Where I Sit With Polyvagal Theory (2026)

There has been renewed debate about Polyvagal Theory recently.

A coordinated critique was published questioning its neurophysiological foundations, its evolutionary framing and its use of RSA as a biomarker. Stephen Porges has since published a formal rebuttal responding to those critiques.

As someone who works clinically with trauma, chronic illness, functional neurological symptoms and nervous system regulation every single day, I’ve been sitting with it.

Not reacting.
Not defending.
Not dismissing.

Just thinking.

Because scientific critique is healthy. It’s necessary. It’s how fields mature.

But critique only moves science forward when it engages a theory as it is actually formulated - not as it’s simplified on Instagram, not as it’s caricatured in training rooms, and not as it’s occasionally misused clinically.

So here is where I sit.

First: I Don’t Use Polyvagal Theory as Dogma

I don’t teach dorsal vagal “shutdown” as a personality type.

I don’t use RSA as a magic trauma biomarker.( A brief note on RSA. Respiratory Sinus Arrhythmia (RSA) refers to the natural fluctuation in heart rate across the breathing cycle - heart rate increases slightly on inhalation and decreases on exhalation. Within Polyvagal Theory, RSA is often described as a peripheral index of ventral vagal regulation, reflecting respiratory-gated influence of myelinated vagal pathways on the heart. However, RSA is not a direct measure of “safety,” nor is it a simple read-out of trauma or resilience. It is influenced by breathing rate, context, development, and measurement method. It offers a window into autonomic flexibility - not a diagnostic verdict. Like any physiological marker, it must be interpreted within a broader clinical and relational context).

I don’t believe humans are stacked in a neat ladder of vagal states like a children’s diagram.

And I don’t think autonomic regulation explains everything.

But I do use something fundamental from Polyvagal Theory every day:

The idea that autonomic state functions as a platform that organises behaviour, emotion and physiology.

That is not an Instagram meme.
That is not a metaphor.
That is a clinically observable reality.

What I See in the Therapy Room

In EMDR, state shifts before cognition shifts.

In somatic work, physiology reorganises before narrative reorganises.

In breathwork, people do not “think” their way into safety- their system experiences safety.

In Functional Neurological Disorder and persistent physical symptoms, autonomic state explains why symptoms are real, embodied and not imagined and why cognitive reassurance alone often fails.

When someone is in sympathetic dominance, they scan, brace, react.

When someone is in dorsal dominance, they collapse, disconnect, dissociate.

When ventral regulation is available, social engagement, flexibility and curiosity return.

Call it what you like.

But the organising role of autonomic state is undeniable in lived clinical practice.

The Scientific Debate

The recent critique focuses heavily on measurement -particularly RSA -and on evolutionary claims. Porges’ rebuttal argues that many criticisms evaluate a reconstructed version of the theory rather than the systems-level framework he actually articulated.

What strikes me most reading the exchange is this:

Much of the disagreement sits at the level of measurement and framing, not at the level of whether autonomic regulation matters.

Polyvagal Theory does not claim that mammals uniquely “have” vagus nerves.
It does not deny respiratory–cardiac coupling in other species.
It does not reduce human behaviour to one nerve.

What it proposes is a systems-level organisation - that in mammals, certain vagal pathways are integrated with social engagement circuits in a way that supports co-regulation and flexible state shifts.

That’s a testable, refinable proposition.

It is not mystical.

The Instagram Problem

We do need to be honest about something.

Polyvagal Theory has been simplified - sometimes beautifully, sometimes irresponsibly - in online spaces.

Colour-coded ladders.
Personality identities.
“Dorsal is freeze forever.”
Overconfident physiological claims.

That is not the peer-reviewed theory.

And poor translation into public education does not automatically invalidate the underlying framework.

Every field suffers when nuance is lost.

Why I’m “With Porges”

Not because I think he is beyond critique.

Not because I believe the theory is complete.

But because at present, it remains the most coherent framework we have that:

• Links brainstem autonomic regulation with observable behaviour

• Explains state-dependent shifts in trauma responses

• Integrates co-regulation into neurobiology

• Makes sense of developmental vulnerability

• Offers falsifiable propositions rather than vague metaphors

It is a systems theory.

And systems theory feels clinically honest.

What Actually Matters to Me

As a consultant nurse and trauma therapist, my job is not to defend theories.

It is to reduce suffering.

If a framework:

• Helps explain why someone cannot “just calm down”

• Validates why symptoms are embodied

• Guides interventions toward safety and co-regulation

• And aligns with observable physiology

Then it is clinically useful.

And right now, Polyvagal Theory - used carefully and critically - still does that.

Science Should Evolve

The theory will be refined.
Metrics will improve.
Language will tighten.
Some claims may narrow.

Good.

That is what mature science does.

But abandoning a systems-level model of autonomic organisation without a more comprehensive replacement would, in my view, be premature.

Where I Sit

I sit in nuance.

I sit in clinical observation.

I sit in physiology that is lived, not abstract.

I welcome rigorous debate.

But until a more coherent, testable and clinically generative framework replaces it, I will continue to work with an understanding of autonomic state that recognises:

We are not thinking machines.

We are state-dependent organisms.

And safety changes everything.