Medication and its Effect on Safe & Sound Protocol Therapy Outcomes in a Pediatric Population

Background and Hypothesis: The current study evaluated the effect of different medications on a child’s response to the Safe & Sound Protocol (SSP) therapy. Informed by the Polyvagal Theory and the evidenced relationship between state regulation and autonomic imbalance, the therapy aims to improve state dysregulation which can manifest in children as emotional reactivity, sensory processing issues, and auditory sensitivities. Prior studies have shown a reduction in auditory hypersensitivities after the SSP therapy plus evidence shows SSRIs and stimulants have a positive impact on hearing in the presence of background noise. We hypothesized that a) the SSP could improve treatment response in those taking neurotransmitter-altering medication due to synergistic effects or b) it could show reduce treatment response due to sensitivities already being managed by medication. Project Methods: Children in the study underwent a month of the SSP therapy with auditory processing standardized parent reports (Brain Body Center Sensory Scale) taken prior to treatment then approximately 1 week and 4 weeks after treatment. The data was then separated into different medication groups: stimulants (n=4), non-stimulant neurotransmitter altering medications (n=4), and other non-neurotransmitter altering medications (n=9) such as albuterol. Non-medication and medication group outcomes were then compared to identify significant differences between the groups using independent and paired samples t-tests. Results: The results from this study found a significant reduced response to the SSP in children taking non-stimulant neurotransmitter altering medications, which included both sertraline, a selective serotonin reuptake inhibitor, and guanfacine, an a2A-adrenergic agonist. In addition, the non-neurotransmitter altering medication group was the only medication group that showed significant improvement in hypersensitivities while each non-medication group improved in hypersensitivity and hyposensitivity. Potential Impact: Commonly-used guidelines for SSP are to maintain typical medication use during the intervention. This study, the first to systematically assess treatment response to the SSP by medication use, could inform how clinicians implement both SSP and medication treatments concurrently. However, these results are based on very small medication groups, therefore follow-up studies with larger samples are necessary to inform current clinical practices.

A new measure of feeling safe: Developing psychometric properties of the neuroception of psychological safety scale (NPSS)

Objective: Psychological safety is increasingly recognised as central to mental health, wellbeing and post-traumatic growth. To date, there is no psychometrically supported measure of psychological safety combining psychological, physiological and social components. The current research aimed to develop and establish the neuroception of psychological safety scale (NPSS), informed by Polyvagal Theory. Method: The study comprised of three stages: (1) item generation, (2) item reduction, and (3) assessment of factor structure and internal consistency. Exploratory and confirmatory factor analysis was conducted from two samples who completed a survey online (exploratory n = 342, confirmatory n = 455). Results: Initially, 107 items were generated. Item reduction and exploratory factor analysis resulted in a 29-item NPSS with subscales of compassion, social engagement and body sensations. The NPSS was found to have a consistent factor structure and internal consistency. Conclusion: The NPSS is a novel measure of psychological safety which can be used across a range of health and social care settings. This research provides a platform for further work to support and enhance understandings of the science of safety through the measurement of psychological, relational and physiological components of safety. The NPSS will help shape new approaches to evaluating trauma treatments, relational issues and mental health concerns. Research to establish the convergent, discriminant and concurrent validity of the NPSS and to explore its use with diverse community and clinical populations is underway.

A Systematic Review of a Polyvagal Perspective on Embodied Contemplative Practices as Promoters of Cardiorespiratory Coupling and Traumatic Stress Recovery for PTSD and OCD: Research Methodologies and State of the Art

Baseline respiratory sinus arrhythmia (RSA) has been proposed as a transdiagnostic biomarker of stress vulnerability across psychopathologies, and a reliable association between PTSD, OCD and lower resting RSA was found. Contemplative practices have been linked to the activation of the vagus as well as to an increased RSA that, according to the polyvagal theory, reflects the activation of the ventral vagal complex (VVC) and may promote PTSD and OCD recovery. PubMed and Scopus databases were selected to conduct a search following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) 2020 guidelines, and A MeaSurement Tool to Assess systematic Reviews-2 (AMSTAR-2) was used to appraise the methodological quality for this systematic review. Six articles met the inclusion criteria (one cross-sectional study, one study with pre-post measurements, two cohort studies and two RCT studies). Mindfulness-related interventions promoted parasympathetic activity, an increased vagal tone and improvements in PTSD and OCD symptoms. According to the polyvagal theory, mindfulness-related and compassion-related meditations would be conceptualized as neural exercises expanding the capacity of the ventral vagal complex to regulate the present state and to promote resilience. Clinical and methodological issues are discussed.

Condition of the uvula and soft palate as an indicator of ventral branch of the vagus nerve function and neurological disorganization in dentists and dental students

Блуждающий нерв является основным компонентом вегетативной нервной системы. Поливагальная теория рассматривает этот нерв как две структурно и функционально раздельные ветви – вентральную и дорсальную. Дорсальная ветвь существует у большинства позвоночных. Она связана с первичными стратегиями выживания в условиях сильного стресса, заставляя «притворяться мертвым, чтобы выжить». Вентральная ветвь характерна для млекопитающих и оказывает тормозящее влияние на симпатические пути к сердцу, тем самым способствуя спокойному и просоциальному поведению. Эта ветвь обеспечивает функционирование пищевода, бронхов, гортани и глотки. Мы изучали функциональное состояние вентральной ветви, учитывая, что именно она иннервирует мышцу, поднимающую нёбную занавеску и мышцы нёбного язычка. В качестве рабочей гипотезы предположили, что дисфункциональное состояние вышеперечисленных мышц встречается при функциональной дезадаптации вентральной ветви блуждающего нерва и регуляторных рефлекторных механизмах нервной системы, то есть при неврологической дезорганизации. У пятой части обследованных была выявлена неврологическая дезорганизация. Среди представителей этой группы дисфункциональное состояние нёбного язычка и нёбной занавески встречалось значительно чаще, чем при нормальной неврологической организации. Поэтому выявление наклона нёбного язычка, одностороннего провисания нёбной занавески в покое и при нагрузке рекомендуем использовать как достоверный визуальный индикатор диагностики неврологической дезорганизации. При нормальной неврологической организации самым чувствительным индикатором диагностики функциональной дезадаптации вентральной ветви блуждающего нерва является одностороннее провисание нёбной занавески при произнесении звука «а-а-а». Полученные результаты рекомендуем использовать для диагностики неврологической дезорганизации и функциональной дезадаптации вентральной ветви блуждающего нерва. The vagus nerve is the main component of the autonomic nervous system. According to polyvagal theory, this nerve is considered as two structurally and functionally separate branches, ventral and dorsal. The dorsal branch is found in most vertebrates. It is associated with primary survival strategies in conditions of severe stress, forcing to «play dead in order to survive». The ventral branch is characteristic of mammals and has an inhibitory effect on the sympathetic pathways to the heart and thus promotes calm and prosocial behavior. This branch ensures the functioning of the esophagus, bronchi, larynx and pharynx. We studied the functional state of the ventral branch, considering that it is the one innervating the soft palate muscle and the muscles of the uvula. As a working hypothesis, we assumed that the dysfunctional state of the above muscles is found in functional disadaptation of the ventral branch of the vagus nerve and in the regulatory reflex mechanisms of the nervous system, i.e. in «neurological disorganization». Neurological disorganization was detected in a fifth of those examined. In this group, dysfunctional condition of the uvula and the soft palate was significantly more common than in normal neurological organization. Therefore, we recommend to use the detection of a tilt of the uvula and unilateral sagging of the soft palate at rest and during exercise as a reliable visual indicator for the diagnosis of neurological disorganization. In conditions of normal neurological organization, the most sensitive diagnostic indicator of functional disadaptation of the ventral branch of the vagus nerve is unilateral sagging of the soft palate when makingg the sound «a-a-a». We recommend to use the results obtained to diagnose neurological disorganization and functional disadaptation of the ventral branch of the vagus nerve.

Asylum-seeking children in shutdown: Neurobiological models

Asylum-seeking children presenting in the shutdown state have been the subject of much discussion and controversy—on both government and medical system levels—in Australia and in Sweden. In this article, we conceptualize the shutdown state as an evolutionary response to extreme threat. We adopt a neuroscience approach to present five plausible models for explaining this shutdown state, their strengths and shortcomings, and the overlaps between them. Model 1—the sustained autonomic arousal model—draws on polyvagal theory. Model 2—the innate-defence model—draws on research pertaining to animal and human innate defence responses. Model 3—the catatonia model—draws on clinical and research data with patients presenting with catatonia. Model 4—the hypometabolic model—draws on an emerging body of work pertaining to hypometabolic states in animals and humans. Model 5—the defence cascade model of dissociation—draws on clinical research pertaining to human trauma states that present as dissociation. At present, each of the models provides a plausible pathophysiological explanation—or a component of a potential pathophysiological explanation—and none of them, for the moment, has enough evidence to be either accepted or disregarded. We hope that our discussion of the models advances scientific discussion and opens up possibilities for effective treatment.

The Complicit Therapist

This chapter explores therapeutic modalities that fit with a complicit theory of human being: feminist therapy, Interpersonal Neurobiology, Polyvagal Theory, Internal Family Systems and intersubjectivity. It examines how to be both systems-oriented and work from a depth approach which is an element of complicit thinking. In exploring how to work therapeutically within this frame, the chapter reiterates the importance of a nonbinary understanding of human being, which has been one of the main points argued throughout the book. This, ultimately, is why the psychological humanities is important: It allows for both the art and the science of psychotherapy to co-exist in a nonbinary way. The chapter also addresses another of the ongoing themes of the book, a complicit approach to identity politics, which is connected to a social-justice-oriented psychotherapy practice.

Is Low Heart Rate Variability Associated with Emotional Dysregulation, Psychopathological Dimensions, and Prefrontal Dysfunctions? An Integrative View

Several studies have suggested a correlation between heart rate variability (HRV), emotion regulation (ER), psychopathological conditions, and cognitive functions in the past two decades. Specifically, recent data seem to support the hypothesis that low-frequency heart rate variability (LF-HRV), an index of sympathetic cardiac control, correlates with worse executive performances, worse ER, and specific psychopathological dimensions. The present work aims to review the previous findings on these topics and integrate them from two main cornerstones of this perspective: Porges’ Polyvagal Theory and Thayer and Lane’s Neurovisceral Integration Model, which are necessary to understand these associations better. For this reason, based on these two approaches, we point out that low HRV is associated with emotional dysregulation, worse cognitive performance, and transversal psychopathological conditions. We report studies that underline the importance of considering the heart-brain relation in order to shed light on the necessity to implement psychophysiology into a broader perspective on emotions, mental health, and good cognitive functioning. This integration is beneficial not only as a theoretical ground from which to start for further research studies but as a starting point for new theoretical perspectives useful in clinical practice.

Recognizing emotions in bodies: Vagus nerve stimulation enhances recognition of anger while impairing sadness

According to the Polyvagal theory, the vagus nerve is the key phylogenetic substrate that supports efficient emotion recognition for promoting safety and survival. Previous studies showed that the vagus nerve affects people’s ability to recognize emotions based on eye regions and whole facial images, but not static bodies. The purpose of this study was to verify whether the previously suggested causal link between vagal activity and emotion recognition can be generalized to situations in which emotions must be inferred from images of whole moving bodies. We employed transcutaneous vagus nerve stimulation (tVNS), a noninvasive brain stimulation technique that stimulates the vagus nerve by a mild electrical stimulation to the auricular branch of the vagus, located in the anterior protuberance of the outer ear. In two sessions, participants received active or sham tVNS before and while performing three emotion recognition tasks, aimed at indexing their ability to recognize emotions from static or moving bodily expressions by actors. Active tVNS, compared to sham stimulation, enhanced the recognition of anger but reduced the ability to recognize sadness, regardless of the type of stimulus (static vs. moving). Convergent with the idea of hierarchical involvement of the vagus in establishing safety, as put forward by the Polyvagal theory, we argue that our findings may be explained by vagus-evoked differential adjustment strategies to emotional expressions. Taken together, our findings fit with an evolutionary perspective on the vagus nerve and its involvement in emotion recognition for the benefit of survival.

Self-Reported Emotion Regulation Is Associated With Response to Test of Cardiac Vagal Function

Parasympathetic function and emotional self-regulation (ESR) share neuroanatomic structures. Based on Porges’ Polyvagal Theory and the Neurovisceral Integration Model (NIM), we compared vagally mediated heart-rate variability (vmHRV) with psychometrically assessed ESR. We hypothesized that vmHRV and ESR would be associated during rest, a vagal function test, and recovery from that test. A significant association would justify the psychometric measuring of parasympathetic health, which is less burdensome than its psychophysiological assessment. Two hundred thirteen healthy males (aged: 18–26 years, M = 20.29 years) took part in the present study. They completed the Emotion Regulation Questionnaire (ERQ) and underwent the Cold Face Test (CFT) for 4 min wearing ambulatory electrocardiograms. A High frequency (HF) band was used as a measure of vmHRV before, during, and after the CFT. Associations between the HF band and ESR were analyzed with partial rank correlations. There was no significant association between ERQ scores and the response to the CFT itself. But there was an almost significant association between the ERQ scale Cognitive Appraisal and baseline vmHRV, and a significant association between Cognitive Appraisal and cardiac recovery from the CFT, that is, participants with higher scores on that ESR scale revealed a tendency to exhibit greater vmHRV during baseline and they exhibited greater vagal withdrawal during recovery from the CFT. Cognitive appraisal as a psychometrically assessed emotion regulatory process was reflected in a more flexible parasympathetic activity (i.e., better cardiac vagal health) during recovery from an exclusively physiological stressor. This lends convergent validity to self-reported emotion regulation, and justification for its use as a measure of ESR as a trait, offering further support for the Polyvagal Theory and NIM.