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The Polyvagal Theory in Therapy: Engaging the Rhythm of Regulation

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The polyvagal theory presented in client-friendly language.

This book offers therapists an integrated approach to adding a polyvagal foundation to their work with clients. With clear explanations of the organizing principles of Polyvagal Theory, this complex theory is translated into clinician and client-friendly language. Using a unique autonomic mapping process along with worksheets designed to effectively track autonomic response patterns, this book presents practical ways to work with clients' experiences of connection. Through exercises that have been specifically created to engage the regulating capacities of the ventral vagal system, therapists are given tools to help clients reshape their autonomic nervous systems.

Adding a polyvagal perspective to clinical practice draws the autonomic nervous system directly into the work of therapy, helping clients re-pattern their nervous systems, build capacities for regulation, and create autonomic pathways of safety and connection. With chapters that build confidence in understanding Polyvagal Theory, chapters that introduce worksheets for mapping, tracking, and practices for re-patterning, as well as a series of autonomic meditations, this book offers therapists a guide to practicing polyvagal-informed therapy.Ìý

The Polyvagal Theory in Therapy is essential reading for therapists who work with trauma and those who seek an easy and accessible way of understanding the significance that Polyvagal Theory has to clinical work.

267 pages, Kindle Edition

First published January 1, 2018

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About the author

Deb Dana

29Ìýbooks207Ìýfollowers
Deb Dana is a clinician and consultant specializing in working with complex trauma and Coordinator of the Traumatic Stress Research Consortium at the Kinsey Institute, Indiana University. She developed the Rhythm of Regulation clinical training series and lectures internationally on ways in which polyvagal theory informs work with trauma survivors.

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5 stars
826 (51%)
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585 (36%)
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164 (10%)
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Displaying 1 - 30 of 112 reviews
Profile Image for Antigone.
590 reviews809 followers
October 6, 2022
Polyvagal Theory is a product of brain science. Developed during laboratory research by Stephen W. Porges, the core of the theory was published in a book that turned out to be a fairly difficult read. Deb Dana, a clinician and subsequent collaborator with Porges, simplifies the material with an eye toward application in therapeutic treatment. I am about to simplify the matter even further (and thus sacrifice a good chunk of nuance) in an effort to assist anyone wondering whether or not such reading might be of interest to them.

The essence of the theory is this: The internal mechanisms of the body and brain register three types of encounter - the safe experience, the dangerous experience, and the life-threatening experience. These judgements are made, to large extent, on the basis of an individual's personal history. If, say, someone smiling at you is remembered as a portent of praise and affection then such a smile would register as a safe experience. If someone smiling at you is, instead, remembered as a precursor to criticism then such a smile would register as the portent of a dangerous experience. If a smile is recalled as the signal of an impending blow, then such a smile would register as a life-threatening experience. A person who has been severely traumatized will spend more time than is healthy in the dangerous/life-threatening end of the experiential spectrum. While these internal judgements are often deeply entrenched, the states themselves are fluid and capable of being maneuvered through. The psychological application involves retraining that registering system so that a mind spends more of its time in the safe (ventral vagal) experience.

The theory is, as I've mentioned, more nuanced than this and Deb Dana does a wonderful job explaining it. That explanation constitutes approximately one-third of this book. The rest is devoted to clinical exercises designed to be used by therapists during treatment sessions. Those exercises make sense in the context of the theory, and offer another avenue to take in the difficult journey toward recovering from trauma.

I've done a lot of reading on this subject, enough to know that neuroscience is bringing fresh strategies into a field that really needs them. Trauma is complicated. Should you find a methodology that speaks to you, it might be worth exploring.
Profile Image for Morgan Blackledge.
784 reviews2,555 followers
December 5, 2021
Polyvagal Theory (PT) is an evolutionarily grounded, neuroscientific and psychological construct that explains the role of the vagus nerve in mammalian threat response and emotion regulation via social connection (co-regulation) initially introduced by Stephen Porges in 1994.

For a good introduction to PT, read The Pocket Guide to the Polyvagal Theory by Stephen W. Porges.

Read my review if it here: /review/show...

This book is author Deb Dana’s practical application of PT to psychotherapy.

And while there’s much more to be said on the subject.

Deb Dana is great.

And this is a nice place to start with her work.

I have it 4/5 stars because the book does not rise to the level of greatness.

But it is still really good.

And really useful.

So go ahead and get it 😜
Profile Image for Michael Maloney.
35 reviews8 followers
March 24, 2019
I can’t recommend this book enough for therapist that work with trauma But even for therapists who don’t this is a great addition to build your skills and bring some of the research of some of the experiential practices in therapy. Deb Dana brings a theory that was very jargon heavy in Stephen Prorges great works work and makes it client friendly and interactive. She goes into play, bodywork, processing different emotions, emotion tracking and so many other skills that will be helpful to any therapy practice.
Profile Image for Sharon.
480 reviews36 followers
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May 13, 2021
I read about polyvagal theory because it seemed to be somewhat commonly cited by current trauma therapies. This book is largely about clinical practice, but does talk about the scientific basis.

I also read some criticisms online that said that the science is not well-founded, specifically that certain nervous system structures don't work the way that Porges says they do, and that nervous systems of mammals and reptiles aren't divided up the way that Porges describes.

I don't have any background in neuroscience myself, and very limited education in natural sciences in general (some college coursework). I didn't understand those criticisms well enough to evaluate them and decide whether I agreed with them.

What I can say is that most of the practice exercises in this book seem relevant regardless of the theory behind them. Naming the ventral vagal, sympathetic, and dorsal vagal pathways / systems helps a person sort their experiences based on how they physically feel.

One takeaway that's repeated over and over: patients who are introduced to polyvagal theory often feel relieved by the idea. Conceptualizing their trauma response as an overactive surveillance system that can be modified helps them shed the shame that society places. In other words: "I thought I was defective, but now I appreciate that my body was reacting in ways that kept me safe before. Now that I'm safe, I can learn to react in different ways."
Profile Image for Lance Hill.
33 reviews2 followers
July 2, 2019
This book has changed the way I help my clients. It’s a must read if you’re in the counseling field.
Profile Image for Lucia Gannon.
AuthorÌý1 book19 followers
August 16, 2019
A clear, well-researched and useful guide to Stephen Porges “polyvagal theory.� An expert translation of the theory into practice for both personal and professional use. Some prior knowledge of the theory is probably necessary as this book simplifies it so well that some of the complexity may be lost and some of the relevance of the proposed exercises missed. Very useful for therapists or anyone in the caring profession.
185 reviews5 followers
December 30, 2019
I'm not really the perfect audience for this book so don't take my 3 star rating as a major critique. I liked the book, but didn't find it life changing or so incredible to warrant a 5 star review the way some therapists may find this completely changing their practice. Disclaimer over.

This was a really cool book. For someone interested in neuroscience, emotions, how we act etc it is very approachable yet deep. It outlines the work of Dr. Porges on the Polyvagel theory then offers a lot of ways to integrate the theory into clinical practice. I was able to get a ton of value out of it in a 2 hour reading session.

My mom suggested I read this book after I mentioned am interest in decision science. While I don't know how to qualify or quantify the accuracy of the science other than it is from a respected researcher who worked on it for decades, I did enjoy some interesting learnings about emotions and emotional regulation concepts.

#1: Ventral vagal nerves
Polyvagel theory is about the anatomy of survival, Deb claims. The two vagal nervous systems and the sympathetic nervous system all work to help us survive. There's a hierarchy of these systems, she claims. We apply a "vagal brake" slowing down the heart when in a connected state. This is activation of the ventral vagal nervous bundle, a series of nerves connecting your lungs, heart, and face. The bundle has about 80% of its connections sending information to the brain and 20% from the brain to your motor system. This is evolutionary the most recent development and essential to mammalian abilities to connect. From this state you're most able to calmly react to whatever happens.

#2: Sympathetic nervous system:
When you feel a sense of danger this system kicks in (and in other situations). The "vagal" brake is released and your heart rate can climb. You take action often with this system activated. This is the 2nd most recent evolutionary system of the 3, Deb claims. One question I have is what system works when you're excited. For example, in taking these notes I feel my heart beating faster than when reading Deb's book. Is my sympathetic nervous system in action? In many ways I feel it is, but I don't feel fear. I'm excited to capture and digest the ideas and science I'm reading about. That part wasn't clear to me in this book.

In any case, Deb claims this is a lower system. From here you can return to the ventral vagal system and apply the "vagal brake" or go to the lowest/oldest system, the dorsal vagal bundle.

#3: Dorsal vagal nerves:
This system is the immobilization system, Deb claims. She uses the metaphor/phrases of "playing possum/dead" to explain it. These are the nerves that connect your gut to your brain via a vagal connection. When active you freeze and this can be a place/system to avoid. You'll go here sometimes but in trauma you get stuck here instead of regulating your way out. I can relate to this in jobs Ive felt stuck in. I've given up trying and in retrospect maybe immobilized myself in some ways. To get out she describes your sympathetic nervous system energy moving you to action and then out of immobilization.

#4: Therapeutic exercises:
Deb describes many exercises to build awareness of these 3 systems and eventually rewire/reshape them to enhance regulation. Breath is a key, connection is key, touch can help, she has many ideas. There's a lot of exercises in this book to work with Porges' Polyvagal theory and Deb describes many of them in the context of trauma work.

#5: Societal survival/power seeking vs. connection seeking
Conceptually it is interesting to see connection at the top of a hierarchy of this sort. We often seek control, power, autonomy as peak states, feelings and perspectives. Personally, as I age I do see the value in trust, connection and its intimate vulnerability as higher states than the ones that lead you to seek control, power or autonomy.

I can also understand many people's (and often my own) desires to seek the effects of the sympathetic nervous system as the goal/peak. When our heart rates and our body produces lots of adrenaline, cortisol, and the hormone cocktail we call flow, it feels great. Like an orgasm at times. I and others can seek that pleasure as superior to connection and its associations. There's a sense of power which can feel good.

Conclusion:
The Polyvagel neurobiological theory of our nervous system's functions, regulations and strategies is an interesting lens to look at society and decision science. As a techie it makes me want to experiment with measurements as teaching tools. If I ran a decision science lab I'd be interested in connecting Polyvagal theory to results on hunger's impact (e.g. judge's granting parole significantly less before lunch). As a data scientist working on behavior change it suggests an experiment with content and coaching to drive awareness and reshaping of the nervous system to avoid chronic health issues. Check out this book if you're interested in learning about our nervous system through a Polyvagal lens and consider how it could drive your work.
166 reviews189 followers
December 21, 2021
Really good as a practical guide to how to implement polyvagal theory in your therapy practice.

As a social work student, I found this quite clear and helpful to understand and practice polyvagal awareness. I am not yet a therapist, but this theory makes a lot of sense for understanding clients and myself.

As a neurodivergent person, I find polyvagal theory more helpful and accessible than mindfulness based on cognitive labeling of emotional states. Because of my alexithymia, I find it easier to notice and name my polyvagal state than my current emotion. This guide offers a practical method for those of us who have trouble with mindfulness-based emotional awareness to more easily tune into our current state of dys/regulation.

As always, it loses a star for not having an explicitly feminist and anti-oppressive lens. You have to do some translating work to connect this theory to the experiences of clients for whom “safety� is not a given experience because of oppression.
Profile Image for Beth.
316 reviews7 followers
February 16, 2023
I'm a psychologist, and I received this book as part of a webinar training with the author, Deb Dana. Polyvagal theory is a relatively new clinical approach, one that is an embodied mind-body intervention. This speaks to me as both a psychologist and a yoga teacher. The book is very well-written, with easy to understand examples and information. There are plenty of handouts/worksheets to use with clients. I wish there had been more about the specific language of introducing this theory to clients, particularly to ones who are more concrete. It also would have been nice to have different perspectives of the theory, like how to utilize it within a short-term framework. My actual rating would be about 4 1/2 stars, but I do definitely recommend the book.
469 reviews7 followers
March 4, 2023
Although I’m not a therapist, I read this one bc my library didn’t have Anchored. In spite of that, this book landed w me exactly how The Body Keeps the Score did when I first read it. All of a sudden, I have language for so many of my lives experiences, regardless of the story/ies I have developed around my experiences. Highly recommend!
Profile Image for Jen.
39 reviews
December 11, 2018
Love this book and it’s practical applications of a complex theory. Helps lay the foundation for therapy work and easily integrates into practice. Use of the maps is bringing another dimension of healing to my clients. Deb Dana is brilliant!
10 reviews
July 21, 2023
De theorie wordt goed uitgelegd, daarna staan er veel oefeningen in.
231 reviews1 follower
October 24, 2020
This book was full of great information and completely changed how I think about our nervous system and its regulation. It is definitely written for therapists not parents of children who are dysregulated, but provides lots of good background. I have since found other resources for parents that build upon the polyvagal theory and I now have a strong foundation to fully understand them.
16 reviews
June 11, 2024
The next time someone asks me about the secret to happiness, I'll take great delight in saying (only half tongue-in-cheek) that it's about finding joy in "co-regulation," an activity which appears to activate most expediously the ventral vagus system (that hallowed bit of nervous machinery which allows us to feel safe in connection with others)
Profile Image for B.
130 reviews2 followers
March 9, 2025
Read for a class.
This book does a great job of explaining Polyvagal Theory in a way that’s easy to understand and actually useful. This is the third time I've read about this and the first time I've really understood it!
Profile Image for Shelley.
386 reviews8 followers
July 1, 2023
Excellent resource for therapists on how to use polyvagal theory in treating clients.
Profile Image for Sarah Beth.
106 reviews1 follower
December 30, 2023
This book is changing my life and my therapeutic practice. I have already started reflecting on how the three vagal states show up in my life, and using the frameworks, interventions, and worksheets with my clients. I know I will come back to this book again and again
Profile Image for Grace.
712 reviews16 followers
January 4, 2024
“With nervous systems toned through experience, our trauma survivor clients are sensitive to the most subtle shaking. Therapy is a process of building the new, deep autonomically supported foundation of safety through attending to environmental, embodied and relational cues�
3:27:51
Profile Image for Max Booher.
114 reviews
January 12, 2024
Polyvagal Theory MAKES SO MUCH SENSE. What we call “personality� is really just a pattern of how one does or doesn’t regulate their autonomic nervous system. Not only does this theory explain “personality�, it also explains behavior in general � how and why people resort to unhealthy choices.
371 reviews
December 7, 2020
Great practical tips for a therapy based on the poly-vagal theory. The book first explains the theory and then mentions the different ways this theory can be used to facilitate the therapy process. Really practical and insightful.
Profile Image for Maryam.
67 reviews
March 13, 2025
So good for trauma and offers a more science based working with the autonomic nervous system.
I really like one of the last sentences, “yet is a harbinger of change�
10 reviews2 followers
September 28, 2019
Informative, easy-t0-understand, practical takeaways and worksheets that help the mental health clinician help their clients understand the autonomic nervous systems actions and reactions to the environment. Gives hope that while our nervous systems are wired to survive, with effort and compassion, we can rewire default responses to live more fully today.
Profile Image for Jack.
52 reviews22 followers
August 22, 2020
I originally bought Stephen Porges' book, but it was way too scientifically technical for me. At that point I could've bought his pocket guide, but this book appealed to me because I care more about the application of the theory than the theory itself. And oh boy is that application fantastic!

This review is going to be a long one, so let me tell you what to expect. I'm going to outline five things that I noticed as cool/helpful or that changed in me from having read about polyvagal theory. I'm not going to explain what the theory actually is though (you can Google for that or checkout Instagram). I'm also not going to spend a lot of time talking about the book itself. My short take away is that it was a relatively easy read, explained concepts clearly, and offered a lot of exercises and concrete application.

So! On to the things that interested me..

1. It's actually pretty important to feel safe. Within this framework, it is physiologically difficult if not impossible to have genuine social connection or a feeling of security while the body is feeling unsafe. This is sort of obvious in retrospect, but I guess I thought that I could think myself calm, or that the feelings of anxiety were aiding me in the moment.

I decided to experiment with this by implementing a small habit: when I notice that I'm feeling unsafe/anxious/wanting to run away/wanting to fight, then I pause what I'm doing. Take deep and slow breaths. Bring as much gentle curiosity as I can. When I did this during solo moments of worry, I found myself feeling less urgent and closed in afterward. When I tried this during interpersonal conflict, both of us were able to settle and have difficult conversations while maintaining connection. Frankly, they were the best, hard conversations I've had.

2. The body/mind connection. Within this framework, your body is tracking the environment around you and it's responding as it believes is correct. My body senses danger? I feel tense and activated. My body senses safety? I feel relaxed and comfortable. How I feel comes after my body taking in information. The stories that I tell myself about a situation are irrevocably linked up to what I'm physically experiencing.

The example from the book about this is how when someone is feeling unsafe, a neutral face is read as angry. That same neutral face will be read accurately as neutral or even positive by someone who's physiologically feeling safe.
There's an example from my life where this clicks and it brought a significant, "ah ha!" moment. When I'm feeling stressed and low energy and I think about my life, it feels like everything is terrible and without meaning. Then I go to bed, wake up feeling rested, and I think about the same things that had been on my mind the night before, and things no longer feel terrible and without meaning. And this has been incredibly confusing for me, because what's the truth? How do I actually feel? How is it that I can think about the very same events in one state and have one interpretation, but when I think about the same things in a different state, I have a different interpretation? Polyvagal theory offers a fairly complete answer to these previously impossible questions.

3. This re-contextualized a lot of my past experiences. I don't want to go into a lot of detail about this one, but the short version is that it was extremely validating to see my past in this light and it allowed for some releasing of tension.

4. This removes any need for internal adversarial orientation. My body is doing its best for me. My body has been conditioned from the experiences that I've had. All of the behaviors that are causing me difficulties now, were at one point mechanisms that served to protect me. This removes a huge chunk of shame and blame.

5. The framework and language itself. The way it structures experience in a way that can be easily mapped onto. The way it provides keywords both for internal use and for communicating to others. Simply having named concepts is useful for understanding.

Anywhoo, would definitely recommend. Only 4/5 because while it was absolutely useful, it's being dissolved into my broader body of knowledge instead of living on as a tool I repeatedly go to use.
Profile Image for TJ.
288 reviews29 followers
May 25, 2021
Did not finish past 50% cause the audiobook version of this just doesn't work for me. I need to highlight and annotate a paperback copy 😭
Profile Image for Jules Morgan.
20 reviews1 follower
July 27, 2020
This book is fantastic. Polyvagal theory is hereby my new therapy baby. I love finding new language to describe internal processes and this book gave me a lot of it. I only wish she had gone into more detail about feelings that require overlapping polyvagal states! It’s absolutely fascinating to me. I also appreciate how I can weave this theory with Pat Ogden’s sensorimotor psychotherapy and Richard Schwartz’s internal family systems theory. I love it when all the pieces fit together. Would highly recommend to anyone dealing with c-ptsd.
2 reviews
April 6, 2021
First came accross the polyvagal theory (poly=many, vagel=wandering) while researching complex cptsd.

A well written book that looks at vagel nerve the circuits that are regulated in the brain stem and how this is regulated when in different states (fight/flight) so over sees the functions of
parasympathetic nervous system
and sympathetic nervous system.
Unfolded are their functions in the bodys reaction /social interactional behaviour and pick of of cues.

The book keeps it simple enabling you to really understand the evolution of the theory.
Profile Image for Katie.
23 reviews
June 22, 2023
My therapist recommended this book for me to help me work through some stuff. It’s a relatively short read and fantastic for working through trauma and the polyvagal response to perceived threats, real or not. This book opened my eyes to a lot of my behaviors that have been “protecting me� but also hindering my relationships and everyday life. I will definitely re-read this one before the end of the year, to pick up on things I may have missed on my first pass.
Profile Image for Jeff Wagner.
11 reviews
February 28, 2023
Wonderful theory of regulation with many clinical tools and exercises to try in the therapy room. Minor peeve: the book is wildly repetitious. I didn't take off any stars since it can be useful as a book to crack open to a certain exercise and be immediately reminded of the standard physiological aspects of the vagus states.
Profile Image for Brian Post.
15 reviews3 followers
January 28, 2020
This is a must read if you work with clients that have trauma. Understanding the autonomic nervous system is key to helping your clients develop self-awareness. Once they master self-awareness, they can begin the work of self-regulation.
Displaying 1 - 30 of 112 reviews

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