Is the Polyvagal Theory dangerous? I am collecting experiences from clients and professionals
Your experience matters—even if things did not go well
Lees je liever de Nederlandse versie?
A theory that does not reach people changes nothing. The polyvagal theory (PVT) has reached a worldwide audience over the past thirty years, and a question that has been on my mind for some time is what those people have gained from it.
In debates around the PVT, the suggestion has recently been made with some regularity that working from a polyvagal-informed perspective is unethical or even harmful. Characterizations that do not fit my experience at all1, but that I am not willing to simply dismiss. There is, after all, a chance that there is some truth to them—and these suggestions, made without any supporting evidence from client stories, made me not only angry but also curious.
In the comments below this article, I would therefore like to collect experiences. From clients, therapists, colleagues, and participants who attended a training with me. I am doing this partly to illustrate the value of the polyvagal theory for clinical practice with concrete examples and partly to collect cases in which harm may have been caused by the polyvagal theory. To my knowledge, this has not been done systematically before, which makes this call all the more relevant.
Next week I will publish an article on evidence and double standards in science. Together with the article you are about to read, they form a two-part series that aims to take an honest look at what the PVT gives people and where things go wrong—because decisions about what professionals may or may not use must be grounded in facts, not unfounded claims, and because the clinical value of the PVT is too great to lose to an unfair debate.
Words for what had no name
One of the most common reactions from people encountering the PVT for the first time is a variation on the same theme: “Finally, I understand why I do what I do.” The account of how the autonomic nervous system works is more than a cognitive explanation; it provides recognition and often feels like a relief. Exculpatory is a word that fits here.
People who spent years believing they were “weak” because they froze in stressful situations learn that freezing is not a character flaw but a biological survival response—older than language and older than human consciousness. People who describe themselves as “always switched on” recognize sympathetic activation as something their nervous system has learned, not something they are. The shift from judgment—and often self-judgment and shame—to understanding is, for many people, the beginning of recovery (Porges, 2011).
A client who worked with exercises developed by Deb Dana described it this way: “It was an eye-opener to understand why my nervous system reacts the way it does. I was constantly in a state of activation and felt empty by the end of the day. Once I understood where I was on the ladder (the ladder is a tool developed by Dana to explain the PVT to clients), I started to relate to myself differently. My brain catastrophized far less.” (Muller & Vu, 2022)
In the consulting room
For therapists working with trauma, the PVT has fundamentally shifted the focus from the story told in words to the physiology—the story the body tells. From “what happened” to “what is the body doing now.” That is not a small change.
Polyvagal-informed practitioners learn to work more consciously with cues of danger and safety: in the treatment room and in the way they make contact—through posture and tone of voice, for instance. The therapeutic relationship becomes less about words and more about a physiological process of co-regulation (Porges & Dana, 2018). Early research suggests that the quality of the therapeutic bond is associated with clients’ autonomic regulation and that heart rate variability has something to say about how safe a client experiences the relationship—and even about the outcome of therapy (Blanck et al., 2019).
This has practical implications. Therapists working from a polyvagal perspective attend to vocal prosody, eye contact, and the layout of the room. They understand that a client who “cannot make contact” is not unwilling but physiologically unavailable, and they do not fall into the trap of applying more pressure or asking more questions. They work with the nervous system rather than against the behaviour.
Children, schools, and early development
The PVT has also found its way beyond the consulting room—into education, childcare, and neonatology. Pediatrician Marilyn Sanders and child psychiatrist George Thompson describe how polyvagal-informed care can make a difference for children who have experienced early trauma or attachment difficulties. Not by talking more, but by organizing safety physiologically. Caregivers who learn how a child’s nervous system signals and processes safety can have a significant positive influence on that child’s development (Sanders & Thompson, 2022).
In Spain, 585 primary school pupils took part in a breathing and heart rate variability training program based on polyvagal principles. Afterward, the children showed significantly lower levels of anxiety and stress (Ruiz-Aranda et al., 2022).
All of this research points consistently in one direction: working with the nervous system pays off, even outside the consulting room.
The Safe and Sound Protocol
One of the most practical applications of the PVT is the Safe and Sound Protocol (SSP), a listening program using filtered music that trains the auditory system to recognize human vocal frequencies as safe while becoming less attuned to lower tones (associated with predators) and higher tones (associated with alarm calls). It was developed by Porges himself and is now used worldwide.
Initial studies with adults with autism showed improvements in social responsiveness, particularly in the area of social awareness (Kawai et al., 2023). These are pilot studies with small groups; larger, controlled studies are needed. People with anxiety, ADHD, and trauma report in practice a reduction in sensory hypersensitivity, improved emotional regulation, and a greater capacity for connection—experiences that are illustrative, not scientific proof.
The SSP is, of course, not a miracle cure. Some people find the stimulation too intense, particularly when the build-up is too rapid. This underlines something essential: every tool requires skilled use. And here, I believe, lies a mechanism behind some criticism directed at the PVT. Negative experiences with the SSP travel well in professional circles and can cast a shadow over the entire polyvagal theory. It is an understandable mechanism, one we encounter more broadly, and one where double standards are sometimes applied. I will address this in depth in next week’s article.
Somatic Experiencing
Another approach that connects seamlessly with polyvagal principles is Somatic Experiencing® (SE), developed by Peter Levine. Where the PVT describes how the nervous system responds to danger and safety, SE offers a method for gently discharging survival responses that have become stuck. Levine observed that animals in the wild literally shake and tremble after a threatening situation—a physiological discharge of accumulated mobilization energy. In humans, this discharge is often blocked. SE works with precisely that blockage: not by reliving the trauma, but by slowly guiding the nervous system towards completion of an interrupted response (Levine, 1997).
What connects SE and the PVT is a shared starting point: the body is not the problem, but the pathway to recovery. SE practitioners work with what Eugene Gendlin, founder of focusing, called the “felt sense”—a concept that Levine adopted and placed at the heart of his method. The felt sense might be described as the subtle, bodily awareness that precedes emotions and thoughts (Gendlin, 1978). By attending to this, at a pace the nervous system can manage, space opens up for regulation that talking alone cannot achieve. Clients often describe a feeling of relaxation after SE sessions that they had not known for a long time—not as an achievement, but as something the body did by itself once it had the space and safety to do so.
From a polyvagal perspective, this is no coincidence. SE is most effective when the client has sufficient ventral vagal tone to tolerate the experience—the zone in which activation remains manageable and integration becomes possible (Dana, 2018); what Daniel Siegel called the “window of tolerance” (Siegel, 1999) and what Levine described in comparable terms. A nervous system deeply in shutdown cannot yet handle discharge. The therapist therefore works first on safety and contact, then on regulation and mobilization, and only then on completion and integration. This is precisely the sequence that the polyvagal hierarchy predicts: ventral regulation as a prerequisite for everything that follows.
SE and the PVT describe essentially the same landscape: the PVT as the map2, SE as the route. Levine and Porges have been friends for decades, and Levine embraced the PVT early on, because it gave him an explanation for what he had been observing in his clients for years3.
Creativity, movement, and the arts therapies
The PVT has also provided a theoretical foundation for fields that had long worked with the body and the senses but could not always account for why. Art therapy, psychomotor therapy, music therapy, and dance—all of these work directly on the autonomic nervous system through sensory and movement experiences. The PVT offers a neuroscientific language for this.
Researchers at HAN University of Applied Sciences in Nijmegen describe how polyvagal principles—attention to physical and sensory experience, co-regulation, and working from a place of safety—connect seamlessly with what arts therapists and psychomotor therapists were already doing. The theory gives their work an academic language and deepens the understanding of why certain interventions work (Haeyen, 2024).
What the PVT offers that cognitive models do not
People who have spent years—sometimes many years—in cognitive therapy and “know” that their anxiety is irrational but continue to feel it often recognize something important in the polyvagal theory: thinking alone does not shift your physiology sufficiently towards safety. You cannot reason yourself out of a state of shutdown. You cannot argue away the flight response. The nervous system operates at a level that words do not reach, and it calls for a different approach.
Porges captured this in a reformulation of Descartes: not “I think, therefore I am,” but “I feel myself, therefore I am” (Porges, 2022). It sounds philosophical, but it speaks to something many people in therapy are missing: recognition that the body is not the enemy but the guide. That the reactions standing in their way are not weaknesses, but marks left by something that once helped them survive. And then there is something else many people recognize: the feeling of not truly feeling oneself, as if watching one’s own life from a distance4. From a polyvagal perspective, this is an understandable phenomenon: a nervous system that has closed itself off to survive.
This reframe—from pathology to adaptation (from disorder to adjustment)—is for many clients and therapists, the core of what the PVT offers. Not a diagnosis, but a story that is recognized and that can be worked with.
My own experience
I have now been working for over six years as a mindfulness therapist in the day treatment unit of the Psychiatry Department at Gelre Hospital in Apeldoorn, the Netherlands. I provide group and individual mindfulness sessions, into which I regularly weave elements of Somatic Experiencing. The people who come to the groups and individual sessions have, alongside a psychiatric diagnosis, a physical component to their presentation—which is precisely why they are seeing a hospital psychiatrist. For nearly all of them, the idea of feeling into their body is, to put it mildly, something they would rather avoid. They have become unaccustomed to it, and have a disturbed relationship with their body, ranging from chronic frustration to outright hatred of it.
In every group, after several weeks, I explain the polyvagal theory. I do so using simple language—something I have also had to learn—and fill the whiteboard with drawings and notes.
One of the most common reactions to a whiteboard full of diagrams is, “Well, you can put my name up there,” meaning recognition. Things click into place. People see connections, better understand why they react the way they do, and become more convinced that their nervous system is actually giving a “normal” response to the abnormal events that have occurred in their lives. Whether it was abuse, bullying, an accident, an emergency operation, serious illness, or another overwhelming event—the body has lost its sense of safety and has adjusted—sensibly, but unfortunately often with unwanted consequences for the here and now—by moving more readily into a defensive autonomic state. Outside conscious control or will, intending to protecting.
In my view, the polyvagal theory is enormously helpful. It gives direction to sessions and motivates people to practice—even though learning to feel in one’s body again is demanding—with the meditations I offer and to engage with exercises during our sessions, to reflect on them afterward, and to gradually become better at recognizing and growing signals of safety.
That said, I have regularly noticed that clients did not fully understand my explanation, and I have had to learn which words and exercises work and which do not. To my knowledge, I have been able to resolve the resulting misunderstandings in the great majority of cases, and over time I have practiced increasingly at explaining the PVT in plain language without losing too much nuance. There is probably a phenomenon here that can never be entirely prevented: how is your explanation heard and remembered?
Share your story
I would very much like to hear more stories. From clients who have read about the polyvagal theory or heard about it from their therapist or psychologist. What did you recognize? What did it teach you? Did it change anything for you?
From therapists, coaches, and other professionals who have integrated the PVT into their work and see what it does. From teachers, parents, and carers. What has the PVT meant to you?
Please send me your experiences via the comments below5.
I read everything and respond.
All of this is important information. Not (or not yet?) as scientific evidence, but as living knowledge—which I will also share with the Polyvagal Institute Netherlands.
The road to evidence-based often runs through practice-based.
Your stories help me understand how the PVT really lands in practice, and they form a richer basis for conversation than abstract debates about neuroanatomy alone.
And also: where did things go wrong?
I am also genuinely curious about experiences where something did not go well. Situations where someone thinks, “Here, working from a polyvagal perspective caused harm.” That is a serious question, and I want to take it seriously.
Please send me your experiences via the comments below6.
I read everything and respond.
My working hypothesis—and I call it explicitly a hypothesis, not a prejudice—is that when polyvagal-informed practice causes harm, the cause is not the theory itself. I suspect it will often involve insufficiently trained therapists applying the theory too simplistically. Or misrepresentation of the PVT: over-popularization in which nuance is lost and people are confronted with overly confident claims. Or general therapeutic incompetence that has nothing to do with the PVT but that damages both the client and the theory’s reputation. Stephen Porges himself has described that the PVT is sometimes applied in wellness and coaching contexts in ways that do not reflect the scientific depth of the theory and that this is a matter of training and responsibility in translating the theory into practice, not of the theory itself (Porges, 2025).
In all of these cases, harm can occur, and I can well imagine that it does. That is serious, and every such case is one too many. But misinterpretation of the theory and therapist incompetence cannot be attributed to the polyvagal theory itself.
But my hypothesis is a hypothesis. And hypotheses deserve to be tested. So if you—as a client, therapist, supervisor, or trainer—know of situations in which polyvagal-informed practice demonstrably contributed to harm, I would like to hear about them. Concrete cases, documented situations, formal complaints. It is important to start collecting this to learn from it. Because if that evidence exists, I want to know it. And if it does not exist—that too is an answer to the question of how dangerous the polyvagal theory actually is. An answer that deserves to be heard.
If you found this article worth reading and (not yet) feel like getting a paid subscription, you can always treat me to a cappuccino!
References
Blanck, P., Stoffel, M., Bents, H., Ditzen, B., & Mander, J. (2019). Heart rate variability in individual psychotherapy: Associations with alliance and outcome. Journal of Nervous & Mental Disease, 207(6), 451–458. https://doi.org/10.1097/NMD.0000000000000994
Dana, D. (2018). The polyvagal theory in therapy: Engaging the rhythm of regulation. W.W. Norton & Company.
Gendlin, E.T. (1978). Focusing. Everest House.
Haeyen, S. (2024). A theoretical exploration of polyvagal theory in creative arts and psychomotor therapies for emotion regulation in stress and trauma. Frontiers in Psychology, 15, 1382007. https://doi.org/10.3389/fpsyg.2024.1382007
Kawai, H., et al. (2023). Initial outcomes of the Safe and Sound Protocol on patients with adult autism spectrum disorder: Exploratory pilot study. International Journal of Environmental Research and Public Health, 20(6), 4862. https://doi.org/10.3390/ijerph20064862
Levine, P. (1997). Waking the tiger: Healing trauma. North Atlantic Books.
Muller, R.T. & Vu, L.H. (2022). Polyvagal theory: An approach to understanding trauma. Psychology Today, June 2022. https://www.psychologytoday.com/us/blog/talking-about-trauma/202206/polyvagal-theory-approach-understanding-trauma
Porges, S.W. (2011). The polyvagal theory: Neurophysiological foundations of emotions, attachment, communication, and self-regulation. W.W. Norton & Company.
Porges, S.W. (2022). Polyvagal theory: A science of safety. Frontiers in Integrative Neuroscience, 16, 871227. https://doi.org/10.3389/fnint.2022.871227
Porges, S.W. & Dana, D. (Eds.) (2018). Clinical applications of the polyvagal theory: The emergence of polyvagal-informed therapies. W.W. Norton & Company.
Porges, S.W. (2025). Polyvagal theory: Current status, clinical applications and future directions. Clinical Neuropsychiatry, 22(3), 169–184. https://doi.org/10.36131/cnfioritieditore20250301
Ruiz-Aranda, D., et al. (2022). Reducing anxiety and social stress in primary education: A breath-focused heart rate variability biofeedback intervention. International Journal of Environmental Research and Public Health. PMC9407856. https://doi.org/10.3390/ijerph191610181
Sanders, M.R. & Thompson, G.S. (2022). Polyvagal theory and the developing child: Systems of care for strengthening kids, families, and communities. W.W. Norton & Company.
Siegel, D.J. (1999). The developing mind: How relationships and the brain interact to shape who we are. Guilford Press.
I first encountered the polyvagal theory in 2013 (give or take a year) and have since heard many misinterpretations of the theory and a good deal of skepticism, but no negative experiences. See also the section “My own experience” below.
It is worth noting that two Dutch therapists have independently used this map metaphor to explain how the nervous system works and to help clients—including children—learn to regulate and process. See mijnwereldintherapie.nl.
From this you might infer that Levine had no better explanation than the PVT, despite being a highly knowledgeable professional and pioneer in the field.
In keeping with Porges’ reformulation (“I feel myself, therefore I am”), I have sometimes heard people question whether their life was truly “real”—which brought to mind the inverse: “I do not feel myself, therefore do I exist?” In trauma therapy this sometimes surfaces in words to the effect that “my life stopped at the moment of X [the overwhelming event].”
If you prefer, you are also welcome to email me your experience. I can then post your story anonymously in the comments on your behalf. Email: ronald@relaxmore.net. Thank you in advance.
See note 5 — you are also welcome to email.