Polyvagal Informed Healthcare

By embodying the principles of Polyvagal Theory within the healthcare system, it becomes possible to improve the experience and outcome for healthcare professionals and patients alike.

The principles of Polyvagal Theory have been described in past articles, as have many of the strategies for training the nervous system in a polyvagal informed fashion.  This article will emphasize a few of the many potential direct applications of these skills and strategies within the healthcare system.  By incorporating a polyvagal informed paradigm within this context, there can be substantial and important benefits for healthcare professionals, their colleagues, and patients.  Across each of these populations, embodiment of these principles will promote health, wellbeing, and sustainable high performance.

From the perspective of healthcare professionals, there are several direct benefits from incorporating a polyvagal informed paradigm.  To begin this consideration, recall the first time performing a particular skill independently.  This could be a very commonly performed skill that during training was performed countless times with supervision.  Now recall how it felt that first time the skill or task was performed without a supervisor present.  For most, if not all of us, it was a completely different experience.  I can vividly recall the drop in confidence, the second guessing, and doubt that I experienced the first time I performed a common surgical procedure without an attending surgeon at my side.  

Why does this occur?  After all, we have performed the skill numerous times, we have demonstrated competence in performing the task, there is no change to our knowledge, skill, or preparation.  And yet, all of a sudden, once the supervising professional is not at our side what was previously a very doable task seems insurmountable.  From a polyvagal perspective, this is readily explained.  When performing a skill in the presence of a supervisor, that individual provides, in an ideal situation, co-regulation to our nervous system.  As soon as they are no longer present, that co-regulation is removed and we can become flooded with cues of uncertainty, risk, and threat.  As this happens, our biology shifts towards sympathetic states and as further stimuli are encountered, we can shift further into sympathetic and, even, dorsal vagal states.

The understanding of the biological processes within this situation can provide several potential strategies to assist.  From the perspective of the supervisor, they can be mindful of ways to continue to provide co-regulation while encouraging independent performance of the skills and tasks.  This would be individual specific and is dependent upon an understanding of the importance of co-regulation.  From the perspective of the professional performing the skill or task, recognition of the shifts in biology with subsequent utilization of specific strategies to shift the biological state towards one with greater ventral vagal stabilization can be highly effective.  These skills should, however, be developed in advance in order to provide optimal benefit.

Healthcare professionals regularly encounter evolving circumstances, emergency situations, and unexpected changes in scheduling.  Each of these stimuli can provide significant cues of uncertainty, risk, and threat, leading to predictable shifts in biological state towards sympathetic and dorsal vagal states.  Not only can this occur for us, but it similarly occurs for many, if not all, of our colleagues and staff.  The application of a polyvagal informed perspective allows us to manage these common occurrences in a more constructive fashion.  The frequent and common reaction to these changes and unexpected events includes frustration and aggravation.  Not only can this lead to nervous system dysregulation for the index individual but their subsequent shift in biological state can impact those around them.  There can be a reinforcing experience of progressive frustration and aggravation that can become counter-productive and unpleasant.

When a polyvagal informed perspective is applied to these situations, we can acknowledge the situation for what it is and recognize the initial shift it may cause in our biological state.  To the extent that this recognition can be achieved without judgement, we can then reduce the amount of frustration or aggravation with which we react.  This can primarily occur by avoiding identification with the situation and any narrative to explain how difficult the scenario may be or how frequently it may occur.  If we are able to accomplish this, we can then implement our mind-based and body-based skills and strategies to shift our biological state towards a more ventral vagal stabilized state which then allows us to not only self-regulate but co-regulate those around us.  George Mumford describes this process as the space between stimulus and response, in which we are able to direct our actions more in alignment with our values, principles, and philosophy.  The polyvagal informed paradigm further allows us to develop compassion for ourselves and those around us through recognition that behaviors exhibited are frequently a reflection of biological state rather than characteristics inherent to that individual.  Such an understanding promotes support and compassion for ourselves and those around us.  This leads to progressively greater regulation of each of our nervous systems.

The primary purpose of each healthcare professional is to care for and assist their patients.  Considering this interaction from a polyvagal informed perspective can provide insights that can be beneficial to the patient and healthcare professional.  As has been described in past articles, the existence of injury, illness, disease, or recovery from a procedure can provide significant cues of uncertainty, threat, and risk to patients.  The nature of the healthcare system and the context within which patients seek care can further increase such cues.  As such, it is often the case that patients and their loved ones can experience biological state shifts towards sympathetic and dorsal vagal states.  In order to optimally provide care for these individuals, it becomes important for healthcare professionals to provide cues of safety and connection to patients.  In order to accomplish this, it is first necessary to self-regulate and increase ventral vagal stabilization.  It is only from this state that we are able to authentically and effectively co-regulate others.  

This has important implications for the dichotomy between compassion and empathy.  When we display empathy, we experience the feelings and emotions of another individual.  If that person, for example, is scared, worried, anxious, depressed, or angry, then we also experience these feelings, leading to a shift in our biological state.  In the healthcare setting described above this would typically lead to providing cues of uncertainty, risk, and threat to patients if healthcare professionals are empathetic to the feelings of their patients.  This may, unintentionally, lead to further shifts in biological state amongst patients. 

Conversely, compassion is considered to be the state in which we can take in and be present with the feelings and emotions of others and provide support and assistance.  This typically does not result in experiencing the feelings of another, thereby avoiding providing cues of uncertainty, risk, and threat and rather emitting cues of connection and safety.  This illustrates a polyvagal informed explanation regarding how compassion can be more beneficial for patients than empathy.  This important topic will be covered in further detail in future articles.

The final consideration for this article is the foundational necessity of ventral vagal states to promote recovery and restoration.  This has been described more completely in past articles.  It does, however, serve as an important reminder that ventral vagal stabilized states are necessary for recovery and restoration of homeostasis.  Without sufficient ability to restore homeostasis, we are at risk of numerous physical, emotional, and psychological illnesses and disorders.  As the primary goal of healthcare should be to improve the health and wellbeing of the population, the ability to enhance ventral vagal activation should be a foundational principle.  This applies equally to healthcare professionals, patients, and the general population.

As can be appreciated from the above examples, there are numerous benefits from implementing a polyvagal informed paradigm within the healthcare system.  These apply to healthcare professionals as well as patients and the general public.  The polyvagal informed Practices of the Healthcare Athlete, thus provides an important foundation for the optimization of health, wellbeing, and sustainable high performance within the healthcare system.  


Allison, M.  The Play Zone:  A Neurophysiological Approach to our Highest Performance.  https://theplayzone.com.

Dana, D.  Polyvagal Exercises for Safety and Connection: 50 Client-centered Practices.  New York: W.W. Norton & Company; 2020.

Dana, D.  Anchored: How to Befriend Your Nervous System Using Polyvagal Theory.  Boulder, Colorado: Sounds True, 2021.

Mumford G.  The Mindful Athlete: Secrets to Pure Performance.  Berkeley, CA: Parallax Press, 2016.

Porges, SW.  Polyvagal Safety: Attachment, Communication, Self-Regulation.  New York: W.W. Norton & Company; 2021.

Porges, SW.  The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, Self-Regulation.  New York: W.W. Norton & Company; 2011.

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