? Is that cause they're waiting for the next thing to happen, or they're feeling like they can't trust the environment?
Deb Dana, LCSW: (29:44)
All of that really, it's the neuroception is one of unsafety and so their wiring will not allow them to feel safe and co-regulating because the nervous system learns. It's a system that learns from experience. That's how it's shaped and that's why therapy works too because it's reshaped. I mean, that's the brilliance of this. It's shaped every moment. So as we are having this conversation, our nervous systems are being shaped. Every moment it's being shaped by what's happening. And you know, you were talking about growing up in an unsafe world or even an unpredictable world where a parent is unpredictably present for whatever reason. We build a pathway, a survival pathway and some of us build a pathway to a sympathetic fight. And others of us build a pathway that takes us further and disappear into dorsal and you see this in your clients. Some tend more towards dorsal collapse and others tend more towards sympathetic bigness. And that's simply how the nervous system learns like my nervous system learned growing up, that dorsal was the safe place, to be invisible, and fly under the radar. So, you know, even though I don't go there as often now. I've done a lot of work.
Deb Dana, LCSW: (31:18)
When push comes to shove, my system takes me right down to the dorsal. And other people, stay much longer in the sympathetic. Sympathetic is a place where being big and getting attention or running away. You know, acting out was the way to be safe. And again, there's no right or wrong here. There's just the way of each nervous system and so that gets shaped by our experience and by the people around us. And what I tell my clients all the time is, you know, we get to know how your nervous system was shaped and how is it being shaped now. That's equally as important and how might we shape it going forward? Because many of our clients are still living in situations that feel unsafe so it's still being shaped that way.
Dr. Keith Sutton, Psy.D: (32:08)
And I'm wondering in that hierarchy that maybe growing up the person had to spend a lot of time on the dorsal end because it wasn't safe. I'm wondering if later in life when maybe it is safer the person spends more time in the sympathetic because it's not necessary of being, and they kind of like didn't get that ability to kind of be in that sympathetic place. Like you're saying kind of in a hierarchical kind of framework. Is that somewhat necessary or somewhat like it?
Deb Dana, LCSW: (32:35)
Well, you know, it's interesting because some people will tell me they're home. I call it a home away from home. I say, we all have a home in the ventral. Every human has a home in the ventral waiting for us. And I truly believe that, and that's a lovely thing for clients to know. It exists inside you. We just have to uncover the pathways and help you get there. And we have a home away from home, which means one of those two survival states where we tend to end up more often. And people's homes away from home can change. Mine has predictably stayed dorsal, which is fine, except I have noticed recently, I have a lot more moments of sympathetic, which is interesting to me. It's like, ooh, I wonder what's going on.
Deb Dana, LCSW: (33:21)
I had a client who came in one week she had been really dorsal for years and years and years. And, you know, could function in the world going through the motions. She came in one week and she said, “Deb, you're gonna be so proud of me” I said, “Ooh, why?” She said, “because I screamed at my boss this week.” And I said, “yay, you came up to the sympathetic. Don't think we wanna stay there, but yay. For coming up to that place.” And she had a boss who understood and was fine with it, but that was something to celebrate. We need to remember that with our clients. That mobilizing, even though it's messy and mobilizing out of dorsal through sympathetic is often messy and yet it is a sign they are moving up towards ventral regulations.
Dr. Keith Sutton, Psy.D: (34:08)
Things you think about too, like clients that couldn't fight back as a child, but as an adult, you know, if somebody messes with them, they're ready to stand up for themselves or stand up for others. Because maybe they, again, weren't safe enough to be in that sympathetic place. Although maybe it's not as developed, I guess the ability to kind of, as you were saying kind of uses it as active rather than reactive. Maybe not having as much time there or using that in a way that we utilize for functionality.
Deb Dana, LCSW: (34:45)
it's interesting because we can have a lot of sympathetic in our system, and yet if we're anchored in the ventral if the neuroception is one of safety. We can use that energy so beautifully for purpose, passion, and forthrightness. Stand up for what I believe in all of those things that take energy, strength, and power. And as long as ventral is there, I do not automatically become a cue of danger to the people around me because there's a thought that they may be able to stay in connection with me. But if I'm in a sympathetic fight I automatically become a cue of danger to the people around me and they will then have their own response. And if we think about the world today and we don't have enough people who have some ventral going on to be able to have these courageous conversations then people just are in survival responses. And we can't, our prefrontal cortex goes into hypoactive mode as soon as we go into either sympathetic or dorsal. And so we don't have the benefit of our thinking brain while we're trying to change the world in some way unless we're anchored in ventral.
Dr. Keith Sutton, Psy.D: (35:58)
So to understand, I'm thinking like, if somebody's in a difficult conversation, maybe with a partner or something like that, if they have enough ventral and feel safe in that connection. They might be able to talk about something they're really angry about or scared about with them and so on. Because there's that kind of, like EFT, that secure attachment or that sense of safety versus if we don't feel safe. Then that anger and so on may come out in more of a less vulnerable way and more of a kind of self-protective way.
Dr. Keith Sutton, Psy.D: (36:35)
That might trigger the other person's kind of nervous system to react, to protect themselves also.
Deb Dana, LCSW: (36:41)
I mean, you do couples work and so you can see how two nervous systems can dysregulate so easily together. They may go in opposite directions, one sympathetic, one dorsal, or they may go in the same direction. But you know what I like to say when I'm teaching, you know, therapists, is there has to be at least one ventral regulated system in the room. And as a therapist, it better be mine.
Deb Dana, LCSW: (37:07)
Because I need to be helping this experience. I need to help my clients find their way back to the ventral so they can continue the conversation. We, think about the emergent properties of each state and the emergent properties of ventral are what you were just talking about. We can be vulnerable. We can be curious. We can communicate difficult things. We can have self-compassion and compassion. These are all the things that are only available to us in the ventral. And when we get pulled out of ventral into survival, we no longer have access to those. So it's not like the person I'm working with doesn't want to listen to their partner. They're no longer able.
Deb Dana, LCSW: (37:52)
And, that I think is also really helpful for people to understand, you know what I'm looking at my partner who's doing this crazy thing, and somebody reminds me their nervous system has just taken them away. They cannot, they're unable to be with you. It's like, oh, that makes a difference. It's not that they want to do this, it's that they're now taken into a survival state that helps.
Dr. Keith Sutton, Psy.D: (38:16)
I do a lot of work with children in adolescents and families too, with oppositional defiance. And, the way we oftentimes think about it is that your average kid, gets their hand caught in the cookie jar, they feel some anxiety, and they learn at that moment. Or a kid that's oppositional, feels backed into a corner, and sometimes can be like a pit bull with their jaw locked. And so that co-regulation piece, particularly on the parent's part, because like you're saying. If a parent is dysregulated and kind of going at the kid, they can either go to dorsal and just kind of submit, or they can go into a fight and kind of fight back. Then they get into this kind of oppositional pattern. So that means somebody that's can be kind of regulated is so important.
Deb Dana, LCSW: (39:02)
Yeah, and that is so hard when we're in those situations with kids, with partners, with friends. Anywhere to hold onto our regulation in the face of somebody's big dysregulation because again, we feel it and it feels unsafe in our system. And then I have to, you know, use my skills to say stay anchored because my brain is giving me some very different story.
Deb Dana, LCSW: (39:29)
And with parents and kids, we off often get they're just doing this to you know, get to me. All the brain stories and again, if we can look over and go, so dysregulated. The guiding question that, that I always use, is what does my nervous system need at this moment? How do I find my way to the ventral and anchor there? And then I can look over at somebody else and go, what does their nervous system need?
Deb Dana, LCSW: (40:02)
It's a very different way of looking at it and it gives me a better chance of being able to stay regulated in the face of somebody who is just having a meltdown.
Dr. Keith Sutton, Psy.D: (40:16)
And tell me about the, I've heard about the different exercises. I've seen some little YouTube videos about the kind of, you know, turning certain ways and so on. Can you say a little bit about that and how that kind of plays into this resetting or kind of shifting from different states?
Deb Dana, LCSW: (40:32)
You know, it's interesting. There are so many people who are finding ways to bring more ventral regulation, which really is the goal for all of us. And, I would like to say the goal is not to be regulated all the time. That's never a goal for any of us. Our survival states are needed. We all move, you know, down the hierarchy and back up many times a day in small ways. Like you might have dipped a toe in sympathetic or dorsal already today. In big ways sometimes when the world is just too challenging. So, the goal is to have a flexibility of response to know, oh, I am being pulled out and how do I reach for regulation and get back? And, you know, there they're basic categories of ways to do that.
Deb Dana, LCSW: (41:22)
Breath is one way because breath is a nervous system experience. Your nervous system is what helps you breathe. And so we can directly change our breath to help bring a different state alive to bring more regulation. I will say breath is both a powerful regulator, but also a powerful activator. So we want to be very careful and experiment with people around, just notice your breath, and let's be very gentle in what we do because it can bring a huge response as we just change some simple aspect of breath movement. Movement is another big category. When you're in the sympathetic, the movement is disorganized and chaotic, and we don't want people to calm down that's never helpful. But let's use this energy, this movement, and organize it in some way.
Deb Dana, LCSW: (42:18)
Because once it begins to become organized and purposeful, we move to ventral, you know, dorsal to begin the movement back up the hierarchy. A very gentle movement. You know, just a gentle swaying back and forth or even, moving your hands. It's just bringing some gentle energy back in. And then when you're in ventral, what are the things you wanna do? How do you wanna move to stay there? Go for a walk, because we don't wanna forget when we're in the ventral, we wanna deepen that. We wanna enjoy that. So, you know, we've got movement, we've got breath, we've got nature, Nature is a brilliant way to begin to feel more regulated. You know, art, music, I often have my clients create musical playlists. So, you know, what are the songs that really bring your sympathetic well alive?
Deb Dana, LCSW: (43:13)
And you can be with safe music. The research says music has that paradoxical effect. You can be with intense emotions safely and even enjoy them. So, you know, what music brings your anger and anxiety alive? What music brings that place of hopelessness, you know, alive and you can be with, and you feel not alone. In those places, which is the other thing, you know, when you think about co-regulation, when we are dysregulated, when we're in a survival state, we're usually alone. Our trauma survivors, their experience is alone. And so even me being anchored in ventral and being with my client as they remember that moment, or we travel together to a moment that is held in a survival state. The experience changes because they're not alone. They're with a regulated other being.
Deb Dana, LCSW: (44:12)
And there's a real brilliance in that and not a lot of work that has to be done. It's simple, I have to stay regulated and we can go be with, and something pretty magical happens then. Because of the autonomic experience, it's a missing experience, right? So that you're giving the nervous system a disconfirming experience, which is beautiful. Rather than from the brain down, you're going from the nervous system up and things change. But back to, you know, resources. What I really invite people to do is, is play around with all the ways that they feel a bit of regulation and then create a menu, their own menu. Because your menu and mine might look very different. And so it really is about finding what are the ways that you anchor in the ventral or you find your way back to the ventral.
Deb Dana, LCSW: (45:02)
Places help, remembering places that brought you a moment so the Imagery. Remembering a person who, when you were around them, you felt welcomed. So, we can bring it to life, because if we've had that experience, it's wired into our biology.
Dr. Keith Sutton, Psy.D: (45:27)
It reminds me of an EMDR when we do the resource installation of a safe place or a nurturing figure and helps the person connect with that kind of neurological experience of feeling.
Deb Dana, LCSW: (45:40)
And the thing that I love about, you know, I do some similar things. I do savoring and sifting and anchoring, and the thing that I am always careful with my clients is to have it be something that they have actually experienced. Because I found sometimes with a safe place when you bring in things that you would like, but haven't actually had, it can get a little tricky. But if you stick with what your nervous system already has experienced, it's wired in there.
Dr. Keith Sutton, Psy.D: (46:12)
That safe place in the EMDR is often like thinking of a memory of a time when you felt safe. Kinda that oftentimes can evoke that kinda neurological memory of the absolutely effective affective state. And then the turning up, turning that up with the EMDR.
Deb Dana, LCSW: (46:33)
Objects, you know, we have objects that we each attach to in certain ways. You know, and if you have an object that reminds you of ventral and brings it alive as you look at it or hold it. You know, I love the beach, it's my place. And so I collect beach stones and I have them all over the place, and some days it just feels like it's gonna be a challenging day and I'll put a beach stone in my pocket.
Deb Dana, LCSW: (47:01)
Something as easy as that. It's because it reminds me the ventral is possible. That's all we're trying to bring in. Ventral exists and it's possible. And it may be a long reach for me today, but it's possible. And I have this thing that reminds me of it.
Dr. Keith Sutton, Psy.D: (47:19)
It makes me think about too, with like emotional flashbacks, you know, because when the person has been triggered and they're feeling some of those unprocessed emotions and sensations. And sometimes even though all the work they've done and all the cognitive and so on, that when that flip and switches flipped. They have a hard time being able to even recognizing that there is this triggering of this emotional flashback and if they're safe in the present or whatever it might be, and all the other stuff kind of goes out the window. Thoughts on that about kind of, like you're saying, you're trying to help the client bring awareness to the cues and also bring awareness to what their experience is that they're in the states.
Deb Dana, LCSW: (48:06)
It's fascinating because when you're pulled into a survival state like that hopefully, someone around you is able to then help you come back to regulation, and then you can reflect on what happened. Because when you're in it, it's really hard to do anything.
Deb Dana, LCSW: (48:28)
But I can reflect on it. I have a discernment question that I have people write on cards and put somewhere where they can find it easily. Because again, we don't find things, we don't locate things when we are dysregulated. So, you know, and the discernment question is, at this moment, in this place with this person or these people, is this response or is this intensity of response needed? And we often have to do that on reflection because we can't do it at the moment. If I'm slightly activated, I can do it at the moment but when I'm in a flashback experience there is no way. But I can then return to it afterward and sort of think about that with somebody else. And then if the answer that, you know, I usually get for myself is, Ooh, probably not needed.
Deb Dana, LCSW: (49:16)
Then you can say, is that a familiar response? Yes, and let's begin to think, when did your nervous system learn that this was the way to keep you safe? And so we can begin to get the information about what happened because those flashback experiences live in the sympathetic and dorsal. Our survival stories live in dysregulated states. They don't live in the ventral, but when we're anchored in the ventral, we can revisit them. We can listen to them, we can be informed by them. Because, again, the ventral brings enough safety so that I can reenter a moment safely and begin to experience it differently.
Dr. Keith Sutton, Psy.D: (49:58)
Like that dual awareness, I'm safe here now, but I'm looking at this memory where felt unsafe. And what you're talking about too, also makes me think a little bit about, like with some of my clients to talk about like when we're feeling so bad sometimes thinking. I probably don't have to be feeling this bad right now unless, you know, it's like it was a car accident or something, you know, and kind of using some of that cognitive therapy. To look at, is there a way that I'm thinking about this? Or, you know, doesn't mean emotional avoidance, but sitting with that emotion that kind of uses like acceptance commitment therapy and just kind of being with that experience, but also kind of noticing. That probably, this is not as extreme as I'm feeling at this moment. There might be a different way that I could be experiencing it.
Deb Dana, LCSW: (50:39)
When I do a simple practice, I call it notice, name, turn toward, and tune in. So you notice, oh my gosh, you know, if this feels a little not helpful or not needed. Name the state. Ooh, I have a lot of sympathetic activation. Turn toward it rather than running away. Turn toward and listen for just a moment, what is the nervous system? What does that state try to do at this moment? What does it need you to know?
Deb Dana, LCSW: (51:09)
Because it's always acting in service of our safety and survival. You know, it can look irrational. It can look crazy, but on a nervous system level because the nervous system doesn't assign motivation or meaning to make moral meaning. It's simply acting in response. So if I can tune in and my nervousness, like the other day, I was having a really challenging day. And, I went to that sympathetic place and I said, “oh, for goodness sake. Okay. What is it you need me to know? Because this is crazy. And I got the message really clear.” If you don't get out of the house on a regular basis you're gonna go crazy. I thought, oh, well that's good to know. I'm a caregiver for my husband. There's all that going on. But it was a clear message which you would think I could get from a ventral place of rational thinking. My sympathetic had to really get big and loud to have me pay attention and give me this message and it was like, oh, okay. Thank you. Now I can do something with that. But it's the turning toward and listening. That we can be so afraid to do. It's so hard to do that.
Dr. Keith Sutton, Psy.D: (52:24)
Well, especially too if you've been dysregulated so dysregulated in the past. It makes me think of temperature drawn kind of holding that emotion in your hand and seeing what it has to tell you and being curious about it. And taking that opportunity rather than just trying to get rid of it or cut it out or push it away. Well, there’s so much wonderful stuff here. I could keep on going forever, but actually, we're nearing the end of our time. I really appreciate your time and this is really helpful to kind of wrap my head around polyvagal. Because it's a complex theory, but I think we've broken it down so nicely to kind of help it be really tangible and useable, so thank you so much. I really appreciate the time today.
Deb Dana, LCSW: (53:07)
It's been a lovely conversation, hasn't it? A lovely back-and-forth.
Dr. Keith Sutton, Psy.D: (53:13)
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