Stanley Rosenberg's Healing Power of the Vagus Nerve

Dr. Stanley Rosenberg, PhD, dispels long-held myths about the autonomic nervous system (ANS) and offers up-to-date research on how our physical health, emotional wellness, and the vagus nerve are all interconnected. Most importantly, he shows how these insights can help you heal your ANS—and live a less stressed, more balanced, and emotionally regulated life. This book offers:

An in-depth overview of Stephen Porges’s Polyvagal Theory

Step-by-step self-help techniques for regulating the vagus nerve

Vagus exercises to relieve emotional, psychological, and physical symptoms

Real-life case studies and stories from the author’s clinical practice

Insights into the vagus nerve’s role in social behavior

An overview of what happens in our bodies when we get stuck in stress states—and how to heal them

Simple, research-backed recommendations for initiating deep relaxation, improving sleep, healing from trauma, and stimulating recovery from illness and injury

Accessing the Healing Power of the Vagus Nerve is written for therapists, bodyworkers, trauma survivors, parents, and anyone struggling with chronic stress. Grounded in neurobiology research, clinical stories, and easy-to-follow exercises, this book gives you the tools to bring your body back into a state of safety, balance, and optimal functioning. - Accessing the Healing Power of the Vagus Nerve: Self-Help Exercises for Anxiety, Depression, Trauma, and Autism

Preface

Stanley Rosenberg is an American-born body therapist living in Denmark who proposes a new approach to healing based on the Polyvagal Theory developed by Dr. Stephen Porges.

The autonomic nervous system (ANS) not only regulates the workings of our visceral organs but is closely tied to our emotional state, which directly influences our behavior.

Rosenberg has been doing various forms of body therapy for more than forty-five years and has studied at the University of Hawaii and the Odin Theater in Denmark.

He learned about Rolfing®, a form of hands-on body therapy created by Ida Rolf, which led him to study craniosacral therapy, visceral massage, and other osteopathic techniques.

Rosenberg believes that becoming a skilled body therapist is not so much “knowing about” something intellectually but “learning how to do something with your hands.”

Introduction: The Autonomic Nervous System

The ANS is an integral part of the human nervous system, monitoring and regulating the activity of visceral organs such as heart, lungs, liver, gall bladder, stomach, intestines, kidneys, and sexual organs. Problems with any of these organs can arise from dysfunction of the ANS.

Old understanding of the ANS: The ANS functioned in two states - stress and relaxation.
- Stress response is a survival mechanism activated when we feel threatened; it mobilizes our body to prepare for fight or flight.
- Relaxation response kicks in after threat has passed, keeping us in a relaxed state until the next threat appears.
Fails to explain why people continue to feel stressed even when they are not under any threat.
Polyvagal Theory (PVT): introduced the concept of three states
- Ventral Vagal State: This state is characterized by social engagement and safety. It is associated with feelings of calmness, connection, and trust.
- Dorsal Vagal State: This state is characterized by immobilization or shutdown. It is associated with feelings of fear, helplessness, and hopelessness.
- Sympathetic Nervous System (SNS): This system is responsible for the fight-or-flight response. It is associated with feelings of anxiety, stress, and tension.
Craniosacral Therapy: A hands-on therapy that has proven to be particularly effective in improving the function of the nervous system. It can reduce chronic stress, release tensions in the muscular system, and bring better balance to the hormonal (endocrine) system.

The brain-body barrier

physical structure made up of epithelial cells that envelop the brain and spinal cord.
These cells form what is called the blood-brain barrier, which prevents direct circulation of blood directly to the neurons of the brain and spinal cord.
Instead, the tissues of these structures are surrounded by colorless cerebrospinal fluid, which circulates to deliver necessary nourishment to the cells of the brain and spinal cord and to carry away waste products of cellular metabolism before returning to the blood.
The cerebrospinal fluid is found in small amounts in the blood throughout the entire body, but it is finer than the rest of the blood. It contains no red or white blood cells, and fewer impurities than blood.
In the brain the cerebrospinal fluid is filtered out of the blood and circulates through the cranium in the spaces surrounding the brain and spinal cord. After circulating around the brain and spinal cord, the cerebrospinal fluid returns to the jugular veins, where it rejoins the blood returning to the heart from the rest of the body.

The blood supply to the brainstem and the nerves arising there is crucial to the function of the five cranial nerves whose function is necessary for the state of social engagement, which includes the ventral branch of the vagus nerve.

Removing restrictions to this blood supply is at the core of successfully improving the function of the ventral branch of the vagus nerve and the other four cranial nerves necessary to social engagement.

Some of the best ways to achieve this are found in the domain of craniosacral osteopathy, which has been taught by John Upledger and others.

The Polyvagal Theory, introduced by Stephen Porges, provides a new understanding of the autonomic nervous system and its role in social engagement.

The neurology of social engagement

Spinal nerves originate in the brain, make up part of the spinal cord, exit between vertebrae, and go to various areas throughout the body. They are mixed nerves carrying motor, sensory, and autonomic signals. The sympathetic chain runs from T1 to L2 supporting visceral organ and muscle activity during a "fight or flight" response.
Cranial nerves originate in the brainstem and make their way to various structures in the cranium and body. Some innervate facial muscles, others go to organs of digestion, and some connect to cells in the nose for smell.

The ventral branch of the vagus nerve (cranial nerve X) and pathways within cranial nerves V, VII, IX, and XI support social engagement behaviors when working together properly.

Social engagement is a state based on these five cranial nerves' activity, enabling social interaction, communication, self-soothing, love, friendship, intimacy, and cooperation for survival. Other inherent values include bonding, friendships, intimate relationships, communication, caregiving, work, raising families, storytelling, sports, singing, dancing, and entertainment.
The old model of the autonomic nervous system does not describe or explain these positive social interactions. Social engagement also helps regulate the autonomic nervous system, making people feel better when with others. Lack of positive social interactions can lead to stress, depression, asociality, or antisocial behavior.
The Polyvagal Theory explains that the autonomic nervous system has three functions: the ventral branch of the vagus nerve (cranial nerve X), dorsal branch of the vagus nerve, and sympathetic activity from the spinal chain. This multiple nature of the vagus nerve gives the theory its name.
The book introduces a new approach to healing that includes self-help exercises and hands-on therapeutic techniques for physical, psychological, and social issues caused by dysfunctions in these five cranial nerves.

Restoring social engagement

The book aims to make vagal function restoration accessible for a broad audience without prior experience in hands-on therapy.
It provides self-help exercises and hands-on techniques based on Alain Gehin's principles.
These techniques restore flexibility in the autonomic nervous system, helping to eliminate chronic stress and depressive behavior.
The book offers noninvasive, medicine-free methods that improve ventral vagus nerve function for better regulation of visceral organs involved in breathing, digestion, elimination, and sexual function.
Tested with over a hundred patients, the exercises have been found to enhance health and social engagement.
The positive effects can last surprisingly long but are not permanent due to life's challenges.
The body, nervous system, and emotions adapt to changing conditions, so temporary states of sympathetic activity or dorsal vagal activity may occur in response to threats or danger.
Repeating the exercises restores ventral vagus function and returns the person to a socially engaged state.
It might be necessary to repeat these exercises occasionally or regularly for cumulative positive effects on the autonomic nervous system's resilience.

PART ONE

Polyvagal Theory: The theory suggests that the nervous system has three branches: sympathetic, parasympathetic, and enteric. It focuses on the vagus nerve, which is part of the parasympathetic branch.
Overcoming Health Challenges: Many people struggle with health issues, similar to Hercules fighting Hydra in Greek mythology. Treating one symptom at a time may not address the root cause and can lead to more symptoms.
Cranial Nerve Dysfunction: The autonomic nervous system regulates important functions of the body such as circulation, respiration, digestion, and reproduction. If it's not working properly, various health issues can arise.
Common Problems Related to Cranial-Nerve Dysfunction:
- chronic physical tensions
- migraines
- back pain
- tense muscles
- eye or facial tensions
- cold hands and feet
- unwarranted sweating
- tenseness after exertion
- arthritis
- nervousness
- dizziness
- lump in the throat
- emotional issues
- heart and lung problems
- visceral-organ dysfunctions
- immune-system problems
- behavioral problems
- interpersonal relationships issues
- mental issues
- other problems.
The Vagus Nerve: If the ventral branch of the vagus nerve is not functioning, it can lead to various health issues. Working with the cranial nerves can bring relief for these symptoms.

Challenges and stresses

The challenges and stresses in life can cause various symptoms such as physical, mental, emotional, and behavioral issues.
These symptoms are often comorbid, meaning they occur together.
If these problems happen frequently or most of the time, it is advisable to address them.
A common thread: linking these seemingly separate issues may be dorsal vagal activity or activation of the spinal sympathetic nervous system.
The ventral vagus nerve branch: and other nerves required for social engagement can help alleviate these problems.
Cranial nerves play a role in health issues, but this is often overlooked by contemporary medicine.

Chapter 1

The human nervous system ensures survival of the physical body.
It is composed of the brain, brainstem, cranial nerves, spinal cord, spinal nerves, and enteric nerves.
Focus is on the autonomic nervous system, which includes elements from the brainstem, some cranial nerves, and some parts of some spinal nerves.
The twelve cranial nerves connect the brainstem with organs and muscles of the head, face, neck, thorax, and abdomen.
One cranial nerve, called the vagus nerve, is long and has many branches, regulating bodily functions necessary for maintaining homeostasis.
Several cranial nerves support non-stress states and facilitate rest and restitution.
They also enable senses of sight, smell, taste, hearing, and touch on the face.
In mammals, some cranial nerves work together to promote social behavior.
Each cranial nerve is numbered with a Roman numeral, starting from the topmost nerve (CN I).

The various functions of cranial nerves

Cranial nerves have multiple functions related to finding food, chewing, swallowing, and digestion.

CN I: The olfactory nerve enables our sense of smell, which is vital for finding food and determining its edibility.
CN II: The optic nerve, transmits signals from the rods and cones in the retina to the visual centers in the back lobe of the cerebral cortex, allowing us to see potential food sources.
CN III, IV, VI: (oculomotor, trochlear, abducens) control the small muscles that move our eyeballs up, down, right, or left, expanding our field of vision.
CN XI: Controls the trapezius and sternocleidomastoid muscles, allowing us to look up, down, and to the sides in order to bring food closer for smelling.
CN V, CN VII, CN IX: Trigeminal, facial, and glossopharyngeal nerves control the secretion of saliva, initiating the digestive process and improving our ability to taste food.
CN V: Controls muscles of mastication are controlled, allowing us to open and close our jaw and grind food with a side-to-side movement.
CN XII: (hypoglossal nerve) controls the tongue muscles, which move food around in the mouth for tasting and swallowing.
CN VII, CN IX, CN X: Facial, glossopharyngeal, and vagus nerves are connected to the taste buds on the tongue.
CN IX, CN X: Glossopharyngeal, and vagus, assist in co-ordinating the act act of swallowing.
CN VIII: Vestibulocochlear nerves play a role in hearing by regulating the middle-ear muscles.

Major Functions of the Cranial Nerves.

CN I - Olfactory nerve: Smell; helps to locate food.
CN II - Optic nerve: Vision; makes it possible to see.
CN III - Oculomotor nerve: Looking; controls some eyeball muscles.
CN IV - Trochlear nerve: Looking; controls some eyeball muscles.
CN V - Trigeminal nerve: Chewing and swallowing, Hearing (tensor tympani muscle).
CN VI - Abducens nerve: Looking; controls some eyeball muscles.
CN VII - Facial nerve: Secretions, Chewing, some facial muscles, Salivary glands, Stapedius muscle.
CN VIII - Acoustic nerve: Hearing; translates sound waves into nerve impulses.
CN IX - Glossopharyngeal nerve: Swallowing.
CN X - New vagus nerve: Innervates and controls the upper third of the esophagus, most of the pharyngeal muscles, regulates heart and bronchi.
CN XI - Spinal accessory nerve: Innervates trapezius and sternocleidomastoid muscles, which turn the head and expand the visual field.
CN XII - Hypoglossal nerve: Moves the tongue.

Cranial nerves also perform other functions such as gathering information from visceral organs to determine safety, health, and social engagement.

Cranial Nerve Dysfunction and Social Engagement

Normal human behavior is an expression of positive social values, beneficial for survival and well-being.
Social engagement makes our actions understandable to others; most people are socially engaged most of the time.
Autonomic nervous system resilience allows us to bounce back from fight or flight/withdrawal states.
Lack of social engagement can lead to difficulty understanding values, motivation, and behavior.
Five cranial nerves necessary for social engagement:
- olfactory (smell) CNI
- optic (sight) CNII
- oculomotor (eye movement) CNIII
- trochlear (eye movement) CNIV
- trigeminal (facial sensation) CNV

Dysfunction of these nerves can cause symptoms that indicate lack of social engagement, such as anosmia (loss of smell), blindness, double vision, strabismus (crossed eyes), facial numbness.

The fifth and seventh cranial nerves

The fifth cranial nerve (CN V) is the trigeminal nerve, which has motor functions controlling muscles of mastication and sensory functions receiving impulses from the skin of the face.
The seventh cranial nerve (CN VII) is the facial nerve, which also has motor functions controlling tensing and relaxing of facial muscles and sensory functions.
CN V and CN VII have interrelated functions with CN VII innervating the muscles of the face and CN V being a sensory nerve to the skin of the face.
The stapedius, the smallest muscle in the body, is innervated by CN VII and protects the inner ear from high noise levels.
Dysfunctions of CN V and CN VII are common in adults, often coming as an undesirable side effect of tooth extractions or orthodontic braces.

The ninth, tenth, and eleventh cranial nerves

The ninth, tenth, and eleventh cranial nerves are closely related and often considered as one nerve for clinical purposes.
The tenth cranial nerve (vagus) has two branches: the ventral vagus and the dorsal vagus.
Both branches of the vagus nerve, along with the ninth and eleventh cranial nerves and the jugular vein, pass through the jugular foramen in the base of the skull.
The fibers of the ninth and eleventh cranial nerves are woven together with those of the tenth cranial nerve.
The ninth cranial nerve (glossopharyngeal nerve) has both sensory and motor functions, innervating the stylopharyngeus muscle involved in swallowing and receiving sensory information from the tonsils, pharynx, middle ear, and posterior third of the tongue.

The Vagus CNX has two branches with different functions.

The dorsal branch of the vagus nerve has motor fibers that innervate visceral organs below the respiratory diaphragm, including the stomach, liver, spleen, kidneys, gall bladder, urinary bladder, small intestine, pancreas, and ascending and transverse segments of the colon.
The ventral branch of the vagus nerve originates in the brainstem and stimulates rhythmic constriction of bronchioles, facilitating oxygen extraction. It also innervates muscles in the throat, including vocal cords, larynx, pharynx, and some muscles at the back of the pharynx.
The eleventh cranial nerve, or accessory nerve, is important for the well-being of the musculoskeletal system as it innervates trapezius and sternocleidomastoid muscles, which enable head and neck movement. Dysfunction in this nerve can cause shoulder problems, stiff neck, migraines, and difficulties rotating the head from side to side.

Treating the Cranial Nerves

Chiropractics and chiropractic-like mobilizations are used to treat spinal nerve dysfunction.
Physical therapists stretch and strengthen muscles of the neck and back to reposition vertebrae, reducing pressure on spinal nerves.
If these modalities fail, orthopedic surgery may be considered.
Cranial osteopathy, craniosacral therapy (CST), or osteopathy in the cranial field (OCF) are used to treat dysfunctions of the cranial nerves.
William Garner Sutherland founded cranial osteopathy and Harold Magoun wrote a seminal book on it.

There are three approaches to cranial work:
- biomechanical: holding two adjacent cranial bones for mobilization in sutures.
- soft-tissue stretching: focuses on dural membranes (dura mater, falx cerebri, tentorium) that become less flexible with age, illness, antibiotics, and trauma.
- biodynamic: aims to maximize movement of cerebrospinal fluid for nourishment and waste elimination.

The Spinal Nerves

Messages to the spinal nerves originate in the brain and travel through the spinal cord, a tube-like nerve bundle that exits the cranium through a large opening in the base of the skull called the foramen magnum (Latin for “large hole”).
Human beings have thirty-three pairs of spinal nerves, with one nerve of each pair going to the right side of the body and the other to the left. Each pair of spinal nerves corresponds to a segment of the vertebral column.
There are always more than one branch of one spinal nerve going to any given muscle, providing insurance that if one of the spinal nerves is damaged, the muscle can still function (albeit less efficiently) using the signals from other available nerves.
Every spinal nerve also affects several muscles, often working together as a unit to control basic movements of the arm or hand.
The motor pathways of a nerve signal a muscle to contract.
Spinal sensory nerves gather information from the body and feed it back to the brain:
- sensations of pain
- positions of the body parts
- movement
- tension in the muscles or fascia
- sense of touch (except the face which is innervated by cranial nerves).
Under normal conditions, the spinal nerves facilitate easy, well-coordinated, graceful movements, and the muscles fire using the minimum amount of energy to achieve the desired movement.
If the body is in a state of stress and all the muscles are more tense than necessary, this natural coordination is often lost, and movements become uncoordinated, awkward, or weak.

The spinal sympathetic chain

Spinal sympathetic chain: Extends from T1-L2 vertebrae, connecting to spinal nerves. Most sympathetics project to visceral organs and head. Accompanied by arteries to destinations.
Stress response:

Increases heart rate
blood pressure
releases stored sugars for energy
opens airways
slows digestion.
Affects whole body in cases of threat or challenge.

Enteric nervous system: Network of nerves interconnecting visceral organs. We know little about its function, but it may help coordinate digestion and is sometimes referred to as "the second brain.

Chapter 2

The Polyvagal Theory recognizes two separate branches of the vagus nerve (ventral and dorsal) instead of one.
This leads to a more accurate representation of the autonomic nervous system, which consists of three neural circuits: ventral branch of the vagus nerve, spinal sympathetic chain, and dorsal branch of the vagus nerve.
These three circuits regulate bodily functions to maintain homeostasis and also relate to emotional states that drive behavior.

Goldilocks and the Three ANS States

Goldilocks and the Three Bears can be used as a metaphor for the three states of the autonomic nervous system (ANS).
- The first bowl of porridge was too hot
- the second was too cool
- and the third was just right.
The quality of the tone of the musculature in the three ANS states:
- too hard or hot (in the fight or flight state)
- too soft or cold (in the shutdown state)
- just right (in the social engagement state).

In the fight or flight state, muscles are tense to allow for quick movement. Higher blood pressure is needed to get the flow of blood into these tensed muscles.

In the shutdown state, there is no need to tense the muscles to fight or flee, so low levels of muscle tonus are found. Low blood pressure is sufficient to get the blood into soft, limp muscles.

The social engagement state is characterized by normal blood pressure and a relaxed body.

A handshake can indicate the state of another person's ANS:

an overly tight handshake may result from a chronic state of activity in the spinal sympathetic chain
while a limp handshake may be due to overactivity in the dorsal vagal circuit.
If our handshake is just right, it indicates that the ventral branch of the vagus nerve is predominant.

Homeostasis and the ANS

Homeostasis and the ANS can be compared to a thermostat linked to both a heater and an air conditioner.
Mammals need to maintain body temperature within upper and lower limits, using behavioral patterns and physiological functions to regulate temperature.
The three parts of the autonomic nervous system work together to control the activity of organs, bring about homeostasis, and help us meet environmental situations.
Polyvagal Theory can be applied to problems and diagnoses in many physiological areas such as digestion or reproduction.
Heart rate variability (HRV) is a potential measurement for predicting health issues like obesity, high blood pressure, heart fluctuations, etc., and may also help predict the onset of cancer, cancer metastasis, or likely mortality in people with cancer.

The Five States of the Autonomic Nervous System

The autonomic nervous system (ANS) has three neural pathways, that comprise its first three states:
- social-engagement: Ventral vagal
- fight or flight: Spinal Sympathetic
- freeze: dorsal vagal
There are two hybrid states
- friendly competition: combines the fight or flight response (spinal sympathetic chain) with feelings of safety (ventral branch of the vagus nerve).
- intimacy: combines slowing down physical activity (dorsal) with feeling safe with another person (ventral).

Historical Recognition

The Vagus Nerve: must function properly for individuals to be healthy, feel good emotionally, and interact positively with others.

Historical Recognition:

First recorded mention by Greek physician Claudius Galen around 130 AD.
Foundational knowledge in medical education since then.

Function:

Believed to be part of the autonomic nervous system.
Traditionally seen as the parasympathetic division, promoting relaxation and rest.

Galen's Observations:

Noted dysfunctions when vagus nerve was severed in gladiators.
His writings formed foundation of European medicine for over 1500 years.

Autonomic Nervous System:

Traditionally seen as sympathetic (stress response) and parasympathetic (relaxation response).
Vagus nerve considered part of parasympathetic system.

Polyvagal Theory (1994):

Introduced by Stephen Porges.
Proposed three divisions of autonomic nervous system: ventral vagus, sympathetic, and dorsal vagus.

Two Branches of the Nerve Called “Vagus”

The two branches of the vagus nerve are the ventral and dorsal branches.
They originate from different locations in the brain and brainstem.
The ventral branch is located on the front side of the brainstem, while the dorsal branch arises in the floor of the fourth ventricle.
The ventral vagus nerve functions in conjunction with four other cranial nerves (V, VII, IX, and XI) to promote rest and restitution for optimal physical and emotional health.
When we are socially engaged, we exhibit positive, prosocial behavior and feel safe, which can help defuse potentially threatening situations.
If the situation is unsafe or dangerous, our autonomic nervous system may shift down one phylum to a more primitive response, such as fighting, fleeing, or withdrawing into a dorsal vagal state of withdrawal, dissociation, and shutdown.

Effects of activity in the dorsal vagus circuit

The dorsal vagus circuit is an older branch of the vagus nerve present in all classes of vertebrates and is sometimes referred to as the "old vagus".
Two autonomic nervous-system states that employ the dorsal vagal circuit: metabolic shutdown and immobilization without fear.
- Metabolic shutdown involves a state of reduced activity in vital functions, enabling animals to conserve energy.
- Immobilization without fear combines activity in the dorsal vagal circuit with activity in the social engagement circuit, appropriate when feeling safe and choosing to be relatively immobilized for intimacy.
Hibernation in mammals involves some degree of dorsal vagal activity but is not the same as shutdown.
Reptiles can shut down almost totally, reducing heart rate, breathing, and digestion drastically to conserve energy until their next meal.
A sudden surge in dorsal vagal activity when faced with mortal danger can result in a state of shock or immobilization with fear.
Immobilization with fear is a defensive strategy that causes physiological shutdown to help cope with traumatic events, extreme danger, or imminent destruction.
Chronic activation of the dorsal vagus circuit can lead to depressive feelings and behaviors.
The Polyvagal Theory focuses on the relationships of the autonomic nervous system, emotions, and behavior, providing a physiological model for conditions such as depression.

Symptoms of a dorsal vagal state

Dorsal vagal state is characterized by a loss of muscle tone, softening and limpness of muscles, feeling heavy, helpless, apathetic, and hopeless.
Heartbeat slows down and blood pressure drops; blood withdraws from the periphery to the thorax and abdomen to maintain basic visceral functions.
Pain may move around the body due to dorsal vagal state, which is often diagnosed as fibromyalgia.
Dorsal vagal state can also cause sweating or nausea, loss of bladder and anal sphincter control in extreme situations, and breathing slows down.
Mental awareness turns inward or disappears entirely when overwhelming danger presents itself, resulting in dissociation and a withdrawal of consciousness from the body.
Dorsal vagal state can cause lethargy, lack of empathy, and difficulty setting goals or taking actions to improve life situations.

Effects of ventral vagus activity

Mammals have a more complex nervous system than reptiles, including ventral vagal circuits which are unique to mammals.
The ventral vagus circuit is activated when an individual feels safe in their environment and proprioceptive feedback.
This circuit allows for social engagement, relaxation, restoring oneself, and can be active during physical activity or immobility.
Negative symptoms such as sympathetic nervous system mobilization (fight or flight) or dorsal vagal immobilization (frozen/depressed behavior) occur when not socially engaged.
Galen, an ancient Roman physician, discovered details about the vagus nerves but failed to distinguish between the ventral and dorsal branches due to limited resources and technology.
The misconception of the two nerve branches being one entity has persisted for thousands of years in various fields of study.

Stress and the Sympathetic Nervous System

Stress is defined as the physiological state that arises from activation of the spinal sympathetic nervous system, resulting in a fight-or-flight response.
The old stress/relaxation model did not describe what happens to the visceral organs in the physiological state of shock or the related emotional state of depression.
Stephen Porges's description of the fight-or-flight state as "mobilization with fear" is preferred over the word "stress".
The neurology underlying this state is major activation of the spinal sympathetic chain, which produces a powerful muscular response and potential for making an extraordinary effort to save our life in a threatening situation.
If activation of the sympathetic chain becomes chronic, it is not good for physical and emotional health or social relationships.
Activation of the sympathetic chain is not limited to a defensive strategy; it also occurs during normal breathing, causing slight increases in heart rate and blood pressure.

The fight-or-flight response

Involves increased blood pressure and heart rate, dilated bronchioles for better breathing, and the release of sugar into the bloodstream as energy.
Bony fish, amphibians, reptiles, and mammals all have a spinal sympathetic nervous system that generates stress states.
The fight response includes verbal aggression, passive aggression, random aggression, and wanton destruction of property.
Flight involves actively avoiding people, situations, or places, as well as withdrawing from social situations.
Playing violent video games can put the nervous system into a state of arousal and fight, while being addicted to these games may keep one in that state.

A new understanding of stress

Three circuits of the autonomic nervous system are a hierarchical with a step-like progression from one state to the next, according to the evolutionary development of the autonomic nervous system in vertebrates.

Social engagement is at the top of the ladder and promotes peaceful immobilization and a sense of well-being.
The spinal sympathetic chain activates the fight or flight response.
The dorsal vagal circuit triggers the defensive response of immobilization with fear.

Activity of the ventral branch of the vagus nerve inhibits the two lower levels.

Ventral vagal circuit activity moves a person directly from shutdown and emotional depression all the way up to a ventral vagal state.
The goal is to bring people out of states of stress or depression and up to the level of social engagement.
Proper function of the ventral branch of the vagus nerve is important for optimal physical and psychological health.
Techniques used in biomechanical craniosacral therapy can help improve the function of the ventral branch of the vagus nerve.

Chapter 3

Neuroception and Faulty Neuroception

Neuroception is a term coined by Stephen Porges to describe how neural circuits distinguish whether a situation is safe, threatening, or dangerous.
It is an ongoing process through which our autonomic nervous system evaluates information from our senses about our environment and the state of our body.
Neuroception takes place in the primitive parts of the brain, beyond our conscious awareness.
- It can be likened to a good watchdog that is always on guard, allowing us to focus on things other than survival, or to sleep soundly, and rousing us only when intrusions could compromise our survival.
Faulty Neuroception occurs when the neural circuits from perception to behavior do not function in an appropriate way.
- A person might react to a safe situation as if it were threatening or dangerous, or react to a dangerous situation as if it were safe. There can be countless reasons for faulty neuroception.
Faulty neuroception can even come from very positive experiences like falling in love and bonding with the partner. We sometimes hear that a person’s judgment was impaired because they were "blinded by love," so that they failed to be aware of a possibly destructive situation.

Other Causes of Faulty Neuroception

Shutdown State: A survival mechanism where the autonomic nervous system goes into a state of shutdown when an animal is threatened, leading to loss of interest from the predator.
Modern Life Challenges: Humans face emotional or mental challenges that require action and cannot always be resolved quickly.
Trauma and Memory: Traumatic experiences can leave lasting effects on the nervous system, causing recurring inappropriate behaviors and ongoing physical symptoms of stress and shutdown.
Psychological Triggers: Abnormal reactions to certain stimuli due to past traumas.

Grounding

Antaeus Story: A myth about a man who gained strength from contact with the ground, symbolizing the importance of staying grounded emotionally and psychologically.
Sensing Our Own Bodies: Focusing on our body can help us remain grounded and in a ventral vagal state, avoiding faulty neuroception caused by strong emotions.
Benefits of Body Awareness: Practices like Pilates, yoga, martial arts, mindfulness meditations, and simple touch (like face stroking or massage) can help individuals reconnect with their body.
Grounding Technique: Placing hands on one's own body and asking oneself to sense the sensation can help individuals get grounded in their body and clear their mind of mental or emotional clutter.

Chapter 4

Testing the Ventral Branch of the Vagus Nerve

Social engagement requires both looking and listening.
Facial muscles around eyes, nostrils, and mouth indicate social engagement.
Orbicularis oculi muscle surrounds the eye; tightens to close the opening, allowing less light in.
Tension in flat rectangular muscles above and below orbicularis oculi allows more light in, indicating surprise or interest.
Eye contact indicates social engagement; look for spontaneous facial expressions in middle third of face.
Facial expressions can be chronic (etched into face), emotional (current mood), or rapid (spontaneous micro-changes).
Rapid changes in facial expressions indicate openness and lack of fear.
People's interactions are affected by their mood, which is influenced by the state of their autonomic nervous system.
People in stress state may look menacing, not listen, react aggressively.
People in fear avoid eye contact, have shallow breathing, tip heads forward or let them hang.
People in depressed state move slowly, have no enthusiasm, sigh before speaking.

Other tests of vagal function

Ventral vagal nerve dysfunction can be identified by observing symptoms such as "heads of the Hydra" and testing throat reflexes.
A secondary test for ventral vagal function is evaluating pulse and blood pressure differences during inhalation and exhalation.
High heart rate variability (HRV) indicates good vagal nerve function and is associated with overall health and longevity.
- Low HRV can indicate various psychological/psychiatric problems, including emotional instability, lack of concentration, and motor inhibition.
- Low HRV may also be linked to physical health issues such as obesity, diabetes, heart disease, and poor survival rates in premature babies.
Improving social engagement and using the Basic Exercise can potentially increase HRV and improve overall health.
HRV testing can serve as a rapid screening tool for altered autonomic nervous system activity.
Further research is needed to explore the possibility of improving heart rate variability and vagal nerve function as a treatment for psychological issues.

Testing for Vagal Function: Early Experiences

The author recalls their early days in craniosacral therapy where they were taught a fixed sequence of techniques to help people relieve stress, but no testing for physiological states was taught.
At that time, the understanding of stress was binary: either stressed or relaxed.
Clients often had difficulty leaving sessions and returning to normal activities, sometimes even falling asleep on the road.
The author now realizes these clients were in a dorsal vagal state after sessions, exhibiting depressive behavior and dissociation.
Today, the author tests every patient's autonomic nervous system before and after sessions to ensure they leave in a calm but alert state.
Testing for vagal function is beneficial for body therapists, psychologists, and other healthcare providers.

Discovering the Polyvagal Theory

In the early 1980s, the author noticed a correlation between asthma symptoms and vagal dysfunction.
The author used a method to test vagal function based on heart rate variability, observing breath and pulse patterns.
This method was inspired by studies from the late 1800s on autonomic nervous system function and variability in blood pressure.
The author wanted to develop a scientific research project with Stephen Porges to measure vagal function during asthma treatment.
In 2002, the author met Stephen Porges at a conference and shared his idea for a research project.
Instead of discussing the project, Porges introduced his Polyvagal Theory, which was new to the author.
The Polyvagal Theory explains three states of the autonomic nervous system: sympathetic (fight or flight), parasympathetic (rest and digest), and dorsal vagal (freeze).
The author was inspired by Porges's work and shifted his focus from asthma treatment to treating children on the autism spectrum using craniosacral therapy.
The author realized that his previous model of the autonomic nervous system was limited, as it did not include the idea of "shutdown" or distinguish between ventral and dorsal branches of the vagus nerve.
The author began to use techniques from biomechanical craniosacral therapy to improve the function of the five cranial nerves necessary for social engagement in autistic clients.
Testing for vagal function became crucial for the author, as it helped him understand why some treatments were not effective and allowed him to address the issue first.

The importance of testing for ventral vagal function cannot be overestimated, as it affects overall health and well-being.

Testing for Vagal Function: Cottingham, Porges, and Lyon

Study by Cottingham, Porges, and Lyon in Physical Therapy (1988) about the importance of evaluating autonomic nervous system (ANS) state for therapy success.
Experiment involved a pelvic lift technique in Rolfing to measure spine flexibility and client's feelings before and after.
John Cottingham, the only therapist, administered the same pelvic lift to all participants.
Younger men generally had positive results (better posture, mood) compared to older men who became stiffer and less flexible.
Researchers found that heart rate variability (HRV), a measure of ANS function, was a better predictor of successful outcome than age.
High HRV associated with desirable outcomes in both younger and older adults.
Measuring HRV requires specialized equipment, but other methods to evaluate vagal function exist for clinical settings.

A Simple Test of the Pharyngeal Vagus Branch

The pharyngeal branch of the ventral vagus nerve is important for swallowing and vocal sounds.
Claudius Galen, an ancient Greek physician, was the first to describe this nerve based on observing a gladiator who lost his voice after neck injury.
Cutting the pharyngeal nerve in pigs stops their squealing, confirming Galen's observation.
Test involves evaluating the movement of the levator veli palatini muscle at the back of the throat.
Dysfunction of this branch can indicate issues with other branches of the ventral vagus nerve.
Improving pharyngeal branch function enhances respiratory diaphragm function.
Dysfunction may result in irregular, rapid, and shallow breathing.
After treatment, clients often experience improved, deeper, and slower breathing.
Clients appreciate being informed about vagus nerve function and the potential for improvement.

How to Test for Pharyngeal Ventral Branch Function

Ask person to sit and open mouth for view of uvula and soft-tissue arches. Use flashlight if necessary.
Person may need to push tongue down with finger for clearer view.
Uvula and arches are lifted by properly functioning levator veli palatini muscles (innervated by pharyngeal branch of vagus nerve).
These muscles also attach to auditory tube, causing "ear popping" during swallowing.
When swallowing or saying "ah," these muscles should lift soft palate equally on both sides.
Dysfunction in ventral branch of vagus nerve can cause one side not to lift, indicating asymmetrical lifting.
Testing for ventral vagal function has implications for managing fear states and restoring autonomic nervous system balance.
Exercises and treatments in the book can help move someone out of stress or shutdown states into a ventral vagal state.
Improvement in soft palate and uvula lifting can be observed after self-help exercises or hands-on treatments.
Another test for ventral vagus nerve function is the "Trap Squeeze Test," described in Chapter 5.

Therapists Can Test for Vagal Function without Touching

Psychologists cannot touch clients due to professional regulations.
Solution: Diagnose by observing throat during "ah-ah-ah-ah-ah" sound.
Testing could help understand client's behavior and emotional state from a Polyvagal perspective.

Origin of the Basic Exercise

First time teaching the exercise resulted in restored ventral vagal function for 60 psychologists with dysfunction.
Psychologist reported improved results after verbal interventions following the exercise.
Began asking patients if they had physical or psychological problems and checking for ventral vagal function.
Taught clients Basic Exercise, all showed restored ventral vagal function.
85 out of next 85 clients had positive outcomes.
Clients gave good feedback after sessions and in following weeks.

Building on Stephen Porges’s success

Stephen Porges's influence: The author had been practicing biomechanical craniosacral therapy for 15 years before meeting Porges in 2002. Afterward, developed a protocol using his Polyvagal Theory to improve the function of the ventral branch of the vagus and other necessary cranial nerves for social engagement.
Craniosacral therapy: The author's protocol involves techniques from Alain Gehin, which usually establish proper function of the ventral branch of the vagus and other cranial nerves. This has proven successful in Denmark and Norway with no negative side effects.
Challenges in teaching advanced techniques: It's difficult to teach these techniques through a book due to the need for direct transmission and long learning process.
New exercises and hands-on techniques: The author developed new methods that are effective, easy to learn, and easy to do to improve social engagement nervous system function.
Wide applicability: This book is primarily for average people seeking alternatives or complements to existing treatments, but also beneficial for healthcare professionals.
Vagus nerve dysfunction: Various health issues can be partly caused by vagus nerve dysfunction. Case stories illustrate successful treatments for respiratory difficulties, migraines, and autism-spectrum disorders using the Polyvagal Theory.
Self-help exercises: The book provides simple self-help exercises that achieve similar results as hands-on techniques, allowing non-trained readers to learn most or all of them.
Therapist application: Therapists can use these exercises and techniques in a clinical setting after testing the client's autonomic nervous system.

Relieving COPD and Hiatal Hernia

COPD (Chronic Obstructive Pulmonary Disease) is a common non-communicable health problem characterized by poor airflow, shortness of breath, and coughing.
Causes include smoking and environmental toxins leading to surplus fibers blocking airways.
Difficulties in employment, financial commitments, and maintaining activity levels due to breathing difficulties.
Temporary relief with steroids and inhalers, but long-term use has negative side effects and most affected people cannot afford them.
No known cure, worsens over time, affects 329 million people worldwide, third leading cause of death.
Medical research focuses on drugs and surgery, but autonomic nervous system dysfunction may be the root cause.
Vagus nerve function can be evaluated inexpensively for COPD patients.
Restoring vagus nerve function is a key element in successful treatment of COPD.
Successful treatment includes hands-on treatments and self-help exercises to improve breathing capacity and oxygen uptake.

COPD and hiatal hernia: a case study

COPD (Chronic Obstructive Pulmonary Disease) case study: a client's vital capacity improved from 70% to 102%.
White areas in lung scans of COPD patients assumed to be extra fibers, but the author believed they were related to muscle function.
Client with severe breathing difficulties due to COPD could not climb a flight of stairs without stopping multiple times.
The author suspected the client's issue was muscular-skeletal, focusing on improving lung and rib movement.
Dysfunction in the autonomic nervous system, specifically the vagus nerve, might contribute to breathing difficulties.
Client described lifting upper chest when breathing, but it was actually neck and shoulder muscles causing movement.
The man had minimal lateral rib movement on one side and no detectable movement on the other.
Ventral branch of the client's vagus nerve was dysfunctional.
Basic Exercise improved client's breathing function, allowing deeper, slower breaths with less strain.
Suspected cause of left-side rib immobility: hiatal hernia.
Hiatal hernia: stomach moves above diaphragm due to vagal dysfunction and esophageal tightening.
Symptoms include difficulty breathing, acid reflux, bloating, and eating small meals frequently.
Normal breathing involves diaphragm moving up and down; hiatal hernia disrupts this movement.
The author believes that shortened esophagus is a common factor in many breathing disorders.
Treating vagus nerve with Basic Exercise and lengthening esophagus can resolve breathing difficulties.

Treating a Hiatal Hernia

Hiatal Hernia Treatment: An osteopathic technique for self-help exercise.
Technique involves gently pulling stomach downward to stretch and relax esophagus.
Stomach is located on the left side, under rib cage, palpable but not painful to touch.
Pull downward until resistance is felt, hold until esophagus relaxes.
This allows diaphragm to move freely, improving breathing depth and capacity.
Client reported improved breathing after climbing stairs post-session.
Technique can also address tensions in other visceral organs.
Man with COPD showed significant improvement after 12 weeks of sessions.
Believed that cause of COPD involves lack of activity in ventral branch of vagus nerve.
Basic Exercise activates function of ventral branch, improving bronchioles function and breathing capacity.
Technique is non-invasive, immediate, and effective with no side effects.
Widely accepted explanation of COPD cause may not be complete.

Diaphragmatic Breathing

Diaphragmatic Breathing:

Important for social engagement.
Normal breathing involves diaphragm movement, detectable as lateral rib movement.
Hiatal hernia affects right side only.
Disturbed patterns of breathing due to stress can result in high costal (shoulder) or abdominal breathing.
High costal breathing associated with fear, anxiety, and panic.
Abdominal breathing associated with anger.
Ideal breathing involves rhythmic expansion of abdomen and chest.
Proper diaphragm function necessary for relaxed, efficient breathing.
Malfunctioning diaphragm can activate sympathetic or dorsal vagal circuits.

Cranial Nerve XI (Spinal Accessory Nerve):

Innervates trapezius and sternocleidomastoid muscles in neck and shoulder.
Dysfunction of CN XI can lead to neck and shoulder pain, stiffness, migraines, forward head posture, breathing difficulties, chronic sympathetic or dorsal vagal state, shortened life expectancy, and spine health issues.
Chronic tension in sternocleidomastoid muscles can change back of head shape.

Trapezius and Sternocleidomastoid Muscles:

Determining factors in neck and shoulder problems, migraines, forward head posture, breathing difficulties, chronic sympathetic or dorsal vagal state, shortened life expectancy, and spine health.
Improper function of these muscles can affect the shape of the back of the head.
The Salamander Exercises in Part Two can improve neck's capacity for lateral movement to alleviate related issues.

The Levator Scapulae Muscle

Issues with head rotation might not be solely related to cranial nerve XI and trapezius/SCM muscles.
Pain in the neck on the same side as head turning indicates a problem with the levator scapulae muscle ("shoulder-blade lifter").
Directly massaging the muscle provides temporary relief, but long-term results require improving its tonus.
Massaging the supraspinatus muscle or performing Salamander Exercises (Level 1) can help.

Trapezius and Sternocleidomastoid Muscles:

Dysfunction in these muscles is more serious than just pain, stiffness, or migraines.
Correcting their function improves CN XI and restores social engagement.
Both muscles are innervated by a cranial nerve.
Dysfunction in the sternocleidomastoid and trapezius muscles is related to various health issues.

Structure and Function:

The trapezius muscles are a pair of thin, flat muscles covering the back of the neck, shoulders, and torso.
They originate on the occipital bone at the base of the skull and attach to the spinous processes of the shoulder blades and cervical/thoracic spine.
The sternocleidomastoid (SCM) muscles attach to the mastoid process of the temporal bones along the sides of the skull behind the ears.
They split into two bellies that wrap diagonally forward and down, attaching to the top of the sternum and medial section of the clavicle.
The SCM muscles control head movement like reins on a horse.
The trapezius and SCM muscles form the outer ring of neck muscles, with smaller muscles inside helping with finer movements, lifting ribs when breathing, and swallowing.
Coordinated muscle control for head movement is programmed into our nervous system.

Trapezius and SCM muscles in action on the Serengeti Plain

Cheetah's hunting technique: Uses eleventh cranial nerve to turn head, antelope zigs and zags to avoid capture.
Importance of trapezius and sternocleidomastoid muscles for turning the head.
Baby development: Uses trapezius muscles to lift head when crawling, changes in muscle use when standing.
Human spine differences from four-legged animals: Changes in trapezius function, forward head posture (FHP) issues.
Trapezius muscle functions: Holds head up when crawling, loses integrity when standing, leads to shoulder problems.
Cheetah's hunting strategy: Studies herd for injured or old prey, half of antelope fawns lost to predators before adulthood.

Asymmetry in trapezius muscle tension

Differences in tension among upper, middle, and lower trapezius muscles on both sides.
Imbalances affect the shoulders and thoracic vertebrae, changing internal space within chest, affecting heart and lungs function.
Can compress spinal nerves (T1–T8), impacting organs they serve.

Asymmetry in sternocleidomastoid tension:

Primary muscles for turning head left and right.
Chronic or acute tension results in stiff neck, affecting blood flow to brainstem.
In adults, may indicate dysfunction of the eleventh cranial nerve.

Complexity of CN XI:

Controls trapezius and sternocleidomastoid muscles through three branches.
Cranial division is now considered part of vagus nerve.
Spinal accessory nerve goes directly to trapezius and sternocleidomastoid muscles.
Another branch leaves spinal cord, extends up into cranium, and exits through jugular foramen.

CN XI and ventral vagus:

Both functionally and structurally linked as two of five cranial nerves necessary for social engagement.
Fibers from CN XI intermingle with fibers of the vagus nerve outside the cranium.
Originate in nucleus ambiguus, a strip of nerve fibers in the brainstem.

Trap Squeeze Test for CN XI:

Indicates function/dysfunction of both CN XI and ventral vagus nerve.
Improving one's function improves the other four nerves' functions.
100% correlation between results of this test and uvular lift test for vagal pharyngeal-branch function.

The Trap Squeeze Test for Shoulder and Neck Problems

Shoulder and neck problems common in physical therapy clients.
Issues often linked to improper tonus of trapezius or sternocleidomastoid muscles.
Many therapists focus on tight shoulder muscles without considering autonomic nervous system.
Research by Cottingham, Porges, and Lyon suggests importance of functioning ventral vagus nerve for successful interventions.
Test for CN XI function (ventral branch of vagus nerve) before other treatments: The Trap Squeeze Test.
Test takes less time and is less intrusive than traditional vagal function test.
Lightly squeeze top of shoulder (trapezius muscle) between thumb and first finger.
Compare tonus on left and right sides; both should be soft and elastic.
Dysfunction in CN XI indicates autonomic nervous system not socially engaged, requiring restoration of ventral vagal function before further treatments.

Health Problems Related to Forward Head Posture

Forward Head Posture (FHP) is a health issue related to poor posture, causing kyphosis.
FHP leads to neck sagging, reducing chest space for heart and lungs.
Difficulty breathing due to blocked muscles responsible for lifting first rib during inhalation.
Loss of internal chest space puts pressure on the heart and crowds blood vessels.
Compresses spinal nerves of neck and upper thorax.
Diminishes blood supply to face, parts of brain, and brainstem.
May contribute to Alzheimer's disease, dementia, and senility.
Reduces breathing capacity, leading to fatigue and low energy levels.
Increases mortality rate in older patients according to research.
Compresses vertebral arteries, reducing blood supply to the face and brain.
Causes pale appearance, lack of spontaneous facial expression, and social disengagement.
Chronic stress or dorsal vagal activity due to nerve failure.
Leads to aches, pains, stiffnesses, herniated discs, arthritis, and pinched nerves.
Loss of cervical curve stretches the spinal cord and causes disease (Dr. Alf Breig).
Stiffening of neck leads to long-term muscle strain and spinal deterioration.
Every inch of FHP increases head weight on spine by ten pounds.
Commonly seen in people with breathing problems like asthma and COPD.

Scar tissue as a contributor to FHP

Scar tissue forms after surgeries to make body stronger, but it can affect the entire body by thickening and contracting fascia beyond the incision site.
During surgery, fluid between muscle layers can dry out, causing them to stick together instead of sliding freely.
Extra collagen fibers produced during healing can bind layers together, reducing flexibility.
Scar tissue forms in deeper layers even with minimally invasive procedures.
Scar tissue restricts movement and space, especially in chest or abdomen surgeries.
Tight suboccipital muscles between the occiput and first two vertebrae can put pressure on the suboccipital nerve and nearby vertebral arteries.
Constant contraction of these muscles can further accentuate forward head posture (FHP) and reduce blood flow to the brainstem.
People with FHP often complain of headaches at the back of the neck, where suboccipital muscles are located.
Reducing FHP can improve breathing for those with asthma by releasing tension in suboccipital muscles and allowing C1 to rotate back into place.

Relieving Migraine Headaches

Migraines are characterized by intense, often one-sided headaches that can last from hours to days, sometimes accompanied by autonomic dysfunction symptoms like blurred vision, nausea, vomiting, fatigue, oversensitivity to light, sound, smell, and touch.
Doctors classify migraines based on accompanying symptoms, but for treatment, only the location and involved muscles are essential.
Trigger points in the trapezius and sternocleidomastoid muscles can cause migraines. Identifying the correct drawing of these trigger points helps determine which muscle is involved.
Dr. Janet Graeme Travell's work on trigger points led to the discovery that treating specific points in muscles can relieve both local and referred pain.

All muscles have trigger points

Trigger points cause local and referred pain.
Massaging trigger points in the neck (sternocleidomastoid and trapezius muscles) relieves migraine headaches.
Wall posters illustrating muscle trigger points help identify involved muscles and appropriate massage areas.
Treating trigger points effectively relieves long-term migraines, even after decades of suffering.
The eleventh cranial nerve (CN XI or the accessory nerve) modulates tension in neck muscles related to migraine pain.
Biomechanical craniosacral therapy frees blockages to the eleventh cranial nerve for faster and longer-lasting migraine relief.
Dysfunction of ventral branch of vagus nerve and ninth cranial nerve often accompanies CN XI dysfunction.
The Basic Exercise improves function of all three nerves, simplifying treatment.
Migraines may have a musculoskeletal component, with patterns of pain caused by tension in trapezius and sternocleidomastoid muscles.
Self-help techniques for trigger point release can effectively relieve migraine headaches without pharmaceuticals or side effects.
Long-term migraine sufferers can benefit from learning self-help techniques to treat themselves.

Migraines: a case study

A woman with a decade-long history of migraines sought treatment due to frequent, debilitating attacks.
Her journalism career allowed some flexibility, but new TV job made scheduling around migraines difficult.
Upon examination, her ventral vagus nerve was not functioning properly.
She learned the Basic Exercise to activate her ventral vagus nerve and treat trigger points herself.
By self-treating, she experienced relief and no migraines for 4.5 months.
When a migraine began, she repeated the exercise and treated trigger points, preventing a full attack.
The woman's independence in treating her migraines was preferred by the therapist.

Chapter 6 Somatopsychological Problems

Somatopsychological problems are those where physiology affects the mind, as opposed to psychosomatic problems where the mind causes problems in the body.
Psychological treatment is costly, while prescription drugs are more cost-efficient but have expenses over time.
The text suggests exploring body-focused alternatives for psychological and mental health issues.
The Polyvagal Theory suggests that by understanding our autonomic nervous systems, we may be able to overcome psychological and psychiatric issues without the need for medication or long-term therapy.

Emotions and the autonomic nervous

Mammals, as social animals, need others for survival and fulfillment.
Proper function of five social-engagement cranial nerves is crucial for communication and bonding.
Autonomic nervous system (ANS) and emotional states are interconnected.
Improving emotional state can be achieved through actions that improve ANS function.
- Social interaction with balanced individuals helps in self-regulation.
- Practices like meditation, tai chi, and yogic breathing help regulate ANS.
- Maintaining a ventral vagal state is essential for optimal health and well-being.
Somatic component exists in various psychological issues like post-traumatic stress, anxiety, phobias, and autism spectrum disorders.
Treating physical manifestations of ANS at the beginning of psychiatric/psychological treatments can be beneficial.

Anxiety and Panic Attacks

Normal anxiety is temporary worry or fear, but anxiety disorders persist and interfere with daily life.
Anxiety involves physical symptoms like rapid heartbeat, increased respiration, stress hormone release, etc., even without an actual threat.
Panic attacks are brief episodes of intense terror and apprehension, peaking in less than ten minutes but symptoms can last hours.
Causes of panic attacks can be specific or general (stress, fear, excessive exercise).
Physical signs of panic attacks include trembling, confusion, dizziness, nausea, difficulty breathing, pale skin, increased sweating.
Techniques like the Basic Exercise can help manage symptoms of anxiety and panic attacks by bringing individuals out of sympathetic or dorsal vagal activation.
Regular practice of these techniques reduces the likelihood of panic or anxiety attacks.
Anxiety can be a side effect of prescription drugs or indicate substance abuse.

Case study: anxiety and panic attacks

Client suffered from anxiety, panic attacks, and pain in the right side of her abdomen.
Anxiety started after a surgical operation to remove her ileocecal valve at age 18.
Problems with ileocecal valve can cause colitis, abdominal pain, bloating, gas, distension, breathing problems, and pain.
Ileocecal valve controls the flow of chyme from small intestine to large intestine.
Problems occur if ileocecal valve does not open properly or stays open too long.
Client had occasional intense pain on right side (location of ileocecal valve).
Doctors could not find cause of her pain despite several tests and explorations.
Surgeon expressed no interest in client's anxiety symptoms.
Dorsal branch of vagus nerve innervates organs of digestion, including ileocecal valve.
Client's nervous system was dysfunctional (dorsal vagal state).
Client learned Basic Exercise to help get autonomic nervous system into ventral vagal state.
Client reported feeling better after doing the exercise, with less anxiety and muscle tension.
Client's pain disappeared after osteopathic visceral-massage technique.
Client's surgery was assumed to be a success but left her autonomic nervous system in dorsal vagal activity.
Client made positive change with appropriate treatment and felt no pain or anxiety a year and a half later.

Social regulation of anxiety states

Supportive social interactions help regulate psychological state.
- Importance of chatting, small talk, and simple social situations.
- Good relationships help nervous systems self-regulate.
- Eliminate or minimize contact with people who make us feel bad.
- Maximize time spent with supportive people.
- Therapist's support may be needed after traumatic experiences.
- Each time we recover, we weaken the hold of the traumatic pattern.
Treating anxiety in children:
- Adult reassurance is effective if they acknowledge child's fear first.
- Hug and positive physical contact helps.
Phobias:
- Characterized by extreme fear with a specific trigger.
- Fear arises from sympathetic division of autonomic nervous system.
- Sufferers may understand fear is irrational but still overwhelmed.
- Phobias can be caused by past experiences or virtual experiences.
- Understanding physiological activity in autonomic nervous system may be more useful than focusing on triggers.
- Basic Exercise can help return from state of extreme fear to social engagement.

Antisocial Behavior and Domestic Violence

Some people who commit violent acts believe their actions are justified or helpful.
Lack of empathy does not necessarily explain the cause of antisocial behavior.
Motives for violent crimes can include territory, power, money, sex, jealousy, alienation, or an unpleasant feeling that escalates.
The perpetrator may enter a psychophysiological state of fight or flight, leading to antisocial behavior.
Extreme mobilization with fear results in uncontrollable fight or flight behavior.

Domestic Violence: Not Just Men Beating Wives

Domestic violence affects all genders and ages, not just men beating wives.
Many people do not admit to being victims due to shame or fear.
Victims of domestic violence are more likely to have health issues like asthma, diabetes, irritable bowel syndrome, frequent headaches, chronic pain, difficulty sleeping, activity limitations, poor physical health, and poor mental health.
Intimate-partner violence often starts with emotional abuse and can progress to physical abuse, sexual assault, or a mixture of both.
The longer the violence continues, the more serious are the psychological effects.
Symptoms may include flashbacks, panic attacks, low self-esteem, difficulty trusting others, and suicidal thoughts.
Victims under the compulsion of their abuser may be unable to talk about what happened due to threats.
Brain changes from domestic violence include an enlarged amygdala and a shrunken hippocampus.

Post-Traumatic Stress Disorder (PTSD)

Trauma and the autonomic nervous system: After a traumatic event, some people rebound to social engagement while others are left in chronic stress or shutdown states.
Two outcomes after a trauma:
- Chronic, spinal sympathetic activation state (fight-or-flight response)
- Chronic dorsal vagal activity (withdrawal or shutdown).
Ineffective treatments for PTSD: Many soldiers with a diagnosis of PTSD are not in a state of chronic stress but in a chronic dorsal vagal state, leading to social isolation and even suicide.
Therapies for PTSD: Focus on the trauma itself rather than the psychophysiological fixation that followed the event.
Effectiveness of nonverbal therapies: A study in Denmark found better results with nonverbal craniosacral therapy compared to verbal therapies for treating post-traumatic stress.
Recalling traumatic events: Can lead to re-traumatization and reinforce the emotional state from the event.

Dorsal branch Activity and PTSD

PTSD Treatment: The goal is to lift individuals out of dorsal sympathetic circuit activity and bring them into social engagement.
Dorsal branch activity is a psychophysiological state, not purely psychological.
Dorsal vagal branch activation results in significant drain of resources and loss of quality of life.
Autonomic nervous system normally self-regulates, but it can get stuck in a state of fight, flight, or freeze after a traumatic event.
Post-traumatic stress occurs when survival responses are aroused but not fully discharged, leading to loss of function in the ventral branch of the vagus nerve.
Restoring self-regulating vagal function involves getting grounded and returning to the present moment.
Exercises in Part Two help restore ventral vagal function and improve resilience.
Neuro-Fascial Release Technique can help restore vagal function through hands-on assistance from another person.
Choose to interact with functional people for effective restoration of nervous system regulation.

Depression and the Autonomic Nervous System

Depression is a leading cause of disability in the US and Canada, with approximately 10% of medical cases related to it.
Antidepressants are the most common form of treatment for depression, with global sales exceeding $9.8 billion in 2013.
People with depression often lose interest in pleasurable activities, experience appetite changes, reduced energy, and various emotional symptoms like sadness, anxiety, worthlessness, etc.
A study published in the Journal of the American Medical Association showed that antidepressants are no more effective than placebos for mild depression cases.
Antidepressants have negative side effects and are still the most commonly consumed medication class in the US, with 270 million prescriptions written each year.
The underlying issue might be a lack of understanding about the autonomic nervous system (ANS) and its role in depression.
The Polyvagal Theory suggests that focusing on the ANS could lead to new approaches for treating conditions like depression, which are often accompanied by dorsal vagal nerve activity.

Bipolar Disorder Bipolar

Bipolar Disorder: A mental health condition characterized by periods of mania (elevated energy, euphoric mood) and depression.
Mania: A state of abnormally elevated energy levels and an elated, jubilant mood, followed by periods of low energy.
Dorsal Branch of the Vagus Nerve: Experienced as low energy during periods of mania in some individuals.
From a Polyvagal Theory perspective, manic phase can be seen as activation of the spinal sympathetic chain.
Woman with bipolar disorder came for craniosacral therapy to relax more.
She had been diagnosed with bipolar disorder and had spent twenty years in and out of psychiatric hospitals due to lethargy followed by hectic activity.
Woman's first two cervical vertebrae were rotated, affecting the function of her ventral vagus nerve.
After craniosacral therapy, woman felt calm and centered, with good energy and confidence to get on with her life.
She was advised to consult a psychologist for relationship management and future planning.

ADHD and Hyperactivity

ADHD is associated with chronic stimulation of the sympathetic nervous system in children.
The author suspects another physical cause for ADHD symptoms.
Five boys with ADHD had hiatal hernias, leading to a theory about discomfort and need to move.
Technique called "Basic Exercise" addresses vagus nerve dysfunction, allowing upper esophagus relaxation.
Hiatal hernia technique gently stretches esophagus, helping stomach return to normal position.
Many ADHD diagnoses overlook potential autonomic nervous system dysfunctions.
Bringing person into a ventral vagal state can help diminish or disappear their problems.

Chapter 7 Autism Spectrum Disorders

Autism Spectrum Disorders (ASD) include conditions like autism, Asperger’s syndrome, and others, affecting people of all ages.
ASD are developmental brain disorders causing social, behavioral, and communication challenges without definitive neural tests.
Autism diagnoses are based on psychologists' observations of behavior, but the autonomic nervous system could also play a role.
The autonomic nervous system determines emotional state and can influence behavior; some individuals with ASD might have dysfunction in this area.
Interventions focusing on improving social engagement and ventral vagus nerve function could lead to better outcomes for individuals with ASD.

Hope for Autism: The Listening Project

Stephen Porges' Polyvagal Theory and Listening Project identified specialized functions of cranial nerves V and VII in middle ear muscles for proper listening and social engagement.
Autistic children often have difficulty understanding spoken language due to potential dysfunctions in cranial nerves V and VII.
Cranial nerve VIII (auditory nerve) tests only measure part of the auditory mechanism, while proper functioning of cranial nerves V and VII are crucial for hearing and understanding human voices.
Cranial nerve V goes to the tensor tympani muscle at the eardrum, helping to regulate sound volume and focus on human voice frequencies.
Cranial nerve VII innervates the stapedius muscle, reducing sounds above and below human voice frequency range to help children focus on their mother's voice.
Dysfunction in cranial nerves V and VII can lead to a lack of facial expression, making it difficult for others to read emotions.
Hypersensitivity to sound (hyperacusis) in autistic children can result from insufficient contraction of middle-ear muscles, making low-frequency sounds unbearably loud and masking human voice sounds.
Some autistic children may become skilled at reading lips and interpreting body language but struggle when the speaker is not directly in front of them.

Children with autism can have significant issues functioning in noisy classrooms due to hyperacusis or sensitivity to sound.

High levels of background noise can be painful for children with hyperacusis, while normally hearing children find the same level acceptable.

Stephen Porges developed the Listening Project Protocol to investigate cranial nerve dysfunction and its relation to autism.

Porges' research has shown significant improvements in communication skills and social behavior for autistic children through his therapeutic intervention.

Dysfunction in the neural regulation of middle-ear muscles (CN V and CN VII) is hypothesized as a reason for language difficulties in autistic children.

Porges conducted research using the Listening Project Protocol with autistic children, demonstrating improvements in auditory processing skills and ventral vagal regulation.

The special music used in Porges' intervention stimulates middle-ear muscles, improving hearing and speech clarity.

The Role of Hearing in Autism Spectrum Disorders

Autistic individuals often have hearing problems that are not related to the auditory nerve (CN VIII), but rather to dysfunctions in cranial nerves V and VII.
Standard hearing tests may not detect these issues as they focus on single tones without background noise.
The ability to filter out background sounds, especially low-frequency ones, is crucial for effective communication.
Many parents report that their autistic children have normal hearing test results despite struggling with understanding speech in noisy environments.
In the author's clinical experience, children who do not respond to simple requests when their back is turned are suspected of having dysfunctional cranial nerves V and VII.

The evolution of hearing

Dinosaurs and large lizards could only detect low-frequency vibrations due to their skeletal structure.
Mammals evolved ears that allowed them to hear higher frequencies, enabling communication without detection by predators.
Humans and mammals filter sounds based on tension in stapedius and tensor tympani muscles.
Early mammals had an advantage with the ability to focus on important frequencies for survival.
Three small bones (ossicles) in the middle ear: hammer, anvil, stirrup.
Movement of ossicles controlled by tensor tympani and stapedius muscles.
Tensor tympani muscle affects eardrum vibration, acting as a volume control.
Stapedius muscle filters out sounds above and below human voice range.
Well-functioning stapedius muscle crucial for understanding language and learning vocabulary.

Treating hearing in autistic children

Autistic children often have a flat, monotonous voice due to a dysfunctional CN VII
Improving social engagement through cranial nerve function enhancement can lead to better voice quality
The Basic Exercise and Neuro-Fascial Release Technique can help improve hearing and reset the function of cranial nerves V and VII.
Autistic individuals often lack social engagement and have faulty neuroception, leading to various communication difficulties.
A flat back of the head or plagiocephaly is a common finding in individuals with autism and ADHD, caused by chronic tension in the right sternocleidomastoid muscle.
Technique for rounding a flat back of the head involves relaxing the sternocleidomastoid muscle to improve skull symmetry.

Autism: a case study

A student named Thor tried the technique on his brother William, who had been diagnosed with infantile autism and was seventeen years old.
William was asocial, did not speak or make eye contact, and could be moody. He had a mute episode that lasted for three months after being made to wear a T-shirt he didn't want to wear.
After Thor applied the Neuro-Fascial Release Technique on him, William looked Thor in the eyes, stood up, and balanced on one foot - behaviors he had never done before.
William started communicating with his family and making friends, traveled, got involved in theater, took yoga classes, finished a bachelor's and master's degree, and became a chess master.
The author treated William several times but most of the work was done by Thor's treatments before William came to him.
William is now doing well, has traveled with friends, and started an apprenticeship.
The author suggests looking up Thor telling William's story on YouTube.

Special considerations in treating autistic children

Autistic children may feel unsafe in unfamiliar environments and with strangers, triggering resistance.
Many autistic children are uncomfortable with being touched; gaining their trust is crucial before effective treatment can begin.
Making the child feel safe is a priority; respecting their comfort zone is essential.
Children may have pain in the head and neck, but may resist touch in these areas.
First sessions may not involve actual treatment; safety and trust building are key.
Once they feel safe and experience improvement, they may become more willing to engage in further treatments.

Part Two

Exercises to Restore Social Engagement

Exercises in this part aim to move individuals from stress or shutdown states to social engagement.
These exercises can prevent problems and maintain general well-being.
After doing the exercises, note any changes in symptom frequency, severity, or disappearance.

The Basic Exercise

The Basic Exercise aims to enhance social engagement by repositioning the atlas (C1) and axis (C2), increasing neck and spine mobility, and improving blood flow to the brainstem.
It involves rotating the head to each side before and after doing the exercise to evaluate movement range and pain/stiffness.
Instructions include lying on your back with interwoven hands behind the head, looking to the right and left without moving the head, and waiting for a sigh or yawn as a sign of relaxation in the autonomic nervous system.
After completing the exercise, evaluate any improvements in neck mobility, breathing changes, and other sensations.

Cervical vertebrae and ventral vagal dysfunction

Ventral vagal dysfunction is linked to an upper cervical misalignment of vertebrae C1 (atlas) and C2 (axis).
Negative thoughts or past traumas can cause a rotation or misalignment of C1 and C2.
Ten muscles connect the occipital bone with C1 and C2, inappropriate tensions in these muscles can shift and hold the vertebrae out of joint.
Rotation or tipping of the vertebrae can twist or put pressure on the vertebral arteries, reducing blood flow to the brainstem.
The Basic Exercise helps realign C1 and C2, relieving tension on the vertebral arteries and improving blood flow to the brain and brainstem.

Why do we move our eyes in the Basic Exercise?

The Basic Exercise involves eye movement due to neurological connection between suboccipital muscles and eyeball muscles.
Movement of eyes causes slight movement or change in tension of upper cervical vertebrae (C1 and C2) under the finger.
Socially engaged individuals have well-positioned C1 and C2, indicating a healthy autonomic nervous system.
Dorsal vagus state or spinal sympathetic chain activation causes C1 and C2 to rotate out of position, reducing blood flow to brainstem and certain areas of the brain.
Treatment for stress and depression includes realigning C1 and C2 using Basic Exercise or myofascial release technique.
Improved alignment increases blood flow to brain and enhances function of five cranial nerves necessary for social engagement.

Neuro-Fascial Release Technique for Social Engagement

Based on principles of craniosacral therapy, osteopathy, and connective tissue release (Rolfing).
Requires no physical effort, takes less than five minutes, and can be used on oneself or others.
Useful for treating babies, children, and adults on the autism spectrum who lack verbal communication skills.
Stimulates reflexes in nerves under skin over base of skull to balance tension in small muscles between skull and neck.
Easier to perform when person is lying stomach-down.
Test slide-ability of skin on each side of occiput, then slide in direction of greater resistance.
Hold position until resistance melts away, then repeat on other side for proper vagus nerve function and head movement.
Can use two hands for added effectiveness.
Key to success is getting skin to slide and stopping at first sign of resistance.
Use fingertips with lightest touch imaginable and slide skin a very short distance over muscles, bones, and tendons.
Stimulates proprioceptive nerve endings in loose connective tissue under skin.
Improvement in slide-ability of skin noticeable as treatment progresses.

The Salamander Exercises

Salamander Exercises enhance flexibility in the thoracic spine, improving breathing capacity and reducing forward head posture and scoliosis.
Afferent vagal nerves monitor oxygen/carbon dioxide levels in blood; improved breathing pattern signals brain of safety and proper organ function.
Forward head posture reduces upper chest space for breathing and puts pressure on nerves to heart, lungs, and visceral organs.
Salamander Exercises create more space in upper chest for heart and lungs and relieve pressure on cervical vertebrae and spinal nerves.
Exercise keeps head in line with spine, allowing better side-bending in thoracic spine and releasing muscular tensions between ribs and thoracic spine.
Thoracic spine has less flexibility than neck and lumbar vertebrae but significantly more with side-bending due to unlocked facet joints.

Level 1: the Half-Salamander Exercise

Salamander Exercise: Look right with stationary head, tilt right ear towards shoulder; hold for 30-60 seconds, repeat on left.
Half-Salamander Exercise: Same as Salamander but look in opposite direction before moving head.
Instructions for Half-Salamander: Look right, tilt head left; hold for 30-60 seconds, reverse for other side.
Benefits: Increases range of motion when looking in the opposite direction before head movement.

Level 2: the Full Salamander Exercise

Full Salamander Exercise is an advanced version of the basic one.
Involves side-bending the entire spine instead of just the neck.
Different body position: on all fours, knees and palms supporting weight.
Head should be in line with the spine, ears neither lifted nor dropped.
Find correct head position by lifting and lowering it slightly.
Once head position is found, look right, bend head and side to right, letting the bend continue down the spine.
Hold for 30-60 seconds, then repeat on left side.

Massage for Migraines

Identify migraine headache pattern from the provided illustrations in Appendix.
Locate trigger points on affected muscles based on identified pattern.
Trigger points are areas with high nerve ending concentration, often feeling thicker or harder than muscle surface.
Use light touch to release tension in trigger points, no need for deep massage or hard pressure.
Circles on trigger point, wait for nervous system reaction (sigh or swallow) before repeating.
Not all trigger points need treatment; focus on those that feel hard, thick, or painful.

SCM Exercise for a Stiff Neck

Extends range of movement and alleviates stiff neck symptoms.
Similar to infant movements.
Lie on stomach, lift head, bring arms under chest, rest weight on elbows.
Rotate head right and left as far as comfortable, hold each position for 60 seconds.
If one side is still restricted, the issue might be with levator scapulae muscle or a hiatal hernia.

Twist and Turn Exercise for Trapezius:

Improves tone of trapezius muscle and balances its parts.
Helps lengthen spine, improve breathing, correct forward head posture (FHP).
Sit comfortably, fold arms, rotate shoulders without stopping or shifting hips.
Three parts: upper, middle, and lower trapezius activation by changing arm position.

A Four-Minute Natural Facelift, Part 1

Benefits include relaxing facial muscles, improving function of cranial nerves V and VII, increasing symmetry, making face more responsive, and enhancing empathy.
Look for acupuncture point LI 20 (Golden Bamboo) on the maxilla bone near the outer edge of nostril.
Technique involves lightly touching skin at LI 20, sliding skin up and down to find resistance, pushing into resistance, holding until release, then repeating process on deeper muscle layers and periosteum.
Massaging this point stimulates cranial nerves V and VII, improving circulation and relaxing facial muscles.
No negative side-effects like scar tissue or toxic accumulations from facelift operations or Botox.
Regular practice can help face be more expressive, communicative, and socially engaged.
Facial expressions are a vital part of communication and social engagement.
Wrinkles form due to constant facial expression and emotional state; regular relaxation of facial muscles can reduce their depth over time.
Light stroking of face skin also stimulates cranial nerve V and reduces tension in all facial muscles.

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