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    Applying Polyvagal Theory in Clinical Care

    The previous Substack articles have described many of the fundamental principles of Polyvagal Theory, including its application to sustainable high performance.  Not only does this theory provide an understanding of how our nervous system functions in response to internal and external stimuli, it provides a framework that we can apply to our everyday lives.  In order to promote health, wellbeing, and sustainable high performance within the paradigm of The Practices of the Healthcare Athlete, application of Polyvagal Theory within the context of clinical care is necessary.

    Each of the physiological states described within Polyvagal Theory, specifically ventral vagal, sympathetic, and dorsal vagal, can be both adaptive and less than ideal dependent upon the specific situation we are encountering.  Each state has distinct benefits.  The ventral vagal state is needed for recovery, restoration, and healing of our mind and body.  In fact, an insufficient amount of ventral vagal tone can lead to physical ailments, including cardiac conditions, high blood pressure, decreased immune function, poor digestion, and increased inflammation.

    Given the importance of the ventral vagal complex for recovery and restoration, it follows that individuals being treated within the healthcare system for an illness or injury or recovering from surgery would be best served by increasing their ventral vagal tone.  Furthermore, the nature of recovery from illness, injury, and/or surgery would inherently be a cue of threat to our neuroception, making the provision of cues of safety even more needed for a ventral vagal state to predominant and facilitate recovery and restoration.

    Within the typical Western medical paradigm, there is little attention paid to promoting cues of safety to patients during their care.  For the reasons described above, it would be beneficial to patients if cues and habits of safety were promoted for each individual and collectively provided within the clinical setting.  This would create a more optimal environment to promote patient health, wellbeing, and healing, which is the primary goal of clinical care.  Alterations within the current paradigm of clinical care could be made to accomplish this objective.

    Another important consideration within clinical care is the role of empathy and compassion.  Empathy involves understanding and, in fact, experiencing the emotions and/or feelings of another individual.  In the clinical context, this involves the healthcare provider feeling what the patient is feeling.  Given the nature of the clinical encounter, it would be common for patients to have feelings of worry, anxiety, fear, and pain.  If a healthcare provider were to truly feel such emotions, then it would be likely that, unintentionally, cues of threat may be portrayed to the patient.  Through neuroception, the patient would then receive these cues and descend further in the physiological state hierarchy towards a more sympathetic or dorsal state.  This is the opposite of what is intended and what is needed for recovery.

    In contrast to empathy, compassion is described as a state in which we are able to be present with the feelings of another individual and provide support and assistance without necessarily experiencing the associated feelings.  From a polyvagal lens, this would allow the clinician to be present with the patient, provide support and assistance without necessarily emitting cues of threat.  In addition, a truly empathetic healthcare provider would be frequently exposed to a high level of strong emotions that may overcome available cues of safety leading the provider to descend in the physiological state hierarchy towards a more sympathetic or dorsal vagal state.

    For the reasons discussed, it seems pertinent to consider whether or not empathy or compassion is the preferred trait for healthcare providers within the clinical context.  From a polyvagal perspective, it seems as though compassion may be more beneficial to the patient and provider alike.  If a provider were to demonstrate empathy, it would be important, from the polyvagal lens, to ensure that the provider is grounded in sufficient ventral vagal tone to avoid providing cues of threat to both the patient and themself.

    In order for healthcare providers to promote their own health, wellbeing, and sustainable high performance it is important to develop skills and habits to promote vagal efficiency and a strong vagal brake.  This is needed in order to sufficiently ground within the ventral vagal physiological state to allow for recovery and restoration as well as to enter the optimal performance zone, the Play Zone (described in a prior article).  The Practices of the Healthcare Athlete involves development of such skills and habits from a polyvagal informed perspective.

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