The Power of Voice for Healthcare Professionals

Our voice is a very important component of the social engagement system and, through this function, is a significant contributor to health, wellbeing, and sustainable high performance.

In the pursuit of health, wellbeing, and sustainable high performance, from the polyvagal informed paradigm of The Practices of the Healthcare Athlete, all skills and strategies that contribute to this pursuit are developed.  This creates a toolbox with many different and complimentary skills that can be utilized as needed.  A previous article described the social engagement system.  Within this system, the use of voice is an important skill to integrate within our routines.

It is very exciting to present this article, written by an expert in the polyvagal informed aspects of using our voice, Mathilde Shisko.  Mathilde is a Polyvagal – Informed voice, public speaking and TEDx speaker coach from Vancouver, Canada. Her passion is helping people rediscover their voice to optimize their performance and revitalize their lives. More information about her work can be found on her website  I strongly encourage you to check out her work!


Almost all of us are born with a 2-4-octave range in our voices capable of expressing a gamut of emotion. As a child, we used it to wail and cry to get attention, cause a terrific scene in the grocery store and communicate through gurgles and delighted screams in the sand box.

Polyvagal Theory, first described by Porges, tells us our breath is a key portal into our physiological state and our voice is the broadcaster of it. The Vagus Nerve’s most recently evolved branch – the Ventral Vagal Complex – forms our Social Engagement System. Our larynx, the engine to our voice, sits on this communication freeway. When we are connected to what we say, “we wear our heart on our face and hear it in our voice,” says Dr. Stephen Porges, father of the Polyvagal Theory. It makes sense. The same superhighway of connection and communication links our larynx to the striated muscles of the face, our inner ear, our head, our lungs and our heart. 

Our voice is directly linked to how we breathe and how we breathe is directly linked to our physiological state. Our voice can be an inhibitor or a promoter of those states, by moving reflexively or intentionally between them. 


Different pitch patterns send different cues and produce different meanings. With our understanding of Polyvagal Theory, we can attune to these patterns to identify physiological states on the autonomic ladder. In turn we can intentionally manoeuvre our breathing and vocal patterns to help change our physiology.

When we are in our Ventral Vagal state of safety and connection, our voice is not necessarily calm, even and quiet. It has prosody. Our voice is connected to our intention, which reflexively changes our volume, pitch and intonation to support our objective. In this state, we can organize our thoughts and vocalize well because we are supported by our breath. Our voice is flexible, free and engaging. We show up as capable, present and connected.

When in our mobilized state of fight/flight, the Sympathetic Nervous System is recruited in defense. Here the result will be a voice that is higher, sometimes breathy, strained or even monotone with minimal breath support. As our heart rate goes up, our breath becomes shallow and quick. There is tightness in all the muscles associated with respiration and a constriction of the muscles in the airways and around the larynx. As the pitch goes up in this sympathetic activation, the message we send is one of nervousness, anxiety, uncertainty, fear or warning. In addition, yelling and screaming in this state will cause discomfort in the vocal diaphragm taking some time to recover.

In the absence of threat and when this hyperarousal state is not deployed for defense ( the mobilized energy in our voices is heard as joy, passion and exuberance. It can also be our authoritative, teacher or parent voice.

When we move down the ladder into the hypo arousal state of the Dorsal Vagus, we withdraw, disconnect or at worst, freeze and shut down. In this state, we can lose our voice altogether. Access to the language centers in our brain is interrupted and therefore, connecting to our thoughts in a cognitive, cohesive way becomes impossible. In this survival state, people may feel shame in not having spoken up or in not having the words, but in this state, it is physiologically a very difficult thing to do. When we are not in survival mode our Dorsal voice becomes softer and more quiet supporting moments of intimacy and comfort. We can rest, digest and restore.


Our voices, in any state, are valid and I believe mine to be my greatest ally. She is my social justice warrior, my advocate, my caregiver, my educator, my truth teller, defender and peacekeeper. She is the one who sang my children to sleep, who soothed them before an operation and played with them when their father left. My voice deserves great respect and careful attention. 

The goal is to have a voice that is flexible enough to move through these states with ease, clarity and intention to support our physiology. Recognising our vocal patterns or “default” voices is the first step in deconstructing limiting beliefs about our voices, then we can begin to return to the abundant voices we were born with.

And our brains LOVE the sound of our own voice. It is soothing and familiar and becomes an incredible resource for self-regulation. Humming, whistling and even singing a gentle, repetitive melody to yourself can help you to down regulate. Our first caregiver soothed us with gentle, melodic tones. It was the prosody of the voice and gentleness in the touch that helped to myelinate our Ventral Vagus Nerve and efficiently activate our Social Engagement System. This co-regulation within a container of safety actually helped to create the nervous system of another human being and is another cornerstone of Porges’ Theory.

We can apply a variety of vocal exercises and extensions to stimulate the Ventral Vagal Complex fostering safety and connection.

Here are 3 things you can do during a busy day to activate the Parasympathetic Nervous System.

  1. Hum while you make a cup of tea. 
  2. Whistle while you walk at lunch. 
  3. Speak gently and compassionately to yourself after a tough meeting or before going into a high stakes environment, it can help you better take control of the situation. 

Also consider how these skills and exercises can be readily integrated into the typical routine of any healthcare professional.  Between surgical cases, walking between clinic patients, rounding on inpatients, or taking a few minutes for oneself are all good opportunities to implement these empowering skills and strategies.

The voice is an intricate and complex creature as beautiful as it is wild. I invite you to pay attention to it. Becoming familiar with its nuance and potential is powerful and liberating.


Allison, M.  The Play Zone:  A Neurophysiological Approach to our Highest Performance.

Porges, SW.  Preseidential Address, 1994.  Orienting in a Defensive World: Mammalian Modifications of our Evolutionary Heritage.  A Polyvagal Thoery.  Psychophysiol 1995; 32: 301-318.

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

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