Polyvagal Theory: Why You Feel So Anxious All The Time - Dr Stephen Porges - #1128
In this episode of Modern Wisdom, Dr. Stephen Porges discusses Polyvagal Theory, which reframes how we understand the autonomic nervous system and its role in anxiety, trauma, and social connection. Porges explains that mammals possess a three-tiered nervous system, with the most recent evolutionary addition—the ventral vagal system—enabling social engagement and co-regulation through facial expressions and vocalizations. He addresses common misconceptions about the theory and clarifies why physiological state, not just cognition, fundamentally shapes our perceptions and behavior.
The conversation covers practical interventions for nervous system regulation, including acoustic therapies, breathwork, and the importance of metabolic foundations. Porges and host Chris Williamson explore how trauma and chronic illness like long Covid can lock the body in defensive states, the role of co-regulation in relationships, and why safety requires specific social signals beyond the mere absence of threat. The episode offers a framework for understanding how physiological states influence everything from anxiety to authentic connection.
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1-Page Summary
Polyvagal Theory: Origins, Evolution, and Common Misconceptions
Understanding Internal Experiences and Physiological States
Stephen Porges describes his early scientific curiosity as focused on people's internal mental and physical experiences, rather than just observable behaviors. Before Polyvagal Theory, science was fragmented: behaviorism ignored internal states, while mental health research often ignored the body entirely. The traditional fight-or-flight and rest-and-digest models provided an incomplete picture of the autonomic nervous system.
Working in neonatal intensive care units, Porges encountered a "vagal paradox" where preterm babies experienced dangerous vagal activity—contradicting the view of the vagus nerve as solely beneficial. This observation highlighted inadequacies in existing models, which failed to account for mammalian social engagement and co-regulation.
A Hierarchical Three-Tiered Autonomic Nervous System
Porges's investigations led to Polyvagal Theory, which proposes that mammals possess a hierarchical, three-tiered autonomic nervous system. The most primitive system enabled basic survival through simple rest-and-restore states and escape mobilization. The middle layer—the sympathetic system—enabled fight-or-flight responses. The most recent addition, unique to mammals, is the ventral vagal system, which enables social engagement, co-regulation, and playful activity through facial expressions, vocalizations, and processes that support safety and connection.
Misinterpretations and Anatomical Distinctions
Polyvagal Theory has faced criticism often due to misunderstandings of neuroanatomy. Porges argues critics fail to distinguish between anatomical structures that predate mammals and evolved neurophysiological components unique to mammals. The theory is about an integrated mammalian brainstem system supporting the full range of social behaviors and physiological states, particularly co-regulation—not simply about the vagus nerve itself.
Nervous System, Safety Signals, Window of Tolerance
Physiological State Shapes Perception and Behavior
Chris Williamson and Stephen Porges emphasize that physiological state is central to behavior, feelings, and social capacity. Porges notes that most neural signals travel from body to brain, but culturally, many focus solely on brain-driven regulation. Anxiety, for example, is reframed as the body being in a defensive mobilized state. He distinguishes between states supporting health and growth versus those supporting stress and burnout.
Safety Requires Specific Social Signals
Porges explains that safety is not just the absence of threat but the presence of specific signals—prosodic voices and warm facial expressions—that convey connection. These signals are evolutionary, shared across mammals, and babies' heart rates drop nearly instantly when mothers use melodic intonations. However, for trauma survivors, even trustworthy signals can be perceived as threatening because their nervous systems have been retuned by past experiences.
Window of Tolerance and Expanding Capacity
The "window of tolerance" refers to the range within which a person's nervous system can function optimally. Porges explains this window expands or contracts based on trauma, illness, or pathogen exposure. Expanding it involves manageable stressors, safe exposure to triggers, and interventions like the Safe and Sound Protocol, which uses filtered music mimicking maternal prosodic cues. Practical approaches include breathwork, yoga, and bodily awareness during exercise.
Practical Interventions for Nervous System Regulation
Acoustic Interventions Signal Safety
Porges describes acoustic interventions like the Safe and Sound Protocol, which mimics maternal vocalization to prime the nervous system for connection. A second intervention, the Rest and Restore Protocol, provides rhythmic immersive experiences simulating physiological calm without requiring active meditation—particularly beneficial for trauma survivors who find meditation threatening.
Breath Work and Interoceptive Awareness
Resonance breathing—slowing breath to roughly 4.5–6 breaths per minute—aligns breathing with natural vascular oscillations, promoting parasympathetic dominance. Porges emphasizes the importance of mindful attention to how breath feels, as this enhances sensory feedback through neural circuits, with 80% of vagus nerve fibers relaying sensory information from body to brain.
Building Autonomic Flexibility Through Challenge
Autonomic flexibility is cultivated through cycles of challenge and recovery. Porges describes daily neural exercises on a tilt table, challenging baroreceptors and vascular regulation to build resilience. However, caution is essential for individuals in chronic fight-or-flight states, where nervous system recovery should precede intense exercises.
Metabolic and Nutritional Foundations
Porges emphasizes that effective interventions depend on robust metabolic and nutritional foundations, including precursors for neurotransmitters and anti-inflammatory agents. Without adequate metabolic resources, nerves cannot communicate effectively and other nervous system interventions will fail.
Trauma, Chronic Illness, and Real-World Recovery
Long Covid and Sentinel Trauma
Porges explains that the body's response to threat—whether traumatic accident, infection, or humiliation—is fundamentally the same: high-alert as if death is imminent. Even after threat passes, the body can remain locked in this defensive pattern, what Porges calls "sentinel trauma." Government-funded research using vagal nerve stimulation and sonic augmentation significantly improved long Covid symptoms, showing that appropriate recovery signals can help the nervous system reset.
Dysautonomia and ANS Dysfunction
Williamson describes his experience with a tilt table test that revealed severe autonomic dysfunction—sweating, nausea, and fainting. His technician notes that such tests increased dramatically post-pandemic, likely linked to long Covid. Porges notes dysautonomia affects everything from sleep to gut function to heart rate.
Balancing Work and Rest in Recovery
Porges poses a critical question for those recovering: Are daily activities nourishing or depleting? High-achieving individuals may find that pre-illness work structures hinder their recovery. The path to resilience involves focusing on nourishing activities and accepting reduced demands without shame.
Transgenerational Trauma
Porges notes that both the US and UK function as transgenerationally traumatized environments. He points to British boarding school culture as cultivating leaders with highly defended, dysregulated nervous systems. These cultural and institutional practices—not just genetic inheritance—perpetuate nervous system dysregulation across generations.
Connection, Co-regulation, Compassion, and Safety in Relationships
Co-regulation as the Biological Basis of Connection
Porges explains that mammals' ventral vagal system allows humans to broadcast visceral states through presence, voice, and facial expressions, directly influencing others' nervous systems—a process called co-regulation. From birth, humans depend on caregiver co-regulation, with this need persisting throughout life. This mechanism explains why trauma survivors often seek animal companionship, which provides nonverbal co-regulation and safety.
Male Socialization and Vulnerability
The absence of consistent co-regulation with secure attachment figures makes it difficult for men to manage vulnerability in relationships. Porges notes that experiencing vulnerability is integral to authentic relationships, and cultural narratives celebrating male independence can deprive men of relational experiences necessary for nervous system health.
Compassion From Understanding Constraints
Williamson reflects on how recovery from chronic illness transformed his perspective, generating greater compassion for those facing adversity. He recognizes that difficult behaviors often stem from constraints beyond a person's control. Deep compassion comes from understanding how limited agency and adversity shape behavior.
Physiological State in Relationships and Authenticity
Porges illustrates that anxiety and intense emotions "bleed" from one nervous system to another, making interpersonal transfer of state a constant reality. Communication responsibility extends beyond words to prosody, facial expressions, and presence. The nervous system is highly sensitive to inconsistencies—while techniques can be learned, real regulation only occurs with genuine safety and authenticity. Manipulation fails because people's systems intuitively detect insincerity.
1-Page Summary
Additional Materials
Clarifications
- The vagus nerve is a major nerve connecting the brain to many organs, influencing heart rate, digestion, and breathing. It has two main branches: the dorsal vagal complex, which controls primitive, immobilization responses, and the ventral vagal complex, unique to mammals, which supports social engagement and calm states. The ventral vagal system regulates muscles of the face and head, enabling communication and connection. These branches evolved to manage different survival strategies, from shutdown to social interaction.
- The "vagal paradox" refers to the unexpected finding that increased vagal nerve activity can sometimes cause harm rather than calm. In preterm babies, excessive vagal activation can slow the heart rate too much, leading to dangerous drops in oxygen supply. This contradicts the usual view of the vagus nerve as solely promoting relaxation and safety. It highlights that vagal effects depend on developmental stage and context.
- The hierarchical three-tiered autonomic nervous system reflects evolutionary layers added over time to support survival and social behavior. The oldest system, the dorsal vagal complex, controls immobilization and energy conservation in life-threatening situations. The sympathetic nervous system evolved next, enabling active fight-or-flight responses. The newest, the ventral vagal complex, unique to mammals, supports social communication and calming states essential for connection and safety.
- The sympathetic system is part of the autonomic nervous system that prepares the body for "fight or flight" by increasing heart rate and energy. Parasympathetic dominance means the parasympathetic system, which promotes rest and digestion, is more active, calming the body. Baroreceptors are sensors in blood vessels that detect blood pressure changes and help regulate heart rate and vascular resistance. They send signals to the brain to maintain stable blood pressure during activities like standing or exercise.
- The "window of tolerance" is the optimal zone where the nervous system can effectively manage stress and emotions without becoming overwhelmed or shutting down. When inside this window, a person can think clearly, regulate emotions, and respond adaptively to challenges. Outside this window, the nervous system shifts into hyperarousal (anxiety, panic) or hypoarousal (numbness, dissociation), impairing function. Expanding this window improves resilience and emotional regulation.
- The Safe and Sound Protocol (SSP) uses specially filtered music to emphasize frequencies similar to human speech patterns that convey safety and calm, particularly those found in a caregiver's voice. This filtering enhances the listener's nervous system regulation by stimulating the ventral vagal pathways involved in social engagement. The Rest and Restore Protocol offers rhythmic soundscapes designed to induce relaxation without requiring active focus, making it accessible for trauma survivors who may find meditation challenging. Both protocols aim to retrain the nervous system to recognize safety cues and improve autonomic balance.
- Resonance breathing synchronizes heart rate and breathing rhythms, enhancing heart rate variability, a marker of autonomic flexibility. This synchronization stimulates the vagus nerve, promoting parasympathetic nervous system activity, which calms the body. It also improves baroreceptor sensitivity, helping regulate blood pressure and stress responses. Practicing resonance breathing regularly can strengthen the body's ability to recover from stress.
- The vagus nerve contains mostly sensory fibers that send information from organs like the heart, lungs, and gut to the brainstem. These neural circuits relay signals about the body's internal state, such as heart rate and digestion, enabling the brain to monitor and regulate physiological functions. This sensory feedback helps the brain adjust autonomic responses to maintain balance and respond to stress or safety cues. Thus, the vagus nerve acts as a communication highway from body to brain, crucial for nervous system regulation.
- Autonomic flexibility refers to the nervous system's ability to adaptively regulate bodily functions in response to changing demands. Baroreceptors are sensors in blood vessels that detect blood pressure changes and help maintain stability. Tilt table tests simulate changes in posture to activate baroreceptors, challenging the body's cardiovascular regulation. Repeated exposure to such challenges can strengthen autonomic responses, improving resilience and balance.
- The nervous system relies on nutrients like amino acids, vitamins, and minerals to produce neurotransmitters, which are chemical messengers essential for nerve signaling. Adequate energy from glucose and healthy fats supports nerve cell membrane integrity and function. Anti-inflammatory nutrients help prevent damage to nerves and maintain efficient communication. Without these metabolic resources, nerve cells cannot transmit signals effectively, impairing nervous system regulation.
- "Sentinel trauma" refers to a lasting state where the nervous system remains on high alert after a traumatic event has ended. This occurs because the body’s survival mechanisms stay activated, anticipating ongoing danger even when none exists. The nervous system’s inability to downregulate leads to chronic stress responses, affecting health and behavior. Recovery involves interventions that help the nervous system recognize safety and return to balance.
- Dysautonomia is a disorder where the autonomic nervous system (ANS) malfunctions, disrupting automatic body functions like heart rate, blood pressure, digestion, and temperature regulation. Symptoms can include dizziness, fainting, rapid heartbeat, digestive issues, and fatigue. In long Covid, dysautonomia may result from viral damage or immune responses affecting ANS regulation. This leads to persistent symptoms that impair daily functioning and require specialized management.
- Transgenerational trauma refers to the transmission of stress and trauma effects from one generation to the next through learned behaviors, emotional patterns, and environmental influences. Cultural and institutional practices, such as rigid social norms or harsh educational systems, reinforce stress responses and limit emotional expression, embedding dysregulation in community behaviors. These environments shape nervous system development by normalizing chronic stress and defensive states across generations. Over time, this perpetuates vulnerability to anxiety, poor emotional regulation, and health issues within populations.
- The ventral vagal system controls muscles in the face and head that regulate expressions, vocal tone, and eye contact, which communicate safety and emotional states. It sends signals from the brainstem to these muscles, enabling social engagement behaviors that calm both self and others. Sensory feedback from these interactions travels back to the brain, helping regulate physiological state through a feedback loop. This bidirectional communication supports co-regulation by synchronizing nervous system states between individuals.
- Prosodic voices have a melodic, soothing quality that signals safety and calm to the nervous system. Warm facial expressions, like gentle eye contact and relaxed muscles, communicate non-threat and social connection. These cues evolved because mammals rely on social bonding for survival, so recognizing safety through voice and face supports co-regulation. Babies instinctively respond to these signals, which help regulate their physiological state and promote attachment.
- During interpersonal interactions, nervous systems communicate nonverbally through subtle cues like facial expressions, tone of voice, and body language. These cues trigger automatic neural responses that can synchronize physiological states between people. This process, called emotional contagion, allows anxiety or calmness to be "transferred" without conscious awareness. It is rooted in evolved mechanisms for social connection and survival.
- The nervous system evolved to detect subtle cues in voice tone, facial expressions, and body language that signal safety or threat. Authenticity creates a consistent, trustworthy signal that calms and regulates others' nervous systems. Insincerity generates conflicting signals, triggering defensive or stressed responses. This biological sensitivity makes genuine connection essential for effective social communication.
Counterarguments
- Some neuroscientists and clinicians argue that the anatomical distinctions proposed by Polyvagal Theory, particularly the strict separation between dorsal and ventral vagal pathways and their behavioral correlates, are not as clear-cut or universally accepted in the scientific literature as the theory suggests.
- Critics note that much of the evidence supporting Polyvagal Theory is correlational or based on animal studies, and that direct causal links between specific vagal pathways and complex social behaviors in humans remain to be conclusively demonstrated.
- The hierarchical, three-tiered model of the autonomic nervous system is seen by some as an oversimplification, as autonomic responses are highly integrated and context-dependent, with significant overlap and interaction between systems.
- Some researchers point out that the emphasis on the ventral vagal system as uniquely mammalian and central to social engagement may understate the role of other neural circuits and neurotransmitters involved in social behavior and emotional regulation.
- The effectiveness of interventions like the Safe and Sound Protocol and other acoustic therapies is still under investigation, with some studies showing mixed or modest results and a need for more rigorous, large-scale clinical trials.
- The claim that most neural signals travel from body to brain (afferent) rather than brain to body (efferent) is accurate for the vagus nerve, but critics caution against generalizing this to all aspects of nervous system function or psychological experience.
- Some psychologists and trauma experts argue that while physiological state is important, cognitive, social, and environmental factors also play critical roles in mental health and behavior, and should not be minimized.
- The assertion that trauma survivors universally benefit from animal companionship or acoustic interventions may not apply to all individuals, as responses to such interventions can be highly variable.
- The concept of "transgenerational trauma" is supported by some evidence, but the mechanisms and extent of its impact remain debated, and cultural or institutional explanations may not fully account for individual differences.
- While the theory emphasizes the importance of co-regulation and social safety signals, some critics argue that it may underplay the capacity for self-regulation and resilience in the absence of external support.
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Polyvagal Theory: Origins, Evolution, and Common Misconceptions
Understanding Internal Experiences and Physiological States in Human Behavior and Social Connection
Stephen Porges describes his early scientific curiosity as focused on what was happening beneath people’s visible behaviors—their internal mental and physical experiences, rather than solely their behavioral outputs such as test scores or reaction times. He observes that, prior to Polyvagal Theory, much of science was mechanistic and fragmented: behaviorism focused only on observable behaviors and physiological conditioning, while psychoanalysis and mental health research often ignored the body entirely. This left open the question of how internal states and feelings influence behavior and social connection.
In the early 1990s, existing models like fight-or-flight and rest-and-digest gave an incomplete picture of the autonomic nervous system. The traditional model viewed the sympathetic system as synonymous with mobilization and stress and the parasympathetic system (vagus nerve) with rest and restoration. However, working in neonatal intensive care units with preterm infants, Porges encountered a "vagal paradox": preterm babies would sometimes experience excessive vagal activity leading to dangerously slow heart rates, compromising oxygen delivery to the brain. This observation contradicted the simplistic view of the vagus nerve as solely beneficial and highlighted the inadequacies of existing models, which failed to account for the complexity of mammalian social engagement and the physiological processes of co-regulation. Porges thus sought to explain the nuanced physiological states—such as those supporting meditation, calm, and feeling safe with others—that traditional models overlooked.
Theory Suggests Mammals Evolved a Unique, Hierarchical Three-Tiered Autonomic Nervous System, Each Tier Adapting To Specific Contexts
Porges’s anatomical and evolutionary investigations led to the formulation of Polyvagal Theory, which proposes that mammals possess a hierarchical, three-tiered autonomic nervous system, each tier adapting to different evolutionary and situational needs.
- The most primitive system, found in ancient vertebrates, consisted of basic chemical signaling (like adrenaline) and a rudimentary vagal system. These enabled basic survival: simple rest-and-restore states and mobilization for escape.
- With evolutionary advances, a middle layer—the sympathetic system—emerged, enabling the familiar fight-or-flight responses necessary for early defense and survival but not equipped for the complexities of mammalian social life.
- The most recent addition, unique to mammals, is the ventral vagal system. This system enables social engagement, co-regulation, and playful activity. In mammals, including humans, the ventral vagal circuit is linked to facial expressions, vocalizations, and processes that support safety and connection in the presence of others. It allows infants to signal needs and adults to co-regulate through eye contact, voice, and touch. Play becomes possible through the ability to mobilize without fear, and intimacy or calmness is supported by safe immobilization—being held or touched by another.
This system enables mammals to broadcast physiological states through behavior and vocalization and to be affected positively b ...
Here’s what you’ll find in our full summary
Polyvagal Theory: Origins, Evolution, and Common Misconceptions
Additional Materials
Clarifications
- The autonomic nervous system (ANS) controls involuntary body functions like heart rate and digestion. It has two main branches: the sympathetic system, which prepares the body for action or stress, and the parasympathetic system, which promotes rest and recovery. The ventral vagal complex is a specialized part of the parasympathetic system unique to mammals, supporting social engagement and calm states. This system influences facial expressions, vocal tone, and heart regulation to help mammals connect and feel safe.
- The vagus nerve is a major nerve that runs from the brainstem to various organs, including the heart, lungs, and digestive tract. It plays a key role in regulating involuntary body functions like heart rate, digestion, and respiratory rate. The nerve has both sensory and motor fibers, allowing it to send information to and from the brain. Its activity influences how the body responds to stress and relaxation, impacting emotional and social behavior.
- The "vagal paradox" refers to the unexpected harmful effect of excessive vagal nerve activity in preterm infants, causing their heart rates to slow dangerously. Normally, vagal activity promotes calm and rest, but in these infants, it can overly inhibit the heart's pacemaker, reducing oxygen flow to the brain. This shows that vagal influence is not always beneficial and can vary depending on developmental and physiological context. It highlights the complexity of autonomic regulation beyond simple rest-and-digest functions.
- Anatomical structures are the physical parts of the nervous system, like specific groups of nerve cells (nuclei) located in the brainstem. Neurophysiological components refer to the functions and activities of these structures, such as the specific nerve fibers that control heart rate (cardioinhibitory fibers). The nucleus of the ventral vagus is a physical location containing neurons, while cardioinhibitory fibers are the functional pathways those neurons use to slow the heart. Understanding this distinction helps clarify how structure and function relate but are not the same.
- Co-regulation is the process where individuals influence and stabilize each other's physiological states through social interaction. It helps people feel safe and calm by synchronizing heart rate, breathing, and emotional responses. This mutual regulation supports effective communication and bonding. In mammals, co-regulation is essential for developing trust and social connection.
- Polyvagal Theory’s three-tiered model reflects evolutionary stages of the autonomic nervous system, each with distinct neural pathways and functions. The oldest tier, the dorsal vagal complex, controls immobilization and shutdown responses. The middle tier, the sympathetic nervous system, manages fight-or-flight reactions. The newest tier, the ventral vagal complex, uniquely supports social communication and self-soothing behaviors in mammals.
- The ventral vagal system evolved in mammals to support complex social behaviors essential for survival, such as bonding and communication. It enables nuanced regulation of heart rate and facial muscles, facilitating social cues like eye contact and vocal tone. This system allows mammals to feel safe and engage socially, which enhances cooperative behaviors and caregiving. Its uniqueness reflects mammals' reliance on social connection for raising offspring and group living.
- The ventral vagal system controls muscles in the face and head, enabling expressions and vocal sounds that communicate safety and connection. It regulates the heart and breathing to promote calm states, allowing safe immobilization without fear or distress. This system supports co-regulation, where individuals can soothe each other through touch, eye contact, and voice. These physiological processes create a feedback loop that reinfo ...
Counterarguments
- Some neuroscientists and physiologists argue that the anatomical distinctions proposed by Polyvagal Theory, particularly the strict separation between dorsal and ventral vagal pathways, are not as clear-cut in the scientific literature as the theory suggests.
- Critics point out that many of the core ideas of Polyvagal Theory, such as the hierarchical organization of the autonomic nervous system, are not universally accepted and lack direct empirical evidence in humans.
- Some researchers note that the theory’s evolutionary narrative, especially the claim that the ventral vagal complex is unique to mammals, is debated and may oversimplify the evolutionary development of the autonomic nervous system.
- There is concern that Polyvagal Theory is sometimes used in clinical and therapeutic settings without sufficient empirical validation or rigorous testing of its interventions.
- Alternative models, such ...
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Nervous System, Safety Signals, Window of Tolerance
Nervous System's Physiological State Shapes Perception, Behavior, and Social Engagement Limits
Chris Williamson and Stephen Porges emphasize the foundational role of the nervous system in shaping how individuals interact with and experience the world. Porges explains that physiological state is central to behavior, feelings, and social capacity. Culture often demands control over one’s feelings, promoting approaches like “just work harder” or “suppress your feelings.” This results in people blaming themselves for physiological constraints they cannot simply will away. Many ignore physiological feedback, which disconnects them from their body’s signals and contributes to burnout and exhaustion.
Porges notes that most neural signals travel from the body to the brain, not the reverse, but culturally, many focus solely on brain-driven regulation, overlooking the influence of body-based states. Anxiety, for example, is reframed by Porges as the body being in a defensive mobilized state—not simply an external or purely psychological phenomenon. People often try to externalize these internal feelings by blaming external circumstances, when in fact, their nervous system is the source of these signals.
He distinguishes between two major physiological states: one supporting health, growth, and restoration, and another supporting stress, resulting in constrained capacity, burnout, and exhaustion. In stressful states, individuals feel a lack of options and creativity and are less able to access their full capacities.
Safety Requires Signals of Connection and Accessibility Through Prosodic Vocalizations and Facial Expressions Recognized by Mammals as Indicators of Social Engagement
Safety, Stephen Porges explains, is not just the absence of threat but the presence of specific signals—such as prosodic (melodic) voices and warm facial expressions—that convey connection and accessibility. These signals are essential social cues rooted in the mammalian vagus nerve, which links facial and vocal muscles to the regulation of calm and social engagement. Humans instinctively recognize these signals; a smiling child or a warm, melodic voice quickly calms others and fosters social bonds. Research shows that babies’ heart rates drop nearly instantly when a mother uses a melodic, engaged intonation.
These calming and bonding vocal frequencies are evolutionary, shared across mammals like dogs, cats, horses, and humans. This shared band of communication frequencies enhances social bonds, enabling humans and animals to calm one another through voice alone.
However, Porges points out that for those with a history of trauma or betrayal, even trustworthy signals of safety can be perceived as threatening. Such individuals may respond defensively to signals intended to convey calm, because their nervous systems have been retuned by past experiences to associate signals of safety or love with vulnerability and potential harm. In these cases, facial and vocal cues that would normally facilitate closeness instead trigger withdrawal or hypervigilance.
Window of Tolerance: Range for Optimal Functioning Based On Experience, Health, and Environment
The “window of tolerance” refers to the range within which a person’s nervous system can function optimally—balancing arousal, emotional regulation, and adaptive engagement with the environment. Porges explains that this window expands or contracts based on factors like trauma, chronic illness, or pathogen exposure. Those recovering from trauma or illness often find their window narrowed, oscillating between hyperarousal (fight or flight) and hypoarousal (shut down), lacking the ventral vagal regulation necessary for smooth transitions and adaptive behaviors.
When the ventral vagus nerve is unavailable as a regulatory “choreographer,” the nervous system is prone to rapid shifts between states rather than coordinated responses. This makes individuals environmentally vulnerable and frequently at the mercy of both internal and external stimuli.
Expanding the window of tolerance involves exposing the nervous system to manageable stressors—stress and recovery cycles—as well as repeated, safe exposure to triggers, in a context where the system feels secure. Porges and therapists have used protocols like the Safe and Sound Protocol, which employs fi ...
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Nervous System, Safety Signals, Window of Tolerance
Additional Materials
Clarifications
- The ventral vagus nerve is part of the parasympathetic nervous system that promotes calm and social engagement. It regulates heart rate and facial muscles to help maintain a state of safety and connection. Acting as a "choreographer," it coordinates physiological responses to keep the body balanced and responsive. When functioning well, it enables smooth transitions between stress and relaxation states.
- Prosodic vocalizations refer to the rhythm, pitch, and intonation patterns in speech that convey emotion and social cues beyond the literal meaning of words. These melodic qualities help signal safety and connection by calming the listener’s nervous system. They are processed by brain areas linked to emotional regulation and social bonding. This form of communication is innate and recognized across many mammalian species.
- The "window of tolerance" is a concept from neuroscience describing the optimal zone of arousal where the nervous system can effectively process emotions and respond to stress. It is regulated by the autonomic nervous system, particularly the balance between the sympathetic (fight/flight) and parasympathetic (rest/digest) branches. When within this window, the brain's prefrontal cortex can function well, enabling rational thinking and emotional regulation. Outside this window, either hyperarousal or hypoarousal impairs cognitive and emotional processing, leading to reactive or shut-down states.
- Hyperarousal is a state of heightened alertness where the nervous system is overactive, causing symptoms like anxiety, irritability, and difficulty relaxing. Hypoarousal is the opposite, characterized by reduced responsiveness, numbness, or shutdown, often leading to feelings of disconnection or exhaustion. Both states represent extremes outside the optimal "window of tolerance" for emotional and physiological regulation. Managing these states involves techniques that help restore balance and promote calm engagement with the environment.
- The mammalian vagus nerve has a branch called the ventral vagal complex that connects to muscles in the face and voice box. This connection allows the nervous system to control facial expressions and vocal tone, which signal safety and social engagement. These signals help regulate heart rate and calm the body by activating the parasympathetic nervous system. Thus, facial and vocal cues directly influence physiological states through this neural pathway.
- The Safe and Sound Protocol (SSP) is a therapeutic audio program developed by Stephen Porges to improve social engagement and reduce stress. It uses specially filtered music that emphasizes frequencies similar to a mother's calming voice, targeting the middle ear muscles to enhance vagal nerve regulation. This filtering helps the nervous system detect safety cues more effectively, promoting relaxation and emotional regulation. SSP is typically administered in sessions guided by a trained therapist to gradually expand the listener's window of tolerance.
- Most neural signals traveling from the body to the brain refer to sensory information like touch, pain, temperature, and internal organ status being sent upward for processing. This afferent signaling informs the brain about the body's current state, enabling appropriate responses. The vagus nerve is a key pathway carrying these signals from organs to the brainstem. This bottom-up communication shapes emotions and behavior by influencing brain activity based on bodily conditions.
- The physiological state supporting health, growth, and restoration is dominated by the parasympathetic nervous system, particularly the ventral vagal complex, which promotes calm, digestion, and social engagement. In contrast, the stress state activates the sympathetic nervous system and dorsal vagal pathways, triggering fight-or-flight or shutdown responses to protect the body. These stress responses increase heart rate, blood pressure, and energy mobilization but reduce functions like digestion and social connection. Chronic activation of stress states can impair immune function and overall health.
- Individuals with trauma histories have nervous systems conditioned to associate safety signals with past harm due to repeated negative experiences. Their brains may misinterpret calming cues as potential threats, triggering defensive responses. This is a survival mechanism where the nervous system prioritizes protection over relaxation. Over time, this rewiring makes genuine safety signals feel unsafe.
- Mammals evolved a common nervous system structure, including the vagus nerve, which supports social communication through vocalizations. These vocal frequencies fall within a specific range that effectively conveys safety and emotional states across species. This shared band allows rapid, nonverbal bonding and calming responses essential for survival and social c ...
Counterarguments
- While the nervous system’s physiological state is influential, cognitive processes, beliefs, and conscious decision-making also play significant roles in shaping perception, behavior, and social engagement, and these are not solely determined by physiological state.
- Cultural norms around emotional control can sometimes foster resilience and self-regulation, rather than always leading to negative outcomes like burnout or self-blame.
- The assertion that most neural signals travel from body to brain does not negate the importance of top-down (brain-to-body) regulation, which is well-documented in neuroscience and psychology.
- Anxiety can have multifactorial origins, including external stressors, learned behaviors, and cognitive patterns, not just physiological defensive states.
- Some individuals benefit from focusing on cognitive strategies (e.g., cognitive-behavioral therapy) rather than body-based interventions, suggesting that brain-driven regulation can be effective for many.
- The concept of a “window of tolerance” is a useful metaphor but lacks precise scientific measurement or universal acceptance in clinical practice.
- Not all individuals with trauma histories misinterpret safety cues; responses to safety signals are hig ...
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Practical Interventions for Nervous System Regulation
Acoustic Interventions Mimicking Maternal Vocalization Signal Safety and Calm the Nervous System Without Cognition or Meditation
Stephen Porges describes the development of two acoustic interventions designed to regulate the nervous system by mimicking the calming qualities of a mother's voice and providing sensory input that conveys safety. The first, the Safe and Sound Protocol, has been used by hundreds of thousands of people, especially children and trauma survivors. It works by broadcasting acoustic features associated with calmness and engagement, priming the nervous system for connection and making clients more accessible and responsive in therapies such as EMDR and cognitive behavioral therapy. Sensitive individuals benefit from gradually increasing exposure, as these protocols open a “window of tolerance,” creating temporary flexibility in the nervous system that can be expanded over time.
A second intervention, the Rest and Restore Protocol, uses Sonic Augmentation Technology to provide a rhythmic, immersive experience akin to floating safely in a sea. This "stealth meditation" achieves effectiveness similar to vagal nerve stimulation, simulating physiological calm acoustically without requiring active meditation or cognitive effort. These interventions are especially beneficial for trauma survivors who may find meditation threatening, as passive safety signals can prepare their system for therapeutic work and support deeper engagement with therapy.
Breath Work Activates Feedback, Oscillating Vascular Activity, Shifting the Nervous System To Parasympathetic Dominance
Resonance breathing—slowing the breath to frequencies of 0.1–0.12 Hz, or roughly 4.5–6 breaths per minute—effectively aligns breathing with the body’s natural vascular oscillations, supporting nervous system regulation. This breathing rhythm shifts the system toward parasympathetic dominance, promoting calm.
The power of resonance breathing comes from interoceptive awareness, closing the feedback loop between internal sensory input and motor outputs. Porges emphasizes the importance of paying mindful attention to how breath feels, as this actively enhances sensory feedback through neural circuits—80% of vagus nerve fibers relay sensory information from the body to the brain. Practices such as resonance breathing, yoga breathing, and body scans enable the completion of these feedback loops, help regulate muscle tone, and increase overall nervous system flexibility. Breath work is thus most effective when practitioners are attentive to bodily sensations, not just breathing mechanically.
Vagal Nerve Stimulation Signals Safety, Not a Hack Bypassing Normal Function
Vagal nerve stimulation is a real intervention that works by sending safety signals to the vagus nerve, promoting reconnection between the nervous system and organs to support physiological health. However, Porges stresses that this is not a “hack” that can bypass normal function. The nervous system adapts to repeated stimulation; if the stimulation is used while neglecting ongoing stress or environmental dysregulation, its effects diminish as the system compensates.
Therefore, true and lasting benefits require combining vagal stimulation with contextual and relational interventions—changing how one relates to the environment and others, and building new patterns of regulation. Isolated stimulation without addressing underlying stressors or dysregulation is ultimately futile.
Challenge Through Stress and Recovery Builds Autonomic Flexibility
Autonomic flexibility is cultivated by cycles of challenge and recovery, or oscillating between stress and calm. Porges describes daily neural exercises performed on an inversion or tilt table: tilting the body quickly and slowly, doing sit-ups in the i ...
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Practical Interventions for Nervous System Regulation
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Counterarguments
- The evidence base for acoustic interventions like the Safe and Sound Protocol and Rest and Restore Protocol is still limited, with a need for more large-scale, independent, peer-reviewed studies to confirm efficacy and clarify mechanisms.
- Some critics argue that the effects of acoustic interventions may be attributable to general relaxation or placebo effects rather than specific neural mechanisms related to maternal vocalization.
- The generalizability of these interventions to diverse populations, including adults without trauma histories or those with neurodevelopmental differences, remains uncertain.
- While resonance breathing and interoceptive awareness are supported by some research, the optimal breathing rate and the necessity of strict adherence to specific frequencies (e.g., 0.1–0.12 Hz) are debated in the scientific community.
- The claim that vagal nerve stimulation cannot be a "hack" is contested by some researchers who view neuromodulation as a legitimate adjunct or alternative to behavioral interventions, though they agree it should not replace addressing underlying stressors.
- The safety and appropriateness of neural exercises involving inversion or rapid tilting may not b ...
Actionables
- you can create a daily sound environment checklist to identify and adjust background noises in your home or workspace, swapping harsh or unpredictable sounds for gentle, rhythmic ones (like soft fans, water features, or curated playlists), to passively reinforce a sense of safety and calm throughout your day.
- a practical way to support nervous system recovery before challenging activities is to schedule short, low-stimulation breaks (such as sitting quietly with eyes closed or lying down with a weighted blanket) after any stressful event, helping your body shift from fight-or-flight to a more regulated state before engaging in demanding tasks.
- you can track your energy, mood, and ...
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Trauma, Chronic Illness, and Real-World Recovery
Long Covid and Other Post-Pathogenic Conditions Maintain the Nervous System in Defense Mode Post-Threat, Requiring Specialized Recovery Signaling
Stephen Porges explains that the body's physiological response to threat, whether from a traumatic accident, infection like COVID-19, or humiliation, is fundamentally the same: the nervous system enters a state of high-alert as if death is imminent. Even after the immediate threat passes, the body can remain locked in this defensive pattern—a phenomenon Porges calls "sentinel trauma." With conditions such as long Covid, the nervous system does not automatically reset once the pathogen is defeated; it continues to interpret past danger as ongoing, keeping the individual in a chronic state of vigilance.
Porges describes how he participated in government-funded research utilizing vagal nerve stimulation and sonic augmentation (SonaSIA), which send calming signals to the body’s vagus nerve. Both interventions, over a four-week period, significantly improved symptoms like fatigue, anxiety, and depression for long Covid patients, showing that if the nervous system receives the right recovery signals, it can begin to reset and restore function.
Dysautonomia: Ans Dysfunction Disrupts Blood Pressure and Heart Rate Feedback During Posture Changes
Chris Williamson recounts his experience with a tilt table test used to assess autonomic nervous system (ANS) flexibility. The test involves securing a patient and gradually elevating their body to observe blood pressure and heart rate responses. Williamson describes intense symptoms during his test—sweating, nausea, visual blurring, and eventually fainting with a heart stoppage—clearly demonstrating a severe failure of autonomic regulation (dysautonomia). Williamson’s technician shares that before Covid, they performed only a few such tests per month, but now conduct several each day, indicating a dramatic post-pandemic rise in dysautonomia, likely linked to long Covid.
Porges notes that dysautonomia is a comprehensive regulatory disorder, affecting everything from sleep to gut function to heart rate. To gradually retrain the system, he himself performs daily exercises using a tilt table, repeatedly challenging his baroreceptors and vascular system to improve adaptability and nervous system plasticity.
Chronic Illness and Trauma Create Similar Nervous System Patterns Due to Perceived Threat
Both Porges and Williamson emphasize how chronic illness, traumatic accidents, and emotional trauma elicit a unified physiological defense pattern. One key difference is cognitive awareness: after, say, a car crash, people can recognize their nervousness about driving again, but after a pathogenic event like infection, the link between what happened and how the body feels is less obvious and often subconscious.
This lack of awareness is compounded by cultural attitudes. Many people, pushed by societal messaging to "push through," become numb to their own bodily signals. Training oneself to ignore signs of depletion further divorces individuals from recognizing when recovery support is needed, prolonging or worsening their dysregulation.
Balancing Work and Rest In Nervous System Rehab: Focus On Nourishing Vs. Depleting Activities
Porges poses a critical question for those recovering from chronic conditions: Are their daily activities—such as Williamson’s demanding podcasting work for millions—nourishing or depleting for their nervous system at this stage? High-achiev ...
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Trauma, Chronic Illness, and Real-World Recovery
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Clarifications
- When the nervous system enters a "high-alert defensive state," it activates the sympathetic branch of the autonomic nervous system, triggering the "fight or flight" response. This causes increased heart rate, rapid breathing, muscle tension, and heightened sensory awareness to prepare the body for immediate action. Stress hormones like adrenaline and cortisol are released to sustain this alertness. Prolonged activation can impair digestion, immune function, and cognitive processes.
- "Sentinel trauma" refers to the nervous system remaining in a heightened defensive state even after the original threat has passed. Unlike typical trauma responses that gradually subside, sentinel trauma keeps the body locked in alertness as if danger is ongoing. This persistent state can occur without conscious awareness, especially after infections or non-obvious threats. It requires specific interventions to signal safety and reset the nervous system.
- The vagus nerve is a major part of the parasympathetic nervous system, which controls rest and digestion functions. It helps slow heart rate, reduce inflammation, and promote relaxation by sending calming signals from the brain to various organs. Stimulating the vagus nerve activates these calming pathways, counteracting the body's stress response. This can help reset the nervous system from a state of high alert to one of calm and recovery.
- Sonic augmentation (SonaSIA) uses specific sound frequencies to stimulate the vagus nerve indirectly through the ear or skin. This stimulation promotes parasympathetic nervous system activity, which helps calm the body and reduce stress responses. The technique leverages the nervous system’s sensitivity to auditory signals to encourage physiological relaxation and recovery. It is a non-invasive method aimed at resetting nervous system balance in conditions like long Covid.
- Dysautonomia is a disorder where the autonomic nervous system (ANS) malfunctions, disrupting automatic bodily functions like heart rate, blood pressure, digestion, and temperature regulation. Symptoms can include dizziness, fainting, rapid heartbeat, digestive issues, and fatigue due to poor regulation of these involuntary processes. It often results from nerve damage, autoimmune conditions, or infections, and can severely impact daily life. Treatment focuses on managing symptoms and improving ANS function through lifestyle changes, medications, and therapies like tilt table exercises.
- A tilt table test evaluates how the autonomic nervous system controls blood pressure and heart rate when changing posture. The patient lies on a motorized table that tilts from horizontal to upright while vital signs are monitored. It helps diagnose conditions like dysautonomia or fainting disorders by revealing abnormal cardiovascular responses. The test is safe and typically lasts 20 to 45 minutes.
- Baroreceptors are sensors located in blood vessels that detect changes in blood pressure. They send signals to the brain to adjust heart rate and vessel dilation, maintaining stable blood flow during posture changes. Vascular system adaptability refers to the ability of blood vessels to respond and adjust to these signals effectively. This dynamic feedback loop is crucial for autonomic regulation and preventing symptoms like dizziness or fainting.
- Cognitive awareness means consciously recognizing the cause of one’s distress. After accidents, people often clearly link their fear or anxiety to the event because it is a distinct, memorable experience. Infections like COVID-19 cause internal bodily changes that are less visible and less directly connected to specific memories, making the link to symptoms less obvious. This subtlety leads to subconscious nervous system responses without clear conscious understanding.
- Cultural attitudes like "push through" encourage ignoring physical and emotional signals of stress or fatigue. This suppression reduces bodily awareness, making it harder to recognize when the nervous system is overwhelmed. Over time, ignoring these signals can worsen nervous system dysregulation and delay recovery. Healthy nervous system function requires tuning into and responding to bodily cues, not dismissing them.
- Nervous system plasticity refers to the nervous system's ability to change and adapt in response to experiences or injuries. It allows the brain and nerves to reorganize pathways, form new connections, and adjust functions. This adaptability is crucial for recovery because it enables the nervous system to "retrain" itself after trauma or illness. Therapeutic interventions, like exercises or stimulation, promote plasticity to restore normal regulation and function.
- Transgenerational trauma refers to the transmission of trauma effects from one generation to the next through learned behaviors, emotional patterns, and social environments rather than just DNA. Social and institutional practices, like harsh schooling or cultural norms, shape how individuals respond to stress and regulate emotions, embedding trauma responses in communities. These environment ...
Counterarguments
- While the nervous system does respond to various threats with similar physiological patterns, the specific mechanisms and long-term outcomes can differ significantly between psychological trauma, infection, and physical injury, suggesting that a unified model may oversimplify complex biological processes.
- The concept of "sentinel trauma" and the idea that the nervous system remains locked in a defensive state after threat is not universally accepted in mainstream medical or psychiatric literature, and more empirical evidence is needed to validate this framework.
- The efficacy of interventions like vagal nerve stimulation and sonic augmentation for long Covid is still under investigation, and current evidence is limited; these treatments are not yet widely endorsed as standard care.
- The reported increase in dysautonomia post-pandemic may be influenced by heightened awareness, increased testing, and changes in diagnostic criteria, not solely by a true rise in incidence due to long Covid.
- The assertion that cultural practices such as British boarding schools are a primary cause of transgenerational nervous system dysregulation is a sociological hypothesis that lacks broad empiric ...
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Connection, Co-regulation, Compassion, and Safety in Relationships
Co-regulation: The Biological Basis of Love and Connection, Regulating Others' Nervous Systems Through Presence, Voice, and Expressions
Stephen Porges explains that mammals possess a unique ventral vagal system, evolutionarily tied to the muscles of the face and head, and to vocalization. This system allows humans to broadcast their visceral states through presence, voice, and facial expressions, directly influencing and regulating others' nervous systems—a process called co-regulation. As social beings, humans thrive in groups where relational proximity is essential for nervous system regulation and wellbeing.
From birth, infants and children depend on caregiver co-regulation for survival, with this need for relational safety persisting, evolving but never disappearing throughout life. When safe and attuned, being held in another’s arms regulates physiological states, supporting health, growth, and restoration. This fundamental mechanism explains why trauma survivors often seek animal companionship—gravitating to dogs, cats, or horses who co-regulate through nonverbal cues, providing the safety their nervous systems crave. Porges emphasizes that survival depends on these connections, not on self-contained independence.
Male Socialization Hindering Fatherly Co-regulation May Impede Vulnerability and Community Connection in Adulthood
The absence of consistent co-regulation with a secure attachment figure, such as a father, makes it difficult for men to manage vulnerability in relationships and communities. Porges notes that experiencing vulnerability is integral to authentic relationships; without it, navigating complexities of life and community becomes challenging. Sometimes, not acknowledging one’s vulnerability may seem adaptive, but more often, it prevents genuine community connection and locks individuals out of meaningful relationships. This trend has societal implications, contributing to a generation of men who struggle with vulnerability and authentic relating, fostering polarization. The cultural narrative celebrating male independence and self-reliance can deprive men of the relational experiences necessary for nervous system health, consistent safety, and emotional wellbeing.
Compassion and Benevolence Arise From Understanding Others' Lack of Privileges or Opportunities
Porges and Williamson discuss how genuine compassion arises from recognizing that not everyone shares the same privileges or opportunities. Williamson reflects on his recovery from chronic illness, describing how the uncertainty about whether he would ever get better profoundly transformed his perspective. This experience led to greater compassion for people facing illness, addiction, disability, or persistent behavioral struggles. He recognizes that many difficult behaviors stem from constraints or hardships beyond a person’s control, rather than being purely elective. Lacking personal vulnerability, people often judge others harshly; deep compassion comes from truly understanding how limited agency and adversity shape behavior and experience. This humility and expanded empathy, Williamson suggests, are cultivated by facing periods of personal uncertainty and vulnerability.
Physiological State Influences in Relationships: Nervous System Regulation
Porges illustrates that anxiety and other intense emotions “bleed” from one person’s nervous system into anothe ...
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Connection, Co-regulation, Compassion, and Safety in Relationships
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Clarifications
- The ventral vagal system is part of the parasympathetic nervous system that helps calm the body and promote social engagement. It controls muscles in the face, head, and neck, enabling facial expressions and vocalizations that communicate safety and connection. This system also slows the heart rate and supports digestion, signaling a state of relaxation. Its activation fosters feelings of safety, allowing people to connect and regulate each other's emotional states.
- Co-regulation is the process where one person's nervous system helps stabilize another's through nonverbal cues like tone, facial expressions, and body language. It involves the ventral vagal complex, which supports social engagement and calming responses. This biological interaction helps reduce stress and promotes feelings of safety and connection. Essentially, co-regulation is an unconscious, mutual adjustment of physiological states between individuals.
- The ventral vagal nerve controls muscles in the face and head, enabling expressions and vocal sounds that communicate emotional states. These facial and vocal signals send cues to others' nervous systems, promoting feelings of safety or threat. This biological link allows humans to influence each other's physiological states nonverbally. Thus, facial expressions and voice tone are integral to nervous system regulation through social connection.
- Relational proximity refers to being physically or emotionally close to others, which helps regulate the nervous system by providing cues of safety and support. This closeness activates the ventral vagal system, calming stress responses and promoting feelings of security. Without such proximity, the nervous system may remain in a heightened state of alert, increasing anxiety and impairing emotional regulation. Thus, relational proximity is essential for maintaining physiological balance and psychological wellbeing.
- Trauma survivors often experience difficulty trusting humans due to past relational harm, making animals safer companions. Animals provide nonjudgmental, consistent presence that helps soothe the nervous system without complex social demands. Physical touch and eye contact with animals release oxytocin, a hormone that promotes calm and bonding. This biological response supports emotional regulation and feelings of safety.
- A secure attachment figure is someone who consistently provides safety, comfort, and emotional support, especially in early life. This reliable presence helps individuals develop trust and the ability to express vulnerability without fear. Without such a figure, people may struggle to feel safe enough to show weakness or ask for help. This difficulty can hinder forming deep, authentic relationships in adulthood.
- Male socialization often emphasizes independence and emotional restraint, limiting opportunities for men to experience co-regulation, which is the mutual regulation of nervous systems through connection. Without early experiences of secure attachment and emotional attunement, men may struggle to recognize and express vulnerability. This lack of co-regulation can impair emotional wellbeing by reducing the ability to form deep, supportive relationships. Consequently, societal norms around masculinity can hinder men’s nervous system health and community connection.
- Emotions like anxiety can be unconsciously communicated through subtle body language, facial expressions, and vocal tone. This nonverbal communication activates similar neural and physiological responses in the observer, effectively "mirroring" the emotional state. Mirror neurons in the brain play a key role by simulating others' feelings, fostering empathy and social bonding. This process helps explain why being around anxious people can cause one to feel anxious as well.
- Prosody refers to the rhythm, pitch, and intonation patterns in speech that convey emotion and intent beyond the literal words. It helps listeners interpret feelings and social cues, influencing th ...
Counterarguments
- While co-regulation is important, research also shows that individuals can develop robust self-regulation skills, and some cultures emphasize and successfully foster independence without apparent detriment to wellbeing.
- The emphasis on the ventral vagal system and co-regulation is primarily based on polyvagal theory, which, while influential, is still debated and not universally accepted within the scientific community.
- Some people thrive in solitude or with minimal social contact, suggesting that the need for relational proximity and co-regulation may not be universal or equally necessary for all individuals.
- The assertion that survival depends on social connections rather than self-contained independence may overlook examples of individuals who have adapted well to isolation or who prefer and benefit from autonomy.
- The focus on male socialization and its negative effects on vulnerability may not account for cultural, individual, or familial variations where men are encouraged to express vulnerability and form secure attachments.
- The claim that cultural narratives celebrating male independence are inherently harmful may not consider that some men find fulfillment, resilience, and wellbeing through independence and self-reliance.
- While animal companionship can be beneficial for trauma survivors, not all individuals respond to animals in the same way, and some may find other for ...
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1-Page Summary- Polyvagal Theory: Origins, Evolution, and Common Misconceptions
- Nervous System, Safety Signals, Window of Tolerance
- Practical Interventions for Nervous System Regulation
- Trauma, Chronic Illness, and Real-World Recovery
- Connection, Co-regulation, Compassion, and Safety in Relationships
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