Polyvagal Interventions for Anxiety
S. Porges and his Polyvagal Theory may provide innovative interventions for both anxiety 
and depression. Many people become trapped in ruminating about the past or worrying about the future; they cannot seem to keep their mind and body in the present moment. Some strong, fear-based, bodily defenses may not respond well to “talk therapy” alone. In helping clients with such suffering it is important to include a very strong clinical alliance and relationship, as well as personal narrative on internal introjected messages about their vulnerabilities, fears, and self-doubts. Recall that anxiety is generally a body-based defense from lower brain areas (limbic and brain stem). These areas are often un-affected when just “talk” occurs in therapy. There are certain signs that a person’s anxiety is acting up in a clinical session. These are:
- Higher pitched voice, sometimes with speedy delivery;
- Prolonged silences;
- Tighter, flat face and tight jaw – often with the upper face lifting slightly;
- Random nervous body movements;
- Rapid, higher-chest breathing;
- Problems in awareness, memory, and cognitive comprehension; and,
- Sometimes full blown panic.
When such anxious defenses appear, the therapist needs to move to grounding and calm breathing interventions. Talking it through, working it through may be insufficient to restore emotion regulation. Porges makes the following suggestions to activate polyvagal interference to anxiety. If successful, emotion regulation will be re-established.
- Request the client to exhale more slowly, and with more emphasis.
- Then have the person extend slightly their exhalation. Be careful not to extend too far; discomfort will follow.
- If the person is fearful of public speaking or presenting in a group therapy session, request that they add more words to their sentences. This will require a change in breathing process – thus extending the exhalation.
- Practice longer exhalations as the client breathes more slowly and more deeply.
- Have the client lay on their back with their slightly bent legs high up on a wall – breathe
Anthony R. Quintiliani, PhD., LADC
From the Eleanor R. Liebman Center for Secular Meditation in Monkton, Vermont and the Home of The Monkton Sangha
Author of Mindful Happiness
