Therapeutic Approach
The key implication is that there is a hierarchy of survival responses, with the most primitive
- PNS – being potentially the most difficult to deal with. Both survival responses – PNS and SNS are activated because of the perception of Both responses are inhibited by the engagement of the Soc NS. PNS is also inhibited by the engagement of the SNS.
So there are two approaches to PNS immobilisation. The client can be encouraged to orientate, engaging in nonUthreatening eye contact and assisted to feel safe in order to switch on the Soc NS. The Soc NS may be stimulated through stimulating cranial nerves V,VII, IX, X, XI.
Alternatively the client may be encouraged to mobilise – moving the body to activate the SNS. From a mindUbody perspective this would mean activating the truck, adrenals, moving the body, walking etc.
To come out of SNS you would need to stimulate the SocNS.
Porges [2003] argues that input from the viscera that enters the vagus nerve can change activity throughout the brain:
“There is a strong neuroanatomical and neurophysiological justification to predict that stimulation of vagal afferents would change activity of higher brain structures”.
The vagal system is a key system for inhibiting sympathetic nervous system activity. When people are too sympathetic – overactive, overstimulated, restless – the vagal system is probably underUactive and unable to apply a brake to sympathetic activity.
38% of all afferent input to the brain comes from the mouth, jaw, and face [Parker 2006, pg38]. In theory you should be able to calm sympathetic activity by stimulating the vagal system. This includes input to middle ear muscles through sound, slow rhythmic breathing, slowing heart rate, calmly and slowly ingesting foods and relaxing the muscles of the neck, the dura and the cranium.
The vagus nerve can be stimulated by:
- calming the heart and upper respiratory system (SocNS part of the vagus), the facial muscles, neck muscles, dura of the cranium, muscles related to vocalisation
- moving into a more open human posture (upright and heart open posture)
- Rocking and swinging the head relative to the position of the heart
- stimulates the baroreceptors
- activating extensor muscles (SocNS)
- listening to melodies engages the middle ear muscles
- calming the gut (PNS part of the vagus).
The vagal brake can be encouraged by:
- breath in quickly and breath out slowly – out breath engages vagal brake (respiratory sinus arrhythmia)
- singing encourages this type of breathing + engages middle ear
Safety is a key to intervention. This can be dealt with by:
- Using points to sedate and calm
- Using points that diffuse stress in areas of the brain associated with danger perception and processing
- Addressing beliefs and behaviours that lead to a person distrusting their
- Using points that diffuse stress in areas of the brain associated with danger
How to Work with Defensive People
People internalise and control emotional expression by armouring/defending. This is romanticised by tensing specific muscles. Relaxing and releasing these muscles can cause suppressed emotions to bubble to the surface. When this happens they may begin to tense the musculature in a subconscious attempt to repress these emotions again [Parker 2006].
If this occurs it will be important to talk the client through it. Have them become more conscious of their body, so that they can recognise what they are doing and try to voluntarily relax those muscles.
This is particularly relevant for fire defensive patterns. Very often ‘calling out’ their behaviour is enough for them to become aware of their subconscious defensive behaviour.
Given the insights of Polyvagal theory we could also activate and relax the muscles of the face, jaw and neck to unwind this defence. The muscles could be palpated and the client asked to voluntarily relax them.
You can also ask the client to notice how changes in the face affect how the rest of the body is feeling.
How to Work with People Stuck in Freeze
It is important to get freeze clients to reengage with the environment. This would help prompt orienting reflexes to be engaged and safety to be reassessed.
The most obvious way of accomplishing this is to have the client leave their eyes open while you work on them, or at least for part of the time you are working on them. Eye to eye contact is also important and having a non-threatening clinical environment would also assist.
Freeze responses lead to frozen facial expressions. One way to work to disengage freeze is to have the client voluntarily start to mobilise their face. You may even give them a mirror to watch their own facial expressions in order to reengage awareness of their own facial muscles.
Walling off of visceral awareness may mimic the walling off of painful or traumatic memories. Reengaging the visceral awareness enables the survival response to be disengaged. So reconnection to the body is generally a key component of unravelling survival reactions.
At end of session if the client is a bit spaced out it can be good to reengage orientation by speaking with them with good eye contact. This helps engage the Soc NS before they leave the clinic.
One sign of progress will be that they will start to notice things in the environment that they have not noticed before when the Soc NS is reengaging.
Client Intake and Observation
Low Soc NS activity would produce a lack of facial expression, or lack of genuine expression.
Clients may use facial muscles voluntarily but not instinctively.
The difference can be seen around the eyes. Genuine expression is seen around the eyes (the contraction in the muscle around the eye is subconscious and only seen with genuine smiles). If hypertonic (SNS) then they may have a wrinkled forehead and raised eyebrows.
SNS indications (hypertonic)
- Difficulty swallowing and/or pain and soreness
- TMJ Dysfunction
- Tinnitus
- Eyebrow headache (if the masseter is hypertonic)
- Earache
- Dizziness, tension headaches in general, tearing of the eyes, impaired hearing
- Headaches above and behind the ear and upper
- Tightness in the scalp
- Malocclusion
- Rapid speech, possibly
PNS symptoms (hypotonic)
- Slow movements and speech, speech probably soft
- Depression
- Lack of awareness of symptoms and body