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Moving up the ladder! Get to know your anxiety though a Polyvagal Theory lense

A conceptual image of nerves influencing the brain

Case study by Amy O’Neill

Polyvagal Theory provides a framework for understanding the role of the nervous system in human behaviour. Psychotherapist Amy O'Neill provides her guidance on how to harness the theory to understand our thoughts and address our emotions.

Picture this: You are feeling anxious. Your hands start to sweat, and you can feel your heartbeat quicken. Thoughts start running through your head. You start to hyperventilate. Someone says to you "You just need to calm down." Unsurprisingly, you don't calm down.

You don't calm down because in that moment, you simply can't – and it's true.

Anxiety management techniques can be helpful in managing anxious symptoms, but understanding your anxiety in terms of your physiology can provide insight as to what actually happens when you are anxious and bring compassion to this very human experience.

With reference to Dr Stephen Porges' Polyvagal Theory, we can look at our nervous system and understand what is happening in our biology when we are experiencing these symptoms.

Get to know your nervous system

Understanding your nervous system and what is going on, can be helpful in giving us insight to our internal processes. We can think of it as befriending our anxiety – and you wouldn't befriend just anyone before you got to know them first. Firstly, we can look at our Autonomic Nervous System (ANS).

The ANS is part of our peripheral nervous system that controls our involuntary body functions. This means it is responsible for regulating physiological processes that are out of our conscious control, such as blood pressure, digestion and heart rate. The ANS can be split into two pathways:

1) Sympathetic nervous system (SNS)

The SNS gets us ready for action. So, if you can imagine being face-to-face with a lion – your body has involuntary physiological processes to keep you alive. You will either fight the lion or run for your life. Your brain doesn't allow you to "think" your way out of a lion attack – your body just knows what to do! Your heartbeat increases, your body produces adrenaline and your pupils dilate.

2) Parasympathetic nervous system (PNS)

The PNS slows you down to conserve energy. In Polyvagal Theory, one nerve in the PNS – the vagus nerve – is of particular interest. This nerve has two sides: the dorsal (back of the nerve) and the ventral (front of the nerve).

The dorsal vagus nerve

If you were standing in front of a lion, you may be so overwhelmed that you are unable to fight the lion or run away from it. You may instead feel paralysed and "play dead" until the lion moves past us. This is our freeze response, which can be considered an emergency state, where we can feel a sense of hopelessness and immobilisation. The dorsal vagus nerve is responsible for this freeze response.

The ventral vagus nerve

Our ventral vagus nerve is responsible for our "rest and digest" state. If we are in this state, we are more grounded, connected with the world, empathetic and compassionate. We are in a state of social connection and feel present, calm and safe. When looking at our physiology, our digestion, immune responses and circulation is improved.

A scientific illustration of the human nervous system
macrovector | Freepik


Our senses are constantly involuntarily reading social cues and scanning our environment for signs of danger and threat, which activate either a parasympathetic or sympathetic response.

Neuroception (a term coined by Stephen Porges) refers to our awareness and understanding of the levels of threat in our environment. We constantly observe other people's facial expressions, body language, tone of voice – almost like a surveillance system to keep us safe!

Neuroception means that we are (remember, involuntarily!) constantly monitoring what is happening inside our body and our internal organs, outside of our bodies by scanning the external environment for danger, and between other nervous systems (for example, looking at the systems of other people, like a smiley face may make us feel safe whilst an angry face may make us sense danger), which trigger our own nervous systems.

This means that the temperature of the room you are in, a rumbling stomach, a headache, a comfy chair and the smile on a stranger's face are all taken in through neuroception and bring about the following responses:

  • Cues of danger – activates your sympathetic nervous system (fight or flight)

  • Cues of life-threat – activates your parasympathetic dorsal vagus nerve (freeze/immobilisation)

  • Cues of safety – activates your parasympathetic ventral vagus nerve (social engagement)

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The Polyvagal Ladder

By exploring the PNS, we can see that our vagus nerve regulates both our shutdown response (dorsal) and our safe and social response (ventral). The Polyvagal Ladder developed by Deb Dana helps us to visualise our nervous system as a ladder with our ventral vagus system at the top, dorsal vagus system at the bottom, and our SNS in the middle (our fight and flight). This visual can help us see where we are on the ladder, and what "state" we are in.

Polyvagal Theory emphasises that there is a fluidity in the movement of states, and that it is a normal human experience to move up and down the ladder throughout the day. It is therefore inevitable to not always be in our "safe state". The theory also shows that if you are at the bottom of the ladder in your immobilised state, it is not possible to jump up the ladder into your safe state, and that you have to access your sympathetic nerve that will bring you out of your immobilised state.

An infographic of the polyvagal ladder

Applying the Polyvagal Ladder to anxiety and depression

What happens to you when you are feeling anxious? What happens in your body? You may notice a tightness in your chest or a dry throat, or perhaps an impulse to run away or lash out. What about if you are experiencing more depressive symptoms? Maybe your legs feel heavy, and you feel stuck to the ground? Maybe you don't feel anything at all, and more numb.

By bringing your attention to the Polyvagal Ladder, you can visualise what is happening physiologically and in turn, normalise this. All too often we want to shun away our anxiety and

general negative feelings and "fix it". Make it all go away – but you can't "fix" a normal human and physiological experience. By understanding what our bodies are doing and why they are doing it, we can bring some compassion to ourselves and know that our bodies are just doing what they were designed to do.

Managing anxious symptoms really starts through neuroception. We want to shift our neuroception from a state of perceiving threat and danger to a state of safety.

Techniques to activate your ventral vagus nerve

So... how do we activate the ventral vagus nerve and get back to safety? You can try some of the following strategies (note: it is important to find what helps you access your ventral vagal nerve and move up the Polyvagal Ladder).

Identify your state

  • Firstly, it is helpful for you to identify where you are on the ladder. Are you anxious and in the middle of the ladder? If so, you may want to think about what will calm your system down. You can have a think about what makes you feel more relaxed. If you are at the bottom of the ladder and feeling disconnected, you may want to think about what will activate your sympathetic system to get you connected and get you mobilised again.

Deep breathing

  • Deep and slow breathing has been shown to stimulate our vagus nerve and can help reduce anxiety symptoms. Research has shown that taking deeper, slower and longer breaths can help bring us up the ladder if we are sitting in the middle. You can try various breathing techniques or guided meditations to help you.

Cold exposure

  • Research has shown that cold water exposure can help bring you up the Polyvagal Ladder, by slowing down your heart rate. Whether this is a cold shower or an ice facial, acute cold-water exposure helps to stimulate your ventral vagus nerve.


  • The actual act of laughter can bring us up the ladder and stimulate our PNS and ventral vagus state. Of course, it is a little awkward to laugh without anything being funny – it isn’t something you can really force. What you can do is try and laugh with a straight face, and feeling how ridiculous that is, you will most likely laugh!


  • It might sound strange, but the act of humming can stimulate our vagus nerve and calm our system down. Children often hum as a way to self-soothe – so why can’t adults? You can try this, and while you hum, notice the sensations you feel in your body and what might feel good about humming.

Get moving

  • Exercise is great for stimulating our ventral vagus nerve for when we are needing to move up our ladder from our dorsal vagus shutdown. You can start with small movements – you can begin by rolling your shoulders up and down, and tipping your ear to your shoulder on each side. This movement can feel great, and stimulate our ventral vagus nerve. There are many vagal toning movements you can find on YouTube that can be helpful.

Stay connected

  • Keeping in touch with the people who make your system feel safe is of course a massive benefit to your health and can bring you right up the ladder. Polyvagal Theory emphasises the importance of co-regulation, which is the reciprocal connection between two nervous systems, both sending and receiving signals of connection and safety. Think about those in your life you feel safest with – do you notice yourself usually being on the top of the ladder when you are around them?

Talking therapy

  • If you have access to talking therapy, it may be a good idea to ask your therapist about Polyvagal Theory if you want to work on ways to reach your safety state. Talking therapy can be helpful due to the focus on the therapeutic relationship being one of co-regulation and safety.

If you are interested in understanding more of Polyvagal Theory beyond this article, I recommend any readings from founder Dr Stephen Porges and Deb Dana.


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