Anxiety through the lens of polyvagal theory

Anxiety is a natural and often adaptive response to stress or potential threats. It is a complex emotion characterised by feelings of apprehension, unease, or fear about future events, situations, or outcomes. While some level of anxiety is normal and can even be helpful in certain situations, such as alerting us to potential dangers, excessive or persistent anxiety can become problematic and interfere with daily life.

What is anxiety?

Anxiety can manifest in various ways, including physical, emotional, and cognitive symptoms. Common physical symptoms may include a racing heart, sweaty palms, trembling, shortness of breath, restlessness, and digestive issues. Emotionally, individuals experiencing anxiety might feel on edge, irritable, or tense. Cognitive symptoms often involve excessive worrying, intrusive thoughts, difficulty concentrating, and an inability to relax. All of these symptoms can greatly affect a person’s view of themselves, others and the world in general.

Anxiety disorders are a group of mental health conditions characterised by excessive and chronic anxiety that can significantly impair a person's functioning and quality of life. Some common anxiety disorders include:

Generalised anxiety disorder (GAD)

This involves excessive worry and anxiety about various aspects of life, often without a specific trigger. People with GAD may struggle to control their worry and find it difficult to relax.

Panic disorder

Individuals with panic disorder experience recurrent panic attacks, which are sudden episodes of intense fear or discomfort accompanied by physical symptoms such as a rapid heart rate, shortness of breath, and a sense of impending doom.

Social anxiety disorder (social phobia)

This disorder involves an intense fear of social situations and interactions, often leading to avoidance of such situations due to the fear of being judged, embarrassed, or humiliated.

Specific phobias

These involve an extreme and irrational fear of specific objects or situations, such as heights, spiders, flying, or public speaking.

Obsessive compulsive disorder (OCD)

OCD is characterised by intrusive and distressing thoughts (obsessions) that lead to repetitive behaviours or mental rituals (compulsions) performed to alleviate the anxiety caused by the obsessions.

Post-traumatic stress disorder (PTSD)

PTSD can develop after experiencing or witnessing a traumatic event. It involves symptoms such as intrusive memories, nightmares, hypervigilance, and avoidance of reminders of the traumatic event.

Anxiety disorders are common, and they can be caused by a combination of genetic, environmental, and psychological factors. In this article, I aim to explain from a polyvagal theory perspective, what is happening in and around the nervous system when anxiety is present.

What is polyvagal theory?

The polyvagal theory, developed by Dr Stephen Porges, is a comprehensive framework that helps us understand the intricate interactions between the autonomic nervous system (ANS), social behaviour, and emotional regulation. The theory highlights the role of the vagus nerve, a major nerve that runs from the brainstem to various organs, in shaping our physiological and psychological responses to stress, safety, and social interactions.

The polyvagal theory has profound implications for understanding various aspects of human behaviour and mental health, including:

Emotional regulation

The theory helps us understand how our nervous system responds to stress and how we can regulate our emotions by engaging the social engagement system.

Anxiety and trauma

Dysregulation of the autonomic nervous system can contribute to anxiety and trauma-related symptoms, including panic attacks and dissociation.

Social interactions

The theory sheds light on how the nervous system influences social behaviour, attachment, and communication.

In the context of anxiety, the polyvagal theory suggests the following:

Anxiety as a dysregulation of the autonomic nervous system

When the ANS becomes dysregulated, it can lead to an imbalance between the different branches, causing excessive activation of the SNS or DVC and inadequate engagement of the ventral vagal complex. This dysregulation can contribute to heightened anxiety and difficulty in regulating emotional responses.

Social connection and safety

The ventral vagal complex is important for creating a sense of safety and social connection. Individuals with anxiety may struggle to activate this system, leading to difficulties in forming and maintaining healthy relationships and feeling safe in social situations.

Hyperarousal and hypoarousal

Anxiety can manifest as either hyperarousal (excessive activation of the SNS) or hypoarousal (activation of the DVC). Hyperarousal can lead to chronic stress, panic attacks, and an inability to relax. Hypoarousal can lead to feelings of numbness, dissociation, and a lack of energy or motivation.

This theory helps us to understand what our bodies are trying to do for us to help us remain in safety and respond to cues of unsafety and react accordingly.

Working with a therapist who is polyvagal informed allows the anxiety to be tracked by noticing how we move up and down the ladder during the day, especially when we are triggered or activated in some way. The reactions can be linked to past events or to present-day circumstances and a therapist can help to identify this. Looking through the lens of polyvagal can help to unravel what the body, especially the nervous system, is trying to do to either keep us in protection or in connection. It cannot be in both at the same time.