Polyvagal-informed therapy

1. Introduction

Version followed: Deb Dana's "Rhythm of Regulation" clinical approach (Dana 2018, The Polyvagal Theory in Therapy; Dana 2020, Polyvagal Exercises for Safety and Connection; the Kripalu 2019 Rhythm of Regulation training outline), built on Stephen Porges's Polyvagal Theory (Porges 2011; Porges 2022). Where only secondary pages are drawn on, that is tagged.

What it is. Polyvagal-informed therapy is a framework, not a single manualised therapy. Porges developed Polyvagal Theory (PVT), a theory of how autonomic states shape safety, threat response and social behaviour; Dana translated it into a clinical approach (the Rhythm of Regulation Clinical Training Series) that can be layered onto other therapies [source: Kripalu 2019 outline; Norton UK page for Dana 2020]. Many clinicians call any therapy that uses the "ladder", mapping and co-regulation "polyvagal-informed"; this guide follows Dana's version.

Core idea of change. Porges holds that feelings of safety "emerge from internal physiological states" and that trusting social engagement uses co-regulation to dampen costly defence reactions [source: Porges 2022 abstract, UNC repository]. In Dana's approach, the client learns to recognise their own autonomic states (in PVT terms: ventral vagal = safe and social; sympathetic = mobilised fight/flight; dorsal vagal = immobilised, shut down), treats those states as adaptive protection rather than pathology, and, through repeated co-regulation with the therapist and small practised experiences of safety, builds the flexibility to return to a regulated state and to tell a new story about what happened [source: Sounds True article on Dana; Sequence Wiz summary of Dana 2018]. PVT's physiological claims are Porges's model and are contested by some physiologists; present them to clients as a useful map, not as established anatomy [synthesis].

2. Framework

No published session protocol or fixed session count exists for polyvagal-informed therapy; Dana describes practices that are "introduced gradually across clinical sessions" (paraphrase) and used within and between sessions [source: Norton UK page for Dana 2020]. The phase order below follows the sequence of Dana's training outline (theory and safety first, then mapping, then tracking and co-regulation, then shaping and an ongoing plan) [source: Kripalu 2019 outline]. Dana's 2018 book is, to my knowledge, organised as befriending, mapping/navigating and shaping the nervous system [uncertain: verify part titles]. Session counts and transition criteria below are [synthesis].

Format. Individual sessions (it is also used in couples, group and supervision contexts), usually 50–60 minutes, integrated into the clinician's existing modality (e.g. trauma-focused, EMDR, IFS, CBT) [synthesis]. Between-session practices are a core component [source: Norton UK page for Dana 2020].

Phase A — Safety and befriending (typically sessions 1–3) [synthesis on timing].

Goals: create an autonomically safe clinical environment ("inside, outside and between") [source: Kripalu 2019]; the clinician tracks and regulates their own state; introduce PVT to the client in plain language (the three states, the ladder, the idea that states are protective) [source: Kripalu 2019; TPI ladder worksheet]; begin non-judgemental noticing of states [source: Sounds True].
Move on when: the client can name at least the three states in their own words and can notice, at least in retrospect, that they shifted [synthesis].

Phase B — Mapping (typically sessions 2–6) [synthesis on timing].

Goals: the client builds a personal map of what each state feels like in body, behaviour and belief; then maps triggers (what moves them out of ventral) and glimmers (what moves them toward ventral); then maps regulating resources [source: Kripalu 2019 "basic mapping sequence" and "alternative mapping exercises"; Canadian Blood Services Personal Profile Map from Dana 2020; TPI worksheet adapted from Dana 2018; Sounds True].
Move on when: the client has a usable map they can refer to and can identify at least a few personal glimmers and resources [synthesis].

Phase C — Tracking, navigating and co-regulating (ongoing, most of therapy) [synthesis on timing].

Goals: track state shifts in session and across time using guide questions; apply the four R's (recognise, respect, regulate/co-regulate, re-story) when a state shift occurs; use the elements of the social engagement system to co-regulate; identify and interrupt habitual response patterns; repair ruptures [source: Kripalu 2019; Sequence Wiz summary of Dana 2018].
Move on (or interleave Phase D) when: the client can catch a shift close to when it happens and use at least one resource to move toward regulation, alone or with the therapist [synthesis].

Phase D — Shaping the system and re-storying (overlaps C; later sessions) [synthesis on timing].

Goals: strengthen "vagal flexibility" with sound, movement, touch and breath; deliberately shape the system through repeated small experiences of ventral safety (glimmers, micro-moments); build individual and interactive resourcing; re-story the client's narrative from the new state [source: Kripalu 2019; Sounds True; Sequence Wiz].
Ending: create an ongoing polyvagal-informed plan the client keeps using after therapy [source: Kripalu 2019 "Create an Ongoing Polyvagal Informed Plan"]. Ending criteria (e.g. reliable return to regulation after ordinary triggers; story told from ventral rather than defence) are [synthesis].

Trauma processing. Dana's approach does not itself prescribe memory processing; when trauma processing is done, it is done by the host modality, with PVT tracking used to pace it [synthesis; uncertain whether Dana 2018 specifies this].

3. Guiding principles

Porges's three organising principles, as Dana teaches them, are neuroception, hierarchy and co-regulation [source: Kripalu 2019]. Other principles are drawn from Dana's practice materials where tagged.

Neuroception. Porges's term for detecting safety and danger below awareness; the body "decides" before the mind explains. Practical meaning: do not argue with a reaction; help the client bring it into awareness (move it from neuroception to perception) [source: Kripalu 2019; Sequence Wiz].
Hierarchy. PVT orders the states ventral → sympathetic → dorsal, and Dana's ladder pictures them as rungs [source: TPI ladder worksheet; Sequence Wiz]. Practical meaning: from shutdown, expect the route back to safety to pass through some mobilisation; a client moving from collapse into irritation may be moving up, not getting worse [source: Sequence Wiz "climbing back up"; interpretation synthesis].
Co-regulation. Porges treats safe connection with another person as a biological need, and Dana treats it as a key part of healing [source: Kripalu 2019; Sounds True]. Practical meaning: your own regulated presence (voice, face, timing) is the main intervention; regulate yourself before you try to regulate the client.
States are adaptive survival responses. Respect the state as protection that once served the person [source: Sequence Wiz summary of Dana 2018]. Practical meaning: name shutdown or fight as "your system protecting you", never as resistance or failure.
Ask what shaped the system, not what is wrong with the person. Dana's reframe: "What happened that shaped my system this way?" [source: Sounds True]. Practical meaning: use it to turn shame into curiosity during re-storying.
Befriending before changing. Notice and name states without judgement before trying to shift them [source: Sounds True]. Practical meaning: spend sessions on curiosity about states before teaching regulation skills.
Story follows state. Dana's approach holds that the story a person tells comes from their autonomic state and can be re-storied once they are regulated [source: Sequence Wiz summary of Dana 2018; Dana's phrase "story follows state" is widely quoted but is not confirmed in a source: uncertain]. Practical meaning: do meaning-making work from ventral; when the client is in defence, regulate first and discuss later.
Safety cues: inside, outside, between. Safety is shaped by the client's body, the environment and the relationship [source: Kripalu 2019; Sequence Wiz]. Practical meaning: check all three when a client cannot settle.
Small doses, many repetitions. Change comes from brief, repeated micro-moments of regulation [source: Sounds True "micro-moments"]. Practical meaning: aim for seconds-long glimmers, not long relaxation sessions.
Flexibility, not permanent calm. The goal is "vagal flexibility", moving between states and returning [source: Kripalu 2019 "Strengthening Vagal Flexibility"]. Practical meaning: do not frame sympathetic or dorsal states as enemies; healthy systems move.
Rupture and repair are expected. Autonomic disconnection between client and therapist will happen; repair is part of the work [source: Kripalu 2019]. Practical meaning: track your own and the client's shifts and name disconnection gently.
The client is the expert on their own map. Maps are personal; the therapist guides and does not interpret [source: Canadian Blood Services and TPI worksheets, which leave all content to the client; principle wording synthesis].
Collaborative, gradual pacing. Practices are introduced a few at a time across sessions [source: Norton UK page for Dana 2020]. Practical meaning: give one between-session practice at a time.
Theory as map, not fact. [synthesis] Present PVT terms as Porges's model; avoid telling clients their "vagus is damaged".

4. Intervention inventory

Scope note: the named practices below come from Dana's training outline, her worksheets and Porges's protocol as far as the sources show them [source: Kripalu 2019; Canadian Blood Services and TPI worksheets; Sounds True; Sequence Wiz; FirstSession]. Dana's books (2018, 2020) contain detailed instructions and about 50 named exercises that are not drawn on here. Where steps are not given in a source, they are written as [synthesis] consistent with the named purpose and do not reproduce Dana's wording. All example language is illustrative.

4.1 Creating an autonomically safe environment ("inside, outside, between")

Purpose / when: From the first session and whenever a client cannot settle. Dana's training teaches building the clinical environment with an "inside, outside, and between" guide [source: Kripalu 2019]: cues from inside the body, from the surroundings and from the relationship.
Steps [synthesis]: (1) Before the session, check the room: seating that lets the client choose distance and angle, a clear view of the door, controllable light and noise, nothing sudden behind the client. For video sessions, frame your face and upper body, use steady lighting and check audio delay. (2) At the start, invite the client to adjust their chair, distance, lighting or the door. (3) Over the first sessions, explore with the client which cues in each of the three areas help them feel a bit safer and which feel slightly threatening. (4) Record these and reuse them. (5) Between sessions, invite small environmental adjustments at home or work (e.g. closing a door while working) [source: Sequence Wiz example].
Example language (illustrative): "Before we start, take a look around. Is there anything you'd like to move or change so this space feels a little easier to be in?"
Watch for: The client's settling (softer face, slower breathing, more eye contact) after an adjustment versus continued scanning. People who comply instead of choosing may need explicit permission to change things.

4.2 Therapist self-tracking and self-regulation

Purpose / when: Before and throughout every session. Dana's training includes tracking autonomic state "in self and clients" and the clinician's responsibilities in a polyvagal-guided session [source: Kripalu 2019].
Steps [synthesis]: (1) Map your own three states (see 4.4) and your typical therapist-specific triggers, such as a client's silence or anger. (2) Before each session, take a few seconds to check: Where am I on my ladder? (3) If you are not regulated, use a brief personal resource: a slow exhale, feeling your feet, looking out of the window. (4) During the session, notice your own shifts as data about the interaction. (5) After the session, note moments of disconnection for supervision.
Example language (to self, illustrative): "I'm getting pulled into mobilisation. Feet down, longer breath out, soften my voice."
Watch for: Speeding up, flattening your voice, over-explaining or going numb. These signal that your system has left ventral, which reduces your ability to co-regulate.

4.3 Presenting Polyvagal Theory to clients (the ladder)

Purpose / when: Early in therapy. This gives a shared, shame-reducing language. "Presenting Polyvagal Theory to Clients" is a named training component [source: Kripalu 2019], and the ladder is the standard visual [source: TPI ladder worksheet adapted from Dana 2018].
Steps: (1) Draw or show a three-rung ladder: top = ventral (safe, social, connected); middle = sympathetic (mobilised, fight/flight); bottom = dorsal (immobilised, shut down, collapsed) [source: TPI; Canadian Blood Services]. (2) Explain neuroception in one or two sentences, and that the system moves between rungs automatically to protect the person. (3) Explain that the states are protective, not character flaws [source: Sequence Wiz]. (4) Give everyday examples of each rung and ask for the client's own. (5) Note that moving up from the bottom usually passes through the middle [source: Sequence Wiz; framing synthesis]. (6) Check understanding and how it felt to hear this; keep it to 10–15 minutes [synthesis].
Example language (illustrative): "Your nervous system has three main ways of keeping you safe. At the top you feel connected and okay. In the middle you get ready to fight or run. At the bottom it shuts things down to protect you. None of these is wrong. Each one has been trying to help."
Watch for: Relief and recognition, which are good signs. Watch also for the client using the terms to self-criticise ("I'm always dorsal, I'm broken"); reframe this as protection (see 5.8). Do not present the anatomy as settled fact [synthesis].

4.4 Basic mapping sequence: Personal Profile Map

Purpose / when: Phase B. The client builds a personal description of each state. Dana's training names a "basic mapping sequence", and its objectives include summarising "body responses, behaviors, and beliefs" for each state [source: Kripalu 2019]. The Personal Profile Map worksheet from Dana 2020 has a section for each of the three states [source: Canadian Blood Services worksheet]. Use the worksheet only from a legitimate copy of Dana's book; do not reproduce it.
Steps: (1) Explain that the map is personal and there are no right answers. (2) Map one state at a time. In Dana's book the sequence is, to my knowledge, dorsal first, then sympathetic, then ventral, so that the exercise ends in safety [uncertain: if unsure, always end on ventral] [synthesis on ordering rationale]. (3) For each state, ask what the body feels like, what the client does and what they believe about themselves and the world in that state [source: Kripalu 2019 "body responses, behaviors, and beliefs"]. (4) The client writes, draws or says the words; you write only what they say. (5) Before moving to the next state, check whether the client has drifted into the state they are mapping; if so, pause and use a resource (4.13–4.17). (6) Close by looking at the ventral section together and asking what it is like to remember that state. (7) The client keeps the map and adds to it over the following weeks.
Example language (illustrative): "Let's get to know what it's like for you when your system goes into shutdown. You don't need to go there now, just remember it from a little distance. What happens in your body? What do you tend to do? What does that part of you believe?"
Watch for: Mapping dorsal can bring on dorsal. Signs include a flat voice, slumping, long pauses and a glazed look. Keep this part short, stay closer than usual and move on sooner. The map is working when the client starts recognising states in daily life ("I noticed I was on the bottom rung on Tuesday").

4.5 Triggers and Glimmers Map

Purpose / when: After the profile map. It identifies what moves the client out of ventral (triggers) and the brief cues of safety and connection that move them toward it (glimmers) [source: TPI worksheet; Canadian Blood Services worksheet].
Steps: (1) Using the ladder or profile map, ask for triggers toward sympathetic, e.g. experiences of feeling overwhelmed, disrespected, frightened or angry. (2) Then ask for triggers toward dorsal, e.g. feeling unwanted, left out, alone or helpless. (3) Then ask for glimmers: moments of connection, safety, being seen, joy or beauty [source: Canadian Blood Services worksheet prompts, paraphrased]. (4) Write triggers and glimmers next to the relevant rung [source: TPI]. (5) Add any further observations [source: TPI "additional notes"]. (6) Always spend the last part on glimmers [synthesis]. (7) As homework, the client notices one glimmer a day and adds it to the map [synthesis].
Example language (illustrative): "Glimmers are tiny moments, even a few seconds, when something in you settles a little. The smell of coffee, a dog in the park, a kind text. What are some of yours?"
Watch for: Clients who cannot find any glimmers. Lower the bar to very small sensory moments (see 5.4). Watch also for the triggers list growing long enough to deflate the client; keep a balance. Progress shows when glimmers are noticed spontaneously and the list grows.

4.6 Regulating resources map (individual and interactive resourcing)

Purpose / when: Phase B–D. It identifies what helps the client shift toward ventral, both alone (individual) and with others (interactive). Dana's training covers "Individual and Interactive Autonomic Resourcing" [source: Kripalu 2019]. The personal map includes "what helps you shift", such as a particular piece of music or a person's voice [source: Sounds True]. Dana's 2018 book has a worksheet usually called the Regulating Resources Map [uncertain: name and layout not verified].
Steps [synthesis on sequence]: (1) For each state, ask what has helped, even slightly, to move one rung up. (2) Sort the answers into things the client can do alone (music, a walk, a pet, a breath) and things they do with others (a friend's voice, a hug, texting someone) [source: Sounds True; Sequence Wiz "bag of tricks" examples]. (3) Match resources to the state they are in. Mobilised states need active, discharging options, such as movement for anger; collapsed states need gentle, comforting options [source: Sequence Wiz]. (4) Write the resources on the map. (5) Test one in session and note its effect.
Example language (illustrative): "When you're on the middle rung, what has ever helped you even a little? And when you're right at the bottom, what's the smallest thing that has ever helped you come up a bit?"
Watch for: Resources that are actually avoidance or numbing, such as substances or scrolling. Name these kindly as protective, and look for alternatives that leave the client more connected rather than less.

4.7 Alternative mapping exercises

Purpose / when: For clients for whom written maps do not suit, e.g. children, clients with low literacy or neurodivergent clients, or when words fail. "Alternative Mapping Exercises" and "alternative mapping procedures" are named in Dana's training [source: Kripalu 2019]. The specific procedures were not available in the sources [uncertain].
Steps [synthesis]: Offer non-verbal formats for the same content as 4.4–4.6: colours or shapes for each state; three objects or images; positions in the room for each rung; a piece of music for each state. Process each format the same way: what is it like here, what moves you up or down, and end in ventral.
Example language (illustrative): "If each of the three states had a colour, what would they be?"
Watch for: Engagement and accuracy of self-recognition. The format matters less than whether the client can use it to recognise states.

4.8 Tracking state across time (guide questions)

Purpose / when: Phase C onward. The client builds moment-to-moment and day-to-day awareness of state shifts and patterns. Dana's training includes "Using the Guide Questions to Track Across Time" [source: Kripalu 2019], and her published advice includes checking one's state through the day to see patterns [source: Sounds True]. The guide questions themselves are not drawn on [uncertain].
Steps [synthesis]: (1) Agree two or three check-in times a day, e.g. waking, midday and evening. (2) At each, the client notes which rung they are on, what was happening, and anything that moved them. (3) A brief daily log or a mark on the ladder picture is enough. (4) In session, review the log for patterns, such as times of day, people, places or body cues. (5) Start sessions with a brief state check-in for both of you.
Example language (illustrative): "Where would you put yourself on the ladder right now? And what tells you that?"
Watch for: Tracking turning into anxious self-monitoring; reduce its frequency if so. Progress shows when the client catches a shift earlier, during an event rather than afterwards.

4.9 The four R's (in-session sequence for a state shift)

Purpose / when: Whenever a state shift happens in or outside a session. Recognise the autonomic state; respect the adaptive survival response; regulate or co-regulate into ventral; re-story [source: Sequence Wiz summary citing Dana 2018. Dana's original text is not drawn on, so the exact wording is uncertain]. Ashley 2020 adapted the same four R's for shame work [source: PESI blog, secondary].
Steps: (1) Recognise: notice body signs such as a racing heart, heat, sweaty hands, tense muscles, a flattened voice or a vacant look, and name the state. This moves it from neuroception into awareness [source: Sequence Wiz]. (2) Respect: acknowledge the state as protection; the client may even thank it [source: Sequence Wiz]. (3) Regulate / co-regulate: use the three supports of internal resources, environmental safety and social support, including the therapist's presence [source: Sequence Wiz]. (4) Re-story: once the client is in ventral, revisit what happened and what story the system was telling, and look for a more accurate, compassionate version [source: Sequence Wiz]. Do not go to step 4 until step 3 has worked [synthesis].
Example language (illustrative): "Something just shifted. Your voice got quieter. Can we pause and notice where you are on the ladder?" … "That makes sense. Your system is trying to protect you." … "Let's see what helps you come up a little. Would you like to look out of the window with me for a moment?" … "Now that you're a bit more settled, what was the story that came up just then?"
Watch for: Rushing to regulate before respecting the state, which clients can feel as being told to calm down. Progress shows when the client starts using the sequence on their own between sessions.

4.10 Befriending: notice, name, return

Purpose / when: A basic skill from Phase A on. Notice when you feel safe, name your state without judgement, and practise gently returning to regulation [source: Sounds True, paraphrasing Dana].
Steps: (1) Invite curiosity about the current state. (2) The client names it in their own words or by its rung, without evaluating it. (3) Notice also what regulation feels like when it is present [source: Sounds True]. (4) Practise a gentle, small return toward ventral using a known resource. (5) Repeat many times briefly, in session and as homework [synthesis on dosing].
Example language (illustrative): "Just notice where you are, as if you were saying hello to it. No need to change anything yet."
Watch for: Judging ("I shouldn't be here"). Model warmth toward the state yourself.

4.11 Co-regulating through the social engagement system

Purpose / when: Throughout every session, and especially when the client is in sympathetic or dorsal. Dana's training uses "individual elements of the [social engagement] system to co-regulate" [source: Kripalu 2019]. Porges describes the social engagement system as linking the face, head and voice. The listed elements (facial expressivity, prosody, eye gaze, head orientation, listening) come from Porges 2011 and 2017, which are not drawn on here [uncertain]. Cues of safety include eye contact with someone trustworthy, a soothing sound and a steady breath rhythm [source: Sounds True].
Steps [synthesis]: (1) Regulate yourself first (4.2). (2) Voice: slow down, lower your pitch a little and use a warm, melodic tone; avoid a flat or clipped delivery. (3) Face: soft eyes, a gentle and responsive expression; avoid a still or blank face. (4) Gaze: offer eye contact without insisting on it; let the client look away. (5) Timing: leave pauses and match the client's pace. (6) Posture and orientation: turn slightly toward the client, keep an open posture and avoid sudden movement. (7) Watch the client's response and adjust.
Example language (illustrative, spoken slowly and warmly): "I'm right here. There's no rush."
Watch for: The same cues can feel threatening to some clients. Eye contact, closeness or warmth may be linked to past harm (see 5.6). Co-regulation is working when the client's breathing slows, colour returns to their face and they reconnect with you.

4.12 Identifying and interrupting patterns

Purpose / when: Phase C, once the map and tracking show recurring sequences, e.g. criticism leading to collapse. "Identifying and Interrupting Patterns" is a named component of Dana's training [source: Kripalu 2019]; specific steps are not drawn on [uncertain].
Steps [synthesis]: (1) From tracking logs, pick one recurring pattern: trigger, then state, then behaviour, then belief. (2) Map the earliest body cue in the sequence. (3) Choose a small action to take at that cue, a resource from 4.6. (4) Rehearse it in session by recalling a mild version of the trigger, never a severe one, and practising the interruption. (5) Try it between sessions and review the outcome.
Example language (illustrative): "So the pattern usually starts with your jaw tightening. What if, at that exact moment, you tried one slow breath out and put your feet on the floor?"
Watch for: Picking patterns that are too charged. Start with low-intensity patterns.

4.13 Breath practices

Purpose / when: Phases C–D, to shift state and build flexibility. Dana's training includes "breathing patterns" [source: Kripalu 2019]. Slow breathing through the nose is offered as a vagal-tone practice [source: Sounds True]. Practices that emphasise a longer exhale are common in polyvagal-informed teaching, but specific ratios are not confirmed [uncertain].
Steps: (1) Starting position: seated, feet on the floor, eyes open or lowered as the client chooses. (2) Breathe in gently through the nose without forcing [source: Sounds True]. (3) Let the out-breath be a little longer and softer than the in-breath, perhaps with pursed lips or a soft sigh [synthesis]. (4) Do 3–5 breaths, then return to normal breathing [synthesis]. (5) Close by asking what the client notices and where they are on the ladder.
Example language (illustrative): "Let's try a few slow breaths, only if it feels okay. Breathe in gently, and let the breath out be a little longer, like a slow sigh."
Watch for, and contraindications [synthesis]: This is a gentle practice, not breath intensification. Stop if the client feels dizzy, tingling, air hunger, panic or a pull into dorsal. For clients with asthma, COPD or panic disorder, keep breathing natural and use non-breath resources instead. Some clients find any focus on breathing threatening; offer an alternative such as looking around the room or feeling their feet.

4.14 Sound and voice (humming, singing)

Purpose / when: Phases C–D. Dana's training includes sound for vagal flexibility [source: Kripalu 2019]. Humming and singing are offered as vagal-tone practices [source: Sounds True], and singing is an example in Sequence Wiz's "bag of tricks" [source: Sequence Wiz].
Steps [synthesis on detail]: (1) Explain the purpose and ask permission; some clients feel self-conscious. (2) Seated, the client takes a comfortable breath and hums a single low or mid tone on the out-breath for several seconds. (3) Repeat 3–5 times. (4) Notice vibration in the chest, throat or face. (5) Alternatively, use a favourite song or hum along to music at home. (6) Close with a ladder check.
Example language (illustrative): "Would you be willing to try humming with me, just a low hum on the out-breath? I'll do it too, so you're not on your own."
Watch for: Embarrassment, which moves the client toward sympathetic. Humming with them helps, and so does using music at home. The practice is working if the client reports feeling settled, warm or noticing vibration.

4.15 Movement

Purpose / when: Phases C–D. Use movement to mobilise out of dorsal or to discharge sympathetic energy. Dana's training includes movement for vagal flexibility [source: Kripalu 2019]. Active movement for anger and comfort for withdrawal are matched examples [source: Sequence Wiz]. Yoga and walking are listed as tools [source: Sequence Wiz].
Steps [synthesis]: (1) From dorsal: start very small, such as wiggling fingers or toes, turning the head slowly to look around, or pushing the feet into the floor. Then, if the client wishes, stand up and shift weight from side to side. (2) From sympathetic: offer purposeful, controlled movement such as walking around the room, pressing the palms together or pushing against a wall, then slowing down. (3) Follow every movement with stillness and a ladder check. (4) Keep each round to 30–60 seconds and repeat if helpful.
Example language (illustrative): "Your body might want to move a little. Would it feel okay to press your feet into the floor and notice that?"
Watch for: Movement that escalates rather than discharges, or stopping too suddenly. These are gentle, voluntary movements. Cathartic discharge such as hitting or screaming is not part of Dana's approach as described in the sources [synthesis].

4.16 Touch (self-touch and, with training, therapist touch)

Purpose / when: Phases C–D. Use touch to offer a cue of safety. Dana's training lists touch among the tools for vagal flexibility [source: Kripalu 2019]. A hand placed on the heart is an example micro-moment [source: Sounds True]. The sources do not describe therapist-to-client touch protocols [uncertain]. Default to self-touch [synthesis].
Self-touch steps: (1) Seated, the client places one hand on the heart or chest, or one on the chest and one on the belly, or cups their own cheek or arm [source: Sounds True for hand on heart; other placements synthesis]. (2) They notice warmth and pressure for 30–60 seconds [synthesis]. (3) Close with a ladder check.
Therapist touch (only if trained, supervised and permitted) [synthesis]: Limit it to non-intimate areas, such as a hand on the upper back or shoulder, or holding a hand. Follow these consent steps: (1) explain what and why before any touch; (2) ask explicitly and accept a no; (3) offer a no-touch alternative, such as self-touch or a cushion held by the client; (4) agree a stop signal; (5) check in during and after; (6) record the consent. Touch requires specific training and supervision. Check what your licence, professional code and jurisdiction allow. Never use sexual or genital touch.
Example language (illustrative): "Some people find it settling to rest a hand on their chest. Would you like to try that, or would you prefer to just notice your hands in your lap?"
Watch for: Touch can trigger trauma memories, especially for survivors of physical or sexual abuse. A freeze response can look like compliance. If the client stills, holds their breath or dissociates, stop and reorient.

4.17 Vagal brake exercises

Purpose / when: Phase D. Practise flexibly releasing and re-engaging the "vagal brake", Porges's term for the ventral vagal influence on heart rate. Dana's training includes "neural exercises to relax and re-engage the vagal brake" [source: Kripalu 2019]. The exercises themselves are not drawn on [uncertain].
Steps [synthesis, based on the stated aim]: (1) From a ventral starting point, the client does a brief, mildly activating activity of their choice, such as marching on the spot or a quick stretch. (2) They notice the activation. (3) They return to settling with a known resource, such as a slow exhale, looking around or a hand on the heart. (4) They notice the return. (5) Repeat 2–3 times and increase intensity only slightly across sessions.
Example language (illustrative): "We're going to practise going up a little and coming back. Notice your heart picking up, and then notice it settling again."
Watch for: Activation that does not come back down. If that happens, reduce intensity and stay with co-regulation. Screen out cardiac conditions before any exercise that raises heart rate [synthesis].

4.18 Glimmers and micro-moments

Purpose / when: Phase D and ongoing. Use brief, repeated moments of ventral safety to shape the system. Micro-moments such as a hand on the heart or stepping outside for fresh air [source: Sounds True]. Glimmers are mapped on the ladder [source: TPI; Canadian Blood Services].
Steps [synthesis on detail]: (1) Ask the client to notice glimmers in daily life. (2) When one happens, they pause for a few seconds to register it in the body. (3) They note it briefly. (4) In session, review a glimmer, recall it, and savour it for 20–30 seconds. (5) Over time, the client creates glimmers on purpose by choosing music, places and people.
Example language (illustrative): "When you notice a glimmer, stay with it just a few seconds longer than usual. What happens in your body?"
Watch for: Forced positivity. Glimmers are noticed, not manufactured. The practice is working when the client finds more glimmers with less effort.

4.19 Rupture and repair

Purpose / when: Whenever autonomic disconnection occurs between therapist and client. "Rupture and Repair in Clinical Sessions" and identifying autonomic disconnection and repairing it are named training components [source: Kripalu 2019].
Steps [synthesis]: (1) Notice the signs of disconnection in both of you: a withdrawn gaze, a flatter voice, the client agreeing too quickly, or you becoming defensive. (2) Regulate yourself. (3) Name the moment tentatively and take responsibility for your part. (4) Invite the client's experience without defending yourself. (5) Notice the return of connection together. (6) Later, frame the repair as part of building safety.
Example language (illustrative): "I think I may have moved too quickly a moment ago, and something between us shifted. I'd like to understand what that was like for you."
Watch for: Clients who appease ("it's fine") with dorsal or sympathetic signs. Return to it gently later. The repair is working when warmth and spontaneity return.

4.20 Re-storying

Purpose / when: After regulation is achieved, in Phases C–D. Change the story the client tells about why they feel or act as they do [source: Sequence Wiz summary of Dana 2018]. Use the reframe "What happened that shaped my system this way?" [source: Sounds True].
Steps [synthesis on detail]: (1) Only begin once the client is in ventral. (2) Ask the client to say the old story, such as "I'm weak" or "People always leave". (3) Ask which state that story comes from. (4) Ask what happened that shaped their system to respond this way. (5) Co-create a version from ventral that acknowledges the protection. (6) The client may write it down and revisit it. (7) Return to the new story in later sessions.
Example language (illustrative): "When you say 'I always freeze, I'm useless', which rung is that coming from? What happened that taught your system that freezing was the safest thing to do?"
Watch for: Re-storying from sympathetic or dorsal, which produces debate or hopelessness. If that happens, pause and regulate first.

4.21 Intentionally shaping the system and the ongoing plan

Purpose / when: Phase D through ending. Deliberately and repeatedly practise patterns that build ventral capacity, and create a plan the client takes forward. "Intentionally Shaping the System" and "Create an Ongoing Polyvagal Informed Plan" are named components [source: Kripalu 2019].
Steps [synthesis]: (1) Review the maps, logs and the resources that worked. (2) Choose a short daily routine: a check-in, one glimmer and one resource. (3) Identify the client's people for co-regulation. (4) Write an early-warning list of their personal signs of each state and what to do. (5) Plan for setbacks. (6) Agree follow-up arrangements.
Example language (illustrative): "Let's put together what you know now about your own nervous system: your early signs, what helps, and who helps."
Watch for: A plan that is too ambitious. A few small, reliable practices are better than many.

4.22 Safe and Sound Protocol (SSP) — an adjunct developed by Porges

Purpose / when: A listening programme developed by Porges and described as a "therapeutic listening program". It is often used alongside talk, somatic or occupational therapy [source: FirstSession page]. It is not part of Dana's talk-based approach. It is delivered by trained practitioners who determine whether it suits the client [source: FirstSession].
Steps: (1) Complete provider training and licensing through the distributor, currently Unyte [uncertain: training details]. (2) Screen the client and make sure they have regulating resources first [synthesis]. (3) The client listens to specially processed music through headphones in a calm setting [source: FirstSession]. (4) Sessions run roughly 30–60 minutes, spread across days or weeks [source: FirstSession]. (5) The therapist monitors responses and adjusts the pace [source: FirstSession]. (6) Integrate the client's reactions into therapy using the mapping language. The current pathway names, total listening hours and remote-delivery rules come from distributor materials, which are not drawn on [uncertain]. Follow current provider guidance.
Example language (illustrative): "While you listen, we'll keep checking how your system is doing. If anything feels like too much, we stop or slow down."
Watch for: Over-stimulation or dysregulation during or after listening, such as fatigue, irritability, emotional flooding, sleep change or sensitivity to sound. If these appear, reduce the dose and pace [source: FirstSession on adjusting pace; specific signs synthesis]. Explanations of how SSP works are hypotheses [source: FirstSession].

5. Handling problems

The sources address only a few of these directly: rupture and repair, interrupting patterns, pacing practices gradually, and adjusting SSP pace [source: Kripalu 2019; Norton UK page; FirstSession]. Everything else in this section is [synthesis] unless tagged otherwise.

Screening before body-based practices [synthesis]. Before breath, movement, vagal-brake or touch work, ask about pregnancy, cardiovascular conditions such as arrhythmia or fainting, respiratory illness such as asthma or COPD, epilepsy, recent injury or surgery, psychosis, severe dissociation, active suicidality, and recent trauma without stabilisation. If any are present, keep to the gentlest options (orienting to the room, self-touch, co-regulation through voice) and get medical advice where relevant. Polyvagal-informed practices are not a treatment for physical disease.

5.1 Overwhelm or flooding during mapping or tracking

Signs: speeding up, tears that escalate, tremor, or loss of contact.
Response: stop the content. Name the shift (4.9). Orient the client to the room and to you. Use a slower voice and a longer exhale yourself. Invite the client to press their feet into the floor or look around. Resume only from ventral, and with smaller doses: map at a distance ("remember it from across the room"), and keep dorsal and sympathetic sections short [synthesis]. End every session on ventral or with a glimmer [synthesis].

5.2 Dorsal shutdown or dissociation in session

Signs: a flat or glazed look, a slumped posture, long pauses, sentences fading out, feeling far away.
Response: do not push talk. Lean in slightly, use a warm and lively prosody, and say the client's name. Invite small movements, such as wiggling the fingers, turning the head to look around or pushing into the chair (4.15). Offer sensory orienting by naming three things they can see. Expect some sympathetic energy on the way up and welcome it [source: Sequence Wiz ladder; response synthesis]. If shutdown is frequent or severe, assess for a dissociative disorder and slow the pace of therapy [synthesis].

5.3 Sympathetic escalation (anger, agitation, panic)

Response: regulate yourself first. Do not mirror the escalation. Make space: offer more distance and a clear view of the door, and let the client stand or walk. Use purposeful movement (4.15), then slowing down. Respect the protective function ("part of you is ready to defend you") [source: Sequence Wiz respect step; wording illustrative]. Re-story later, not in the moment.

5.4 "I don't have any glimmers" / "nothing helps"

Response: lower the bar to seconds-long sensory moments such as warmth, light or a sound, or to neutral rather than pleasant moments. Look for moments in the session itself, and use the therapeutic relationship as the first glimmer [synthesis]. Mapping and finding glimmers can take weeks. Persistent hopelessness also calls for depression and suicide risk assessment (see 5.10).

5.5 Non-adherence to between-session practices

Response: give one practice at a time, introduced gradually [source: Norton UK page for Dana 2020]. Tie it to an existing routine such as tea or brushing teeth, and keep it under one minute. Explore what got in the way, using the ladder: avoidance often has a state behind it, such as shutdown or overwhelm. Respect that state rather than labelling it resistance [synthesis].

5.6 Cues of safety experienced as threat

Some clients feel eye contact, warmth, closeness, a gentle voice or being looked at as dangerous, for example because of past grooming, abuse by people who were "nice", or neurodivergent sensory profiles [synthesis].
Response: map the client's own cues of safety and danger. Do not assume the typical ones. Offer side-by-side seating or less eye contact, and let the client control gaze and distance. Ask explicitly how your voice and pace land for them.

5.7 Rupture

Use 4.19 [source: Kripalu 2019]. Common polyvagal-specific ruptures: telling a client to calm down or breathe before respecting their state; over-cheerful prosody that feels false; and the therapist leaving ventral without noticing. Name these and take ownership [synthesis].

5.8 Theory used against the self or misunderstood

Signs: "My vagus nerve is broken", "I'm always dorsal", or self-diagnosis from social media.
Response: return to respect. States are protective, systems are flexible, and the terms are Porges's model rather than a lab diagnosis. Avoid physiological claims you cannot support, and keep the language as a shared map [synthesis].

5.9 The therapist's own dysregulation

Response: a pre-session check-in and self-map (4.2). Brief self-regulation in the moment. Supervision or consultation for recurring triggers, such as a client's anger or silence. Dana's training includes compassion and self-compassion as autonomic processes [source: Kripalu 2019 objectives; application synthesis].

5.10 Suicidality and self-harm

Dorsal collapse can show up as hopelessness and wanting to disappear, and sympathetic states as agitation. Neither replaces standard risk assessment [synthesis].
Response: when hopelessness or self-harm appears, carry out structured risk assessment according to your service's protocol. Make a collaborative safety plan, including the client's mapped warning signs and resources from 4.6. Do lethal-means counselling: safe storage and removal of means. Arrange crisis contacts and increase session frequency or refer onward as indicated. Body practices are an adjunct, never a substitute.

5.11 Telehealth

Response: you have fewer social engagement cues on video. Frame your face well, slightly exaggerate your facial expression and prosody, and minimise audio lag. Check the client's environment at the start (privacy, door, who else is nearby), and agree what to do if the connection drops during dysregulation [synthesis].

5.12 Problems with SSP or other adjuncts

Response: over-stimulation calls for a slower pace or a smaller dose [source: FirstSession on adjusting pace; detail synthesis]. Pause SSP if dysregulation persists between sessions. Make sure regulating resources and co-regulation are in place first. Follow distributor guidance on screening and dosing [uncertain].

5.13 When polyvagal framing is not enough

Polyvagal-informed work is a framework layered on therapy. If symptoms such as PTSD, OCD or severe depression do not improve, add or switch to the evidence-based treatment for that disorder, and use polyvagal tracking to pace it [synthesis].

Sources

Sources:

Further reading (not drawn on) [uncertain where relied on]:

Porges, S. W. (2011). The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation. Norton.
Porges, S. W. (2017). The Pocket Guide to the Polyvagal Theory. Norton.
Dana, D. (2018). The Polyvagal Theory in Therapy: Engaging the Rhythm of Regulation. Norton.
Porges, S. W., & Dana, D. (Eds.) (2018). Clinical Applications of the Polyvagal Theory. Norton.
Dana, D. (2020). Polyvagal Exercises for Safety and Connection: 50 Client-Centered Practices. Norton.
Dana, D. (2021). Anchored: How to Befriend Your Nervous System Using Polyvagal Theory. Sounds True.
Porges, S. W. (2022). Polyvagal Theory: A Science of Safety. Frontiers in Integrative Neuroscience, 16, 871227 (abstract only).
Ashley, P. (2020). Shame-Informed Therapy. PESI.

Research limits: Dana's books and Unyte's SSP materials are not drawn on. Steps marked [synthesis] are not Dana's or Porges's instructions. Check them against the books before relying on them.

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