Polyvagal Informed -EMDR is a specialized approach integrating the clinical applications of PVT and the eight phases of EMDR. EMDR Therapy, developed by Dr. Francine Shapiro, has been widely researched and is an evidence-based approach in the treatment of Post-Traumatic Stress Disorder. It is also a highly integrative therapy model since it is a phase-oriented approach to treatment. Currently, there is a growing demand for EMDR practitioners who specialize in working with the body (soma) and the nervous system (polyvagal theory).
Polyvagal theory (PVT) is an emerging theory based in the work of Dr. Stephen Porges. He has been conducting research on the vagus nerve for over 30 years. Information about the vagus nerve, it's role in our overall health and well-being is gaining popularity in media. It feels like everyday I see more posts on Facebook, Instagram and other sources about "resetting the vagus nerve" and other "nervous system hacks." These programs are often marketed as cure-alls and fixes as if there was a one size fits all approach in the human condition.
As highly specialized trauma experts and EMDR practitioners, we hold a broader awareness of the dance of complexity of the human condition, the soma (body) and the neurobiological structures within an ever-changing environmental context. We also are called to navigate the dance of healing with our clients. Our constant guiding light is hope, knowledge of neurobiology and our embodied guidance of the healing process.
EMDR Therapy Phase 1: Assessing from a Neurobiological Lens
Phase 1 tasks, from the therapist perspective, are the completion of various scales, assessment tools, timelines in order to optimize treatment planning. However, therapy is about relationship. Therefore, from a neurobiological lens of PVT, there is emphasis on the relational components within each phase. PV-EMDR asks, how do I/we become curious about the symptoms, diagnosis, and treatment planning while also avoiding re-traumatization and keeping therapy a safe space.
Pacing with the client's nervous system through the assessment process is the is the foundation of the therapeutic relationship. Through the principles of co-regulation, pacing, joining and bringing curiosity, we are able to bring a dimensional understanding of the assessment tools.
Some questions you may wish to consider in Phase 1.
Have I prepared myself for my time with my client, is my nervous system ready for session and holding the therapy container? (Therapeutic Embodied Presence)
What am I noticing in my body as I listen and begin to join with this person/client?
What am I noticing in the pace, tone, responsiveness of the client?
Maybe beginning with a back of the head scale can begin for us to find mutual language of presence and awareness?
How can I pace with the client, both identifying concerns and building regulation skills together?
How might co-regulation aid in the assessment tools and process, how can I be present with my client and pace the assessments?
EMDR Therapy Phase 2: Preparation from a Neurobiological Lens
Phase 2 is about the preparation of the nervous system for the more active reprocessing phases. Phase 2 goals are about ensuring (1) Ensuring stabilization for active processing; and (2) Dual awareness. This requires the task ability of bi-directional communication of mind-body in current time awareness.
From a PV-EMDR perspective this phase may also include steps of learning about the body, trauma, the nervous system and building what is known as "The Window" of capacity (aka The Window of Tolerance). What is unique in this approach is helping notice and name the nervous system and how it is functioning. From a PVT perspective, the nervous system is not maladaptive, it is intelligent and protective. Frequently the very symptoms that a client is struggling with was at an earlier time a creative coping of the nervous system's defense of experiences of 'trauma.'
In this phase, resourcing strategies are implemented to build the regulatory mechanisms. Trauma constricts, our window of capacity and widening the window of capacity helps clients move into the more active phases of EMDR. Additionally, we learn how the bi-lateral stimulation impacts body and brain in titrated allowing us to understand readiness and/or lack of readiness of the soma and the nervous system.
Phase 2, pacing with the nervous system might look more like the following curiosities:
How is the nervous system identifying this as an effective strategy (symptom)?
When did the nervous system learn this? Is the nervous system oriented to current time, place, 'safe enough' (and is it safe enough or still in the presence of 'danger or life threat').
What stories, metaphors, ways can I utilize as ways to join with my client understanding their nervous system's intelligence?
When and where are the 'cues of safety' for this person/client? (Think the space, distance, level of eye contact, sounds, sights, etc.)
How to we notice and name these?
What are the in-between session supports that can aid the nervous system flexing?
What are the variety of ways I can introduce bi-lateral stimulation and read the responsiveness of the nervous system?
EMDR Therapy- Creative Ideas from a Nervous System Perspective
Phase 2 offers opportunities to engage the ventral vagus and perhaps social engagement. The benefit of toning and stimulating the ventral vagal circuit is to enhance likelihood of Social Engagement System (SES) activation. It is when we have the SES onboard, the felt sense of safety opens and creates capacity and healthy adaptive traits emerge
(More blogs to come on this topic!)
In brief, here are some creative ideas beyond standard resourcing from a nervous system perspective:
Box breathing or Equalized Breath - According to PVT research, optimized breath is 5 cycles of breath per minute. When we engage in the equalized breath count of 4-5 count inhalation (SNS) and 4-5 count exhalation (PSNS) we are introducing this pattern of the optimized breath pattern. However, please also be aware of that breathwork can be activating for a more anxiously wired brain so this might not be a route of engaging depending on the client's system. (downregulating the nervous system)
Orienting - Orienting through the Retinal Active Circuit (RAC) or the eyes, sweeping the room, pausing and defining 'safe enough'. Is another way of activating the vagus nerve and engaging the ventral circuit more indirectly. (downregulating the nervous system)
Humming or Singing - Humming, or maybe even working with Peter Levine's Somatic Experiencing work of the "voo" sound or humming along with a song, is a way of activating through the auricular and glossopharyngeal portions of the ventral vagus. (Ventral vagal toning/stimulating; can be upregulating the nervous system)
Grounding- Because of the number of neuroceptors in of our feet, we are able to sense the world around us. These neuroceptors inform the body of our mobility and stability (cues of safety or mobilization during cues of danger). These cells then signal the the psoas deep in our core as to our proprioceptive sense of safety or danger. The psoas, signals the adrenals and HPA axis (hypothalamus-pituitary-adrenal axis, aka stress response). When we work with proprioceptive cues, such as sense the soles of your feet on the ground, or in your shoes, we are signaling signaling safety through the vagal circuits. (Can be downregulating or upregulating)
Nature - We are nature come alive. Therefore nature time speaks to the language of our body. For some of us urban landscapes and noises bring awareness/cues of safety; for others, it is the mountainscapes, or forestscapes. As we get curios with our clients as to what might help stimulate a "safe enough" response in their body we can enhance the sensory experiences, and build connective experiences. Examples would be making a bird playlist, or water sounds. Perhaps it is the smells (high quality essential oils) that bring a sense of connective nature. Maybe it's having a plant or fresh flowers in their environment. (Co-regulating; Down or Upregulating)
In summary, this has been a deeper dive into the initial phases of EMDR Therapy from the more neurobiological lens. Whether you are working with transforming trauma, depression, obsessions, my hope is that these can aid and empower each of you as EMDR therapists to deepen your curiosity about the neurobiological lens of healing.
Check out my website and other blogs for more about the vagus nerve and EMDRE therapy. If you are a visual learner, there are resources and tools for greater understanding of these methodologies within my EMDR Therapy Tools tab.
I offer individual and group EMDR consultation for those who would like to know and integrate more somatic, yoga, embodiment, nature, art and polyvagal into EMDR Therapy.
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