CEUnits Blog

Parkinson’s disease and mental health

March 27th, 2023

Parkinson’s disease is a neurodegenerative disorder that affects the nervous system, causing tremors, stiffness, and difficulty with movement. While the physical symptoms of Parkinson’s disease are well-known, the mental health effects of the disease are often overlooked. Parkinson’s disease can have a significant impact on a person’s mental health, affecting their mood, cognitive abilities, and overall quality of life.

Depression is one of the most common mental health issues associated with Parkinson’s disease. Studies have shown that people with Parkinson’s disease are twice as likely to experience depression as those without the disease. The reasons for this are complex, but it’s believed that changes in brain chemistry and the psychological impact of the disease can both play a role.

The symptoms of Parkinson’s disease can also make it challenging to stay active and engaged with social activities, which can lead to feelings of loneliness and isolation. This can further exacerbate feelings of depression and anxiety, making it even more challenging to manage the disease effectively.

In addition to depression, people with Parkinson’s disease may also experience anxiety, apathy, and cognitive decline. Anxiety is often related to the unpredictability of the disease and the challenges it can present in daily life. Apathy, or a lack of interest or motivation, is another common symptom that can make it difficult for people with Parkinson’s disease to engage in activities they once enjoyed. Cognitive decline, which can include difficulties with memory and thinking, can also occur as the disease progresses.

The mental health effects of Parkinson’s disease can have a significant impact on a person’s overall quality of life. However, there are steps that can be taken to help manage these symptoms. One of the most important is to work closely with a healthcare team that includes a neurologist, a mental health professional, and a support network of family and friends.

There are also a variety of treatments available for depression and anxiety in people with Parkinson’s disease. These may include medications, psychotherapy, and support groups. In addition, staying physically active and engaged in social activities can also help improve mental health outcomes.

It’s important to remember that mental health is an essential aspect of overall health, and people with Parkinson’s disease should prioritize their mental health just as they do their physical health. This may mean taking steps to reduce stress, practicing self-care activities like meditation or yoga, and seeking professional help when needed.

Mental health professionals can play a critical role in treating the mental health effects of Parkinson’s disease. They can provide a safe and supportive environment for people with Parkinson’s disease to discuss their feelings and develop coping strategies to manage their symptoms. They can also work with healthcare providers to develop personalized treatment plans that address both the physical and mental aspects of the disease. By addressing the mental health needs of people with Parkinson’s disease, mental health professionals can help improve their overall quality of life and ensure that they receive the comprehensive care they need to manage their condition effectively.

What is Feedback Informed Therapy?

February 13th, 2023

Feedback-Informed Therapy (FIT) is a relatively new and innovative approach to psychotherapy that emphasizes the importance of using feedback from clients to guide the therapeutic process.

FIT is based on the idea that the best way to improve psychotherapy is by incorporating the perspectives of clients into the treatment process. This approach has gained popularity in recent years due to its emphasis on accountability and effectiveness, and its ability to improve therapy outcomes. FIT is a client-centered approach that encourages clients to take an active role in their own therapy by providing feedback on their experiences during sessions. This feedback is used to inform the therapist about what is and isn’t working in therapy, and to make adjustments to the treatment plan as needed.

FIT emphasizes the importance of establishing a therapeutic alliance, in which the therapist and client work together as partners to achieve the client’s goals. One of the key benefits of FIT is that it encourages therapist accountability.By incorporating client feedback into the therapeutic process, therapists are held accountable for the effectiveness of their treatment and are encouraged to continuously evaluate and improve their practice. This helps to ensure that clients receive the best possible care and that therapists are providing treatments that are tailored to their clients’ specific needs.

According to Scott D. Miller, a leading expert in the field of psychotherapy, “Feedback-Informed Therapy is a game-changer in the field of psychotherapy. It has the potential to dramatically improve therapy outcomes and make psychotherapy more client-centered and effective.” Miller’s quote highlights the importance of FIT and its ability to bring about positive change in the field of psychotherapy.

Feedback-Informed Therapy is a new and innovative approach to psychotherapy that emphasizes the importance of using client feedback to guide the therapeutic process. This approach helps to ensure that clients receive the best possible care and that therapists are providing treatments that are tailored to their clients’ specific needs. FIT is a client-centered approach that encourages clients to take an active role in their own therapy and provides a structure for therapists to continuously evaluate and improve their practice. By incorporating client feedback into the therapeutic process, FIT has the potential to dramatically improve therapy outcomes and make psychotherapy more client-centered and effective.

Cognitive Behavioral Therapy Vs Schema Therapy

February 13th, 2023

Cognitive Behavioral Therapy (CBT) and Schema Therapy are two popular forms of psychotherapy that aim to help individuals improve their mental health. Both techniques have been widely researched and have demonstrated efficacy in treating various mental health conditions such as anxiety, depression, and personality disorders. However, while they share similarities, they also have distinct differences that make them unique in their approach to treatment.

How long does CBT versus Schema Therapy take?

CBT is a short-term, goal-oriented form of therapy that is based on the premise that our thoughts, emotions, and behaviors are interrelated and can impact each other in significant ways. CBT focuses on identifying and changing negative thought patterns and beliefs that contribute to psychological distress and maladaptive behaviors. Through CBT, individuals learn to challenge and reframe negative thoughts and beliefs in order to develop a more positive outlook on life and improve their mental health. CBT sessions typically involve discussing current problems and setting goals for improvement, as well as teaching coping strategies and behavioral techniques to help manage difficult emotions and situations.

In contrast, Schema Therapy is a long-term form of therapy that is based on the idea that our early life experiences shape our personality and can lead to the development of “schemas” or negative coping patterns. Schemas are thought to be deeply ingrained patterns of thoughts, feelings, and behaviors that are triggered by specific situations and lead to emotional distress and maladaptive behaviors. Schema Therapy aims to help individuals identify and change these schemas in order to improve their overall mental health. This is done through a combination of talking therapy, behavioral techniques, and imaginative techniques such as role-playing and visualization exercises.

One key difference between CBT and Schema Therapy is the length of treatment. CBT is typically a short-term form of therapy that lasts anywhere from 6 to 20 sessions, while Schema Therapy is a longer-term form of therapy that can last up to two years or more. This difference in treatment length reflects the difference in the underlying theories of the two approaches. CBT assumes that negative thought patterns and beliefs can be changed relatively quickly, while Schema Therapy assumes that deep-seated schemas developed over a lifetime will take longer to change.

Schema Therapy is gaining in popularity

According to a publication by the Schema Therapy Society, “Schema therapy has been gaining increasing recognition as a highly effective evidence-based treatment for a range of mental health problems, including personality disorders, anxiety, and depression.”

It’s increasing popularity is seeing many CBT therapists retrain in aspects like imagery rescripting.

Different approaches

Another important difference between CBT and Schema Therapy is the focus of treatment. CBT is more focused on the present and helps individuals manage their current difficulties, while Schema Therapy is more focused on the past and helps individuals understand and change their negative schemas. Schema Therapy is often described as a “whole-person” approach to treatment, as it takes into account the individual’s entire life history and personality, while CBT is more focused on specific problems and symptoms.

In terms of effectiveness, both CBT and Schema Therapy have been shown to be effective in treating a range of mental health conditions. However, research suggests that Schema Therapy may be more effective for individuals with more severe or chronic psychological difficulties, such as personality disorders. CBT has been found to be effective for treating a range of conditions, including anxiety, depression, and obsessive-compulsive disorder, and is often recommended as a first-line treatment for these conditions.


Stress: Coming Home to Homeostasis

March 16th, 2022

Stress is a physiological and psychological process that helps us manage our day-to-day lives. For most of us, the stress response is a defense mechanism that helps us to deal with multiple daily threats. After the threat, or the perceived threat, has passed, our hormones rebalance and we feel relaxed and safe. We return to a state of homeostasis. Our ability to easily return to homeostasis depends on our resilience.

People who are well adapted to deal with stress often display high levels of resilience. Resilience is our capacity to recover from stress, adapt to change, and maintain homeostasis even when facing stressors. There are multiple factors that determine resilience, but our lifetime exposure to stress has a big impact. Overexposure to stress can mean we are less well-equipped to deal with it. 

When people experience prolonged periods of stress, it can become harder for the body to find its way home to homeostasis. Prolonged exposure may be caused by socio-economic factors, trauma, and addiction.  


Stress and Addiction: A Vicious Cycle

Stress itself can actually help build resilience. It only becomes problematic when our bodies aren’t able to pull us out of the stress response to reach homeostasis. When we stay in the stress response for too long, we can develop symptoms of acute and chronic stress. 

Both acute and chronic stress are key contributors to addiction. Substance abuse and misuse can also trigger maladaptive tendencies across our brain, body, behavior, and social functioning. This results in a dysregulated physiological state which limits our capacity for homeostasis. For people struggling with addiction, stress can perpetuate a cycle that is hard to escape from. Stress causes an increased dependency on alcohol and certain drugs, and these substances in turn reduce our capacity to deal with stress. This is why stress can so often trigger a relapse for people who are in recovery. 


Building Resilience with Embodied Self Awareness

People struggling with addiction, and those who are in recovery, can develop their resilience by fostering embodied self-awareness. This means they can practice noticing their physiological responses to stress. They come into a relationship with their stress response, meaning they are better placed to work with, rather than against it.

Nkem Ndefo developed the Resilience Toolkit to help people recognize when they are in a stress response. The toolkit is founded on somatic psychology and helps people to build their capacity for homeostasis and resilience. When people feel triggered, stressed, or upset, there are three questions they can ask themselves to help them better understand what stress feels like.

  • What is my stress level now, and how do I know? 
  • What is happening at this moment and how does it feel in my body?
  • Is my stress level helpful?

These questions seek to help people notice what their unique experience of stress is, so they can recognize it when it appears. This means that they can begin to develop means to deal with stress, as it arises. This helps it dissipate quicker, which means the body relearns how to reach homeostasis. It also helps to value the stress response. If we befriend the stress response, we can work with it. That means finding our way easily back to homeostasis.


Rebuilding Family Relationships On The Road to Recovery

March 16th, 2022

Addiction infiltrates families. Relationships with parents, siblings, grandparents, and more, are often damaged. The recovery process is so much harder for people who no longer have the support of their families. 

But the road to recovery can be a way to rebuild familial bonds. And, what better way to rebuild relationships than through the recovery process? It can be the beginning of a new relationship built on mutual respect and trust.

If you work with people in recovery, then here are some tips to share with family members who are ready and able to support their loved ones. 

  • The best thing family members can do is be supportive and helpful. This doesn’t mean being a pushover but doing what they can to support recovery. This might mean driving them to appointments. It might mean helping them to create a schedule for medication. It might mean sharing online meetups, helping to build and create a network of support. Nobody should force anyone to do anything they don’t want to. But if a family member/friend asks for support in the recovery process, it’s important to let them know they have it. It makes the road to recovery much less daunting. It helps them to know they don’t have to do this alone. 
  • Encourage family members to engage with the therapeutic process of recovery. Say hello to family members when they drop off and collect their relation at therapy. Demystify the therapeutic process. You can encourage your client to recruit the support of different family members. You might even invite family members to some sessions, depending on the modality you’re using. 
  • Often, people seeking recovery will try lots of different treatments. Not all of them are going to work. But that doesn’t mean people should be discouraged from trying! Encouraging support is a beautiful way to rebuild relationships. It will help the person in recovery to believe that they can keep trying different options, knowing they will be supported even if it doesn’t work out. 
  • Many situations can be triggering for people in recovery. Being sensitive to their unique needs will help them to stay in control. Family members should avoid inviting the person in recovery to situations where alcohol or drugs are present. Especially during the early stages of recovery. At the same time, it’s important for people to feel safe, capable, and in control around alcohol. Family gatherings can support this, at the right time. Celebrating (soberly) with family who may be drinking can be empowering for people in recovery when they are ready. 
  • Have your client discuss their stress triggers with their family. This will help the family to identify when the person in recovery may be dealing with extra pressure, so they can offer more support. This support might mean making it clear that they’re available if the person needs them. Or, it might be a more active intervention to help manage the stressor. This will help your client feel resourced and may help prevent a relapse.

Combatting Depression with Behavioral Activation

February 14th, 2022

CBT, or cognitive behavioral therapy, is the most widely practiced evidence-based therapeutic model in the treatment of depression. It’s possible for therapists to focus either on cognition or behavior. ‘B’ represents behavior-based motivations, including behavioral activation. Very often, when people slide into depression, they let go of the things which make them feel good. This is because depression creates apathy. Just getting out of bed can be a challenge, let alone carving time for extracurricular activities.

Behavioral activation involves reconnecting with things that bring joy, purpose, and meaning. It might include very small daily tasks. If these bring a sense of achievement, then they’re relevant as treatment. As a therapist, it’s your job to help your client work out what makes them feel good. And, what doesn’t. This might mean remembering a hobby from childhood. It could involve tackling something which has always been tempting, but challenging. It might also mean exploring something entirely new. This can help your client see how they can grow through the things they engage with, as they slowly rebuild their capacity for joy.

Creating a Program of Meaningful and Supportive Motivations

The research shows that behavioral activation is as effective as medication. It’s also slightly superior to cognitive therapy in the treatment of depression. But it needs to be managed carefully. To identify and encourage activities that are the most beneficial, you need to work with your client to strike the right balance. Behavioral activation should balance activities that spark joy with tasks that require mastery. Everyone will have a unique combination of activities that can be used to target depression. These should build positive reinforcement and shift the focus from cognition and feelings, to behavior and environment.

To develop a program of behavioral activation, work with your client to track what activities make them feel better and which make them feel worse. You can have them keep a journal to note their mood before and after different activities. The journal will help you both to recognize moments of growth and strength. It will also help you identify moments of disconnection and negativity.

Behavioral activation is essentially a twofold process. Over time, you’ll be able to define a schedule of activities that cultivate a greater sense of mastery and enjoyment. You’ll also be able to clearly define what makes feelings of depression worse, and consciously avoid these. That will help make time for more activating behaviors. You increase positive reinforcement through supportive activities and replace negative avoidant behaviors with rewarding behaviors.

Recruiting Support: Social Circles and Feedback Informed Progress

Of course, this doesn’t just work overnight. It takes time and determination. Often, clients will need to push through with activities to see the benefits. Work with your clients to agree on markers for progress. This is essential for helping your client move towards positive reinforcement. You might have them recruit the help of a friend or relative to keep them on track. Enlisting the support of their social circle will help keep them accountable. It will also mean there’s more encouragement available to your client outside of your one on one time. The combined impact of your sessions, support of a social network, and increased capacity for joy and meaning can help your client to climb back out of depression.

ACEs and Intergenerational Trauma: A Public Health Crisis

February 14th, 2022

Acute Childhood Traumas, or ACEs, are the biggest public health issue today. Studies have shown that ACEs are responsible for 7/10 deaths in the US. They reduce life expectancy by 20 years. They affect brain development, immune and hormonal systems, and DNA encoding. ACEs are caused by abuse, neglect, and toxic stress. These are the tragic repercussions for families who are struggling with mental illness and substance dependence. They are also infective. A child that has suffered from ACEs is more likely to inflict trauma on their children later in life. This perpetuates the cycle of intergenerational trauma.

ACEs and Neurodevelopment

For a long time, ACEs were not recognized or diagnosed in children who presented with neurodevelopmental issues. Children with ACEs are often diagnosed with ADHD and prescribed drugs but this doesn’t deal with the root of the problem. Understanding how ACEs affect childhood development can help you to find other ways to support children. ACEs can cause long-term damage as they can inhibit the prefrontal cortex. This handles executive function, impulse control, and learning. MRIs have shown that ACEs also cause measurable changes to the amygdala, which is our fear center. Damage to the amygdala increases high-risk behavior. This is a dangerous cocktail when mixed with other developmental issues, especially in adolescence. Children who experience ACEs are also more likely to develop cancer and heart issues later in life.


Scaling ACEs to Understand Intergenerational Trauma

Before 1998, the severity and proclivity of ACEs were not known. Nor was the impact of health outcomes resulting from them. A seminal study by Felitti et al. researched ACEs to better understand the scale of their occurrence. And to learn more about health outcomes resulting from them. The groundbreaking study showed that 67% of the US population had experienced at least one ACE. 12.6% (1 in 8) had experienced four or more ACEs. The study also showed for the first time that childhood trauma has a significant impact on long-range adult outcomes. It began the investigation into intergenerational trauma.

The risk factor for ACEs and potential resilience against them may be linked to positive/negative childhood experiences of parents. These can be carried forward into future parenting practices. Parents who encounter many ACEs often exhibit symptoms of PTSD. This is a mediator of risk in the intergenerational transmission of ACEs. The mechanisms of intergenerational trauma are not fully understood. But its existence is undeniable.

In its simplest form, intergenerational trauma reflects parents using the same maladaptive parenting styles that they experienced growing up. Intergenerational trauma is also influenced by the impact of environmental stressors like poverty, unsafe living conditions, and systemic prejudices.

Whilst these contributors to intergenerational trauma are vast, they can still be overcome. Trauma-related behavior within individual families can be dismantled through nurturing relationships, enriching activities, and creating safer environments. The earlier an intervention can occur the better so that children avoid adverse development. This is the way to break the cycle of intergenerational trauma.

Defining Toolkits to Recognize and Work with ACEs

ACEs pose the biggest threat to public health in the US. Effective clinical treatment protocols and toolkits should be defined and provided to public health professionals. If you work with children and families affected by ACEs and intergenerational trauma, here are some things to consider:

  • Use the ACEs questionnaire to screen for signs of trauma. This is a great starting point in addressing root causes, instead of diagnosing conditions or prescribing medication. It will open up the conversation about adverse conditions and intergenerational trauma. You can find different versions of this through The American Academy of Pediatrics.
  • Adopt a trauma-informed approach with parents, as well as children. Be careful of language which indicates any sense of blame. Instead of, “what’s the matter with you?” ask “did something happen to you?”.
  • Adopt early intervention and wellness approaches for the whole family. Promote local group/family exercise programs, yoga, and mindfulness communities. Provide information about parenting skills, nutrition, and self-care.
  • Educate families about the impact of toxic stress. You might provide leaflets or websites about this, hold a community meet-up, invite specialists to talk.


Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS. (1998) “Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study.” Am J Prev Med;14(4): pp. 245-58. 

Microaggressions and Mental Health

January 16th, 2022

Microaggressions manifest as subtle but pervasive forms of prejudice. They may be barely perceptible, but microaggressions are damaging and dangerous. For many people, they constitute daily abuse. As mental health and social workers, it’s important to identify and confront microaggressions. Recognizing them will help you to challenge them institutionally, professionally, and personally.

Our ability to defend against microaggressions depends on vulnerability and resilience. For people who are already dealing with mental health issues, the impact of microaggressions can be overwhelming. Prejudice against mental illness is deep-rooted in our language and cultural norms. People don’t always realize the extent to which they are suffering from microaggressions. They can be painful, but hard to pinpoint. This is true in both clinical settings and our day-to-day experience of, and participation in, microaggressions.

Implicit and Explicit Bias

Mental illness microaggressions are varied. They often focus on either invalidating people’s experiences or blaming people for their condition. They may include an implicit or explicit assumption that someone may be violent, dangerous, and volatile. Or, helpless, incapable, and inferior. These are all alienating and damaging assumptions. They are also often inescapable for people dealing with mental health issues. Mental health microaggressions are perpetrated by family, friends, health professionals, and social workers.

Often, microaggressions relating to mental health take the form of a compliment. “You’re doing so well!”. Or, “but you don’t seem crazy?” They can be all-pervasive and are often ingrained within people’s daily experiences. This applies to all walks of life, from the clinician’s couch to the Christmas dinner table. How can we make space for working with microaggressions? How do we get better at noticing them, and calling them out?

Noticing and Confronting Microaggressions

We need to talk about microaggressions. Make space for talking about them with your clients. With your family and friends. Get more and more versed in knowing what to look for. You might ask yourself, do I experience microaggressions? If you belong to a minority group, you likely do. Do you notice when they happen, and what do you do to deal with them? Is there an element of prejudice at play, in the way that someone is speaking or being spoken to? How might you help to challenge that? Listen to your clients. Unpack the specifics about the types of microaggressions that they experience.

Combating with Vulnerability and Resilience

Once you’re able to identify what a microaggression looks and feels like, you can start to work with them. Work with your clients, your colleagues, and friends to legitimize microaggressions. Define clear boundaries to help them feel competent when addressing everyday prejudices. This may involve challenging people head-on, or it may mean being better able to meet microaggressions with compassion. Removing their harmful impact calls for a combination of strength and compassion. Vulnerability and resilience can dissolve both the appearance and impact of microaggressions.

Barber, S., Gronholm, P., Ahuja, S., Rüsch, N., & Thornicroft, G. (2020) “Microaggressions towards people affected by mental health problems: A scoping review.” Epidemiology and Psychiatric Sciences, 29, E82. doi:10.1017/S2045796019000763

Mindfulness-Based Relapse Prevention: Addiction Recovery in a Post-Pandemic World

January 16th, 2022

The pandemic has made addiction recovery harder than ever. Recovery programs, which are often an essential lifeline, have been disrupted or canceled. Treatment has become even less accessible. As in-person services have lessened, addiction specialists are combining mindfulness and cognitive-behavioral release prevention skills to help people stay sober.

Mindfulness-Based Relapse Prevention helps resource individuals who need support. By cultivating mindfulness techniques, you can begin to foster a self-care system.

Here are five steps to adopting Mindfulness-Based Relapse Prevention. These can help support recovering addicts in the absence of interventions and group-based therapies.


1. External Orienting


The first step in cultivating a mindfulness-based approach is external orienting. This means sitting and noticing the world around you, and how it makes you feel. You might feel the chair beneath you, the earth under your feet. The color of the sky outside the window. How a tree moves in the breeze. Notice these things and anything else that draws you in. Is there one thing that brings a greater sense of stillness, or of connection? Writing down what you notice can help to develop an awareness of how you respond to different external triggers.


2. Internal Resourcing


Once you are comfortable with external orienting, you can begin internal resourcing. This means recognizing how you experience external triggers in your body. Creating a body map can help: draw a basic body outline, then tune in to your body. Notice how you feel, where there’s tension, where there’s ease. Mark these on your body map. Tune back in. See if you can breathe into areas of tension. Can you release pressure? Can you change your inner experience? Mark any changes on your body map. Spending five minutes a day doing this can help to create mindful awareness. You will develop body literacy and notice how your body responds to different triggers.


3. Urge Surfing


This helps people in recovery to notice their urges and cravings when they arise. Noticing means that you can start to be curious about these urges. What triggers them, how long do they last, how might you make them subside? With every successfully surfed urge, you become a better surfer. You create new neural pathways which will help you to navigate the next wave. The next wave may be bigger and longer, or smaller and softer, depending on what triggered it. The point is, no matter how big the wave, every time you practice surfing with mindful awareness, the better you get at it.


4. Stay with what arises


For many addicts, the need to control or fix situations is at the root of their addiction. This may be because you have learned that this is how you handle triggers, by reaching for the bottle, the pill, the release, to ‘help’ manage it. By letting whatever arises run its course you can unlearn these addictive habits. Mindfulness is about learning to stay with what arises. Without judgment or attachment.. When you stay with what arises, you can develop responses that are solution-based. Not problem-focused.


5. Solution-based responses


Mindfulness allows you to stop, notice, and witness urges and cravings. If you can remove yourself from the story, then you can regain control of your narratives. Pausing provides you with an opportunity to respond with intention, kindness, and compassion. It stops the automatic reaction. You can better communicate your needs to yourself and others. It will help prevent the urge to drop back into addictive behaviors. Mindfulness can enhance your ability to cope with emotional distress. You become more confident in your ability to respond with a solution-based approach to the triggers and challenges that are a part of modern life.

It seems that the pandemic might be a part of modern life for a while. Mindfulness-Based Relapse Prevention is a solution-focused response to the pandemic itself.

Enkema, M., Bowen, S. (2017) “Mindfulness practice moderates the relationship between craving and substance use in a clinical sample.” Drug Alcohol Depend, doi: 10.1016/j.drugalcdep.2017.05.036

Polyvagal Theory: Meet Your Clients Where They Are At

December 7th, 2021

By Libby Waite

The science of feeling safe enough to fall in love with life” – Deb Dana

Applying Polyvagal Theory in psychotherapy is a powerful way to work with trauma. It means creating a circle of co-regulation between yourself and your client. It involves an interactive process that engages both of your nervous systems. It allows you to meet your client where they are at.

Polyvagal Theory takes its name from the different aspects of the vagus nerve. There are three pieces; the ventral vagal, the sympathetic nervous system, and the dorsal vagal.

When we are in a ventral vagal state, we are part of the social engagement system. We can connect with other people. We are safe, engaged, open, and curious. When we sense danger or threat, we move into our sympathetic nervous system. In this state, we can feel hostile, anxious, and hypervigilant. Many people who face sustained challenges in their lives become ‘stuck’ in this state. This can trigger anxiety attacks and other neurological issues. When we are in this state for a very long time, or when we face a mortal threat, we move into the dorsal vagal zone. In this state, we become numb, we close off, we shut down. We may experience disassociation, a sense of despair, or deep depression.

Using Polyvagal Theory in psychotherapy involves working with these different states. You work with your client to find out which state is ‘home base’ for them. Together, you then carve out new pathways back to the ventral vagal state. This is the place where your client can begin to feel safe, supported, and connected.

Staying Alive: Neuroception

All three of these states are central to our survival. It’s not that any one of them is bad, they all serve a purpose. Many times, when we experience trauma, they serve to keep us alive. Our sympathetic nervous systems mobilize and protect us whenever we experience a threat. This is the fight, flight, freeze, or fawn response to danger or triggers in our environment. Helping your clients to recognize how these responses have served them is a fundamental part of healing trauma.

Our bodies know how to keep us alive. They know this through neuroception. This is the level of awareness below cognition. It’s how the nervous system absorbs information from the environment. It’s the part of us that operates before thinking, before perception.

You can help your clients move from a sympathetic or dorsal state by using titration. This means feeling slowly and softly into the different vagal states. You can help your clients to navigate their way to safety so they reach the ventral state. You can co-create a visualization so that they feel in control of how much, and how fast, they move between states. You might have them imagine a dimmer switch, which they can slowly turn up into a sympathetic state, or down into a dorsal state. Imagining a handbrake or bicycle brakes are other ways to help your client feel in control of the process.

Imagery: The Language of the Nervous System

Working with Polyvagal Theory in therapy means learning how to resource. Before you resource your clients, you need to resource yourself. Before a session, you can ask yourself: What state am I in? What do I need to be anchored in ventral? And throughout a session with your client, keep checking in and feel: Where is the other person? What does their nervous system need, and how can I give it to them? Using images is a powerful way to help yourself anchor at the beginning of a session. They can also help bring your client back to a ventral state throughout a session. Work with your client to find images that are soothing to their nervous system. These will become the fundamental language of your reciprocal healing journey.

Using Polyvagal Theory in psychotherapy involves engaging your social nervous system alongside your clients’. It goes beyond active listening. It asks that you journey with your client as they safely explore different aspects of their nervous systems. Together, you map routes back to a ventral state. It means accepting your clients exactly as they are, and meeting them where they are at. When you as a therapist are open and receptive to this journey, you’ll find that your clients feel accepted and understood. Together, you can begin to heal trauma.

Dana, D., (2018) The Polyvagal Theory in Therapy: Engaging the Rhythm of Regulation, W. W. Norton & Company: New York.