Polyvagal Therapies

Weekend Thoughts and Practices to Explore

When I first met Bethany, she wasn’t in a good place. However, I’ve watched her ebb and flow, as so many people living with complex chronic illnesses do. She always tells me, Art Fills the Void! In addition to beautiful painting (see below), she has been deeply engaged in polyvagal therapies, which have been a very positive influence in her life and health. I asked her to share some of her practices and perceptions with my readers. I have posted them here, largely unedited. I hope they provide some relief for those searching for therapies that work for them.

By Bethany McCraw

Therapies to Explore

Probably the best place to start this list is with breathing exercises. It’s very well known, changing your breathing pattern has profound physiological effects of shifting vagal states and relieving stress or threat response. Simply taking deep, slow, breaths, can be very helpful. But not always. Because when sympathetic (fight/flight) response is activated, increasing oxygen in the body can actually intensify it too. The body requires  extra oxygen for either battle, or running. This is why “counting to 10” when mad, or breathing into a paper bag when having a panic attack, works to calm you down. Both these methods work great to reduce oxygen and are simple to do in the moment. It’s also why most mindfulness practices start with breathing exercises too. It’s very, very effective, and very, very easy to do. 

For me, it’s a bit more complex. The mastectomy scars I have from the breast cancer have healed in such a way there is a “catch” in the pectoral muscles from where the fascia is fused now. It causes an intense, piercing, stabbing pain, especially on the left side, directly over my heart, when my lungs are either completely inflated or completely deflated. This means every deep breath I take provokes a sensation of heart attack symptoms. It forces me to breathe more shallowly than I should, which is problematic also because rapid shallow breathing is what we do in panic attacks, anger, and/or asthma attacks. It can make all of them worse, for the reasons above.

Our bodies and minds are wired to NEVER ignore chest pain. It’s an extremely hard-wired panic response, and for good reason. It’s a deep survival response. Not paying attention to chest pain of any sort can be lethal. Even indigestion can send people running to the ER for how it shows up, as pain near the heart. We simply cannot resist a survival response. It overrides our logic and rational thinking. It’s incredible risky to ever ignore chest pain.  

But what to do, when each and every breath you take provokes panic response simply by default? 

These are the methods I use most often. 

1. The basic polyvagal eye exercise: I do this anytime I need to, and especially while laying down for rest, pacing, meditation, or sleep. It really works! 

2. The physiological sigh: Two short inhalations, followed by a short hold, and then a long, slow, steady exhale. We do this naturally when upset and crying. You can see it happening in children before they learn to control or regulate outbursts. Doing this reduces oxygen and is akin to breathing into a paper bag. It works really well, and like the eye exercise, can be done anywhere, anytime. In fact I now combine the two, and move my eyes left to right sometimes while doing this breathing pattern. I find what works for me is a 2-4-6 pattern: Breathing in two short, quick inhalations through the nose, pausing for twice the time it took to take them, and then controlling a long, slow exhale through the mouth, taking 3 times as long as the first 2 inhalations. 

3. Four-by-four, or “square” breathing: This is now recommended by many long covid clinics. It’s where I first learned of it. This is similar to the physiological sigh and has similar effects, but is simply inhaling to a count of four, not four quick inhalations. So: breathe in, 1, 2, 3, 4. Hold your breath, 1, 2, 3, 4. Exhale, 1, 2, 3, 4. Hold without air, 1, 2, 3, 4. Repeat. It reduces oxygen the same way, by controlling your intake to a 3-to-1 ratio. I have a bit of trouble with this one due to the PMPS pain occurring worst both when my lungs are completely inflated and completely deflated. Holding my breath at the highest and lowest points can make the fascia pain over my heart worse. But it is in fact an excellent tool and an excellent breathing pattern for any type of stress. And again, I sometimes combine this with moving my eyes left to right in the polyvagal eye exercise. 

Moving on to other somatic methods: 

1. The thymus thump: Using one or both hands, alternating, gently thump a relaxed fist just below the clavicle where the thymus gland is located. Think of how gorillas beat their chests. It’s sort of like this, but gentler. We are primates after all. Thump for only about a minute, or until you feel the stress relief. It can also be helpful to vocalize with this method. Give a Tarzan yell and go ape! It produces a calming effect and reduces cortisol, and helps with adrenalin dumps following a panic attack. It helps with asthma too. I like to do this one first thing in the morning. It helps clear any congestion and is also good for allergies/MCAS. 

2. Tapping: Using one or two fingers, tap gently in various places on the head, neck, or shoulders. I like to start at the crown, tapping the top of my head, then tap gently over the eyebrows, on the “third eye”/pineal gland between the eyebrows, both sides of the temples, both sides of the jaw, the clavicle, and the thymus. This is especially helpful for PTSD or CPTSD. It can also be helpful to continue over the entire body for somatic release. Tap shoulders, ribs, abdomen, sides of legs, tops of feet. It can improve vestibular balance issues and is very grounding. I do this one every time I’m at the dentist. I look like an idiot tapping the top of my head while getting my teeth cleaned, but it really helps relieve the anxiety and has been shown to reduce pain sensitivity and sensory processing overload. 

3. Yoga Nidra: This is not yoga as we tend to think of it. Yoga Nidra is more of a mental mindfulness practice instead of physical activity, and is typically done laying down on your back, with arms and legs outstretched and palms upwards, also known as savasana, or “corpse pose”. Despite the name, it has a deeply calming effect just to lie down in this position. Being horizontal takes a lot of stress off the ANS because it doesn’t have to work as hard to regulate the fluid volumes of our bodies. It’s a deeply restful pose. The Yoga Nidra itself is a guided meditation practice of body scanning. It can be done in as little as 10 minutes or up to several hours. It can be done for the purpose of falling asleep and helps with insomnia, or it can also be done to achieve what’s known as “non-sleep rest”, which is a deeply profound relaxed state shown to be almost as effective as REM state in replenishing the brain and CNS. Yoga Nidra can be found free online on YouTube and as podcasts. There’s millions of them out there. One of the most popular practitioners on YT is a Yoga instructor named Ally Boothroyd: 

https://www.youtube.com/@SarovaraYoga but it’s most important to find a practitioner whose voice you like. I listen through headphones. This is also very helpful to do before sleep or as part of a meditation or pacing practice. 

4. Actual yoga: The benefits of physical movement, stretching, and weight training, combined with breathing exercises and mindfulness, has clearly been shown to be beneficial to our health. What most people don’t know, however, is the reason yoga can be so much more powerful a practice is because it works as well the very first time you do it as it does the last. What this means is, from physiological standpoint, a novice beginner doing their first session is getting the same benefits as someone who has had a daily practice for years. This is unique in the exercise world. For instance, think of running. No one can ever really just start running as an exercise practice. It not only takes time to build the muscles for stamina, it takes roughly 20-30 minutes of run time to achieve the anaerobic state which is most beneficial to our systems. You have to start small and work up to it by dashing: Running one block, then walking one block, or in 5-minute intervals. Almost no one out there gets the real benefits from running until they’ve been able to do it for several weeks. This is how most exercise works. You have to start small and work up to it the real benefits. But a yoga practice is different. From the very first time you try it, there are very powerful physiological changes which happen systemwide. This is not saying yoga is easy, nor is it saying you will be able to get into the poses. Achieving the perfect form is in fact out of most people’s range. But this is the paradox: the perfect form isn’t necessary to achieve the benefits of this practice. In fact if you push too hard, you can easily hurt yourself going overboard, because more is happening than you realize. But the way yoga improves body-to-brain communication along the vagus nerve and vestibular communication between both brain hemispheres is well documented. Even if you are entirely unable to move, simply visualizing yourself in the poses can improve your physical and physiological health! This is why chair yoga works. Or even flat yoga, which is where you do the poses best as possible while laying down. Our brains process the information as if we were yogis able to contort into pretzel shapes. People think this is the point of yoga. To be able to twist into pretzels can be fun indeed. But the pretzels themselves aren’t actually important. What is important is the mindfulness, the breath work, and the way our nervous, circulatory, and digestive systems respond to it. In this regard, every person doing yoga is getting benefit from it. At every level, from novice to expert, and every time you do it. When I am unable to stand, I try to do chair yoga. If I am unable to even sit upright, I do what I can laying down. If the dysautonomia is so flared I can’t even move my body laying down, I visualize my yoga routine. All of these things help as if I was an actual yogic pretzel. Yoga is considered weight training because you are in fact using your body weight and gravity as resistance. Even though the benefits are the same as beginner to expert, the strain is not. Starting low and slow with weights to build muscle is the same as any weight training process. This is the aspect which takes time, same as any physical exercise program. It’s the mental and physiological stress relief which is there from the first, not the physical strength nor flexibility. Those parts take time. The mental and emotional benefits are accessible to anyone at any level though. If it seems daunting, a good place to start can be with “Yin Yoga”, which is designed to be more relaxing than invigorating, or even with the Yoga Nidra, which is almost entirely mental rather than physical. Other good candidates in this category can also be Pilates, dancing, and even simply walking while practicing present-moment mindfulness with breathing exercises. 

5. Co-regulation: This is the concept of using someone else’s nervous system to improve our own. Whether we are aware of it or not, our nervous systems as tribal animals are always regulating each other’s. We can lift each other up, or tear each other down. Merely being in the presence of another human is beneficial to our systems. We are meant to function in groups. We are social animals. But if you are so burnt out you can’t socialize, this can become unbalanced. I see this in myself and in other long covid patients. The extreme rest necessary for pacing and symptom management can lead to isolation and separation from our social supports, sometimes dramatically. It lowers serotonin, oxytocin, and dopamine, all necessary things for both physical and mental health. Co-regulation can take many forms. Many people with ADHD find “body doubling” to be very effective. This can be as simple as someone being there with you while you complete tasks. Another good example is a student who uses a "study buddy”. You aren’t necessarily even interacting with the person. Simply being present with another nervous system can in fact help regulate your own. For this to be most effective, the other person needs to also be regulated themselves, grounded and positive, or at least neutral. Co-regulation will not be achieved with someone you are in conflict with. It can be helpful to include physical touch, though not always necessary. Think of how a parent might hug a crying child to soothe them. Another form this can take is by eating together. The physiologic cues we get simply from chewing food in each other’s presence improves digestion and benefits parasympathetic responses. Since I have been isolated so severely by long covid, and it’s not safe for me to eat around others due to my immunocompromised status, I sometimes watch food videos on Youtube while I eat my meals. It sounds odd, but it does help. Other sources of co-regulation besides humans are other tribal animals: Horses and dogs especially. Other pets also give this benefit, but to lesser degrees. Cats, fish, hamsters, and even caring for plants are all good for co-regulatory needs. Any type of nervous system outside your own can be helpful in managing your own stress. This is also why we love to hang out with people we love, or even just with people who have shared interests. Things like how important the super bowl is to some people is a good example of this too. We like to watch sports, movies, or shows with each other. It’s fun and relaxing, and replenishes our reserves while alleviating stress response. Children often need more co-regulation than adults because they don’t have experience yet in navigating their emotional landscapes. A pat on the back or head, or "kissing the boo-boo" are good examples for this concept. Everyone needs to know people are there for them. 

6. Art fills the void! We’ve spoken about this one a lot. Engaging the creative process can be incredibly rewarding, calming, energizing, or relaxing. Music, art, and laughter are some of the most effective vagal shift tools we have. Everyone has creativity. Everyone has access to their creativity. But people get bogged down in thinking it has to be good. Or it has to be an arduous practice of repetition. No it doesn’t! Similarly to yoga, you can get incredible benefit by simply doing it at whatever level you are. If you are capable of writing your name, you are capable of drawing. It doesn’t matter if it’s stick figures! Just draw them, and then allow yourself to feel the changes happening within your nervous system. Listening to music can be as rewarding as creating it. Appreciating art can be as rewarding as creating it too. Engage in whatever art or music speaks to you, regularly. I think I sent you the links to the Neurographic art practice? This is a mindfulness practice which engages creativity in a way which requires no artistic skill whatsoever and has very powerful effect on the brain and ANS. Neurographic art has been shown to reduce chronic pain and is helpful for depression, anxiety, PTSD, and stress. It is recommended by John Hopkins as a mindfulness practice for cancer patients.

ARE YOU TIME LIMITED? Here are some ideas:

Don’t have time for a whole yoga class? Stand on one leg while doing dishes, alternating. Do arm raises and side bends while reaching for the next plate.  

Don’t have time to rest? Do a 10 minute yoga nidra non-sleep deep rest session laying down in your car before you get on the road to go home after work. 

Don’t have time to create art? Doodle neurographic art anytime you have to wait, such as in a clinic lobby. I now carry a small notebook and pen and will even do neurotrophic art waiting in line for grocery checkout or at the pharmacy. 

I think one of the biggest barriers to any mindfulness or stress relieving practice is people think it has to be a big deal and they have to spend a big chunk of time, effort, or money to do so. Sure, a months-long yoga immersion in Costa Rica will have profound effect. But so will doing just ONE sun salutation every morning. Do more if you can. But the most important part is simply doing WHAT you can. And again, if you can’t even do anything at all, visualize doing it. Our brains respond to the thoughts almost the same as if we were actually doing the physical activity. 

It’s hard to believe, but it really does work! I just thought of another good example. “Frozen Shoulder” is a tough condition which occurs to many breast cancer patients, for the ways a mastectomy scar pulls inward, especially when it’s newly healed and very tight. Getting movement back into the shoulders can be crucial because if not addressed, a person may lose complete function of both arms, if they get stuck in place. It was so difficult and painful for me to move my arms or shoulders at first, I could not get the movements needed to reduce this risk. I was working with an OT specializing in lymphedema and breast cancer recovery. She assigned me "shoulder homework exercises” of simply going online and finding images or videos of people with their arms raised or stretching in various positions, and then to visualize myself in those same poses. I did this every day for weeks. Mostly just watching exercise or yoga videos on YouTube, for only about 5 minutes a session, once or twice a day. Every time I did it, I could move my shoulders more. It was tiny, tiny actions, but a dedicated brain practice. As a hairdresser, I could NOT take the chance of losing my arm movement, range, or strength! So I did this practice diligently, and then we built on it, at a snail’s pace. The way to build strength is low and slow, right? I didn’t have access to a gym. So I started using household objects for my weight training to rebuild arm and shoulder strength once I could move my shoulders and we were sure I was no longer at risk for frozen shoulder. It took me 6 months to lift my smallest cast iron skillet over my head, but I still now lift every pot or pan I pick up over my head and do bicep curls and other moves with it, every time I cook or put things away. The point is: start where you are. It doesn’t matter what you can’t do. Just do what you can. It’s still worth it. I will never forget the first time I was able to lift a 30-pound bag of cat litter over my head. I stood in my kitchen crying happy tears, holding this bag up with both hands as long as I could, maybe for a minute or two. It was something I had thought I’d never be able to do, ever again. It took me almost a year to get to that point. Our brains and body are AMAZING. They will heal themselves when given the right support, the right pacing, and a slow, patient practice. Start small. Start where you are. Celebrate every victory, no matter how small. Forgive yourself for not being an Olympic athlete. You don’t have to be one to achieve greater health, physically, mentally, emotionally, and relationally. 

OH and one more important thing we all already know, but is always worth repeating: Hydrate, hydrate hydrate! We are liquid beings. Everything in our bodies works better when we are hydrated. Hydration is not just water. Our bodies need electrolytes in order to deliver the hydration to our cell function. It doesn’t have to be expensive or sugary sports drinks. One dill pickle delivers B vitamins, salt, and trace minerals. Have one and just drink more water throughout the day. Keep a water bottle with you instead of buying more plastic. It will remind you how much you’ve had and how much you need. Since I deal with POTS, electrolytes & hydration are especially important. I drink 100 oz of water a day, all in small sips fairly constantly. It helps not only with the metabolic processes, it relieves stress and improves your mood. A lot of low-level headaches people deal with is in fact mild dehydration. It’s also important to remember you can get more hydration also from the foods we eat. Celery, watermelon, grapes, cucumbers, lettuce, cabbage, citrus fruits, etc., all very good sources of hydration we can access. 

I just think it’s important to break these things down into forms which are actually accessible to most people. We’ve somehow gotten this idea you can only attain health or fitness with a lot of struggle, money, or leisure time. It really doesn’t have to be so. Even 5 minutes of visualizing an exercise routine helps. Lifting your skillet helps. Do anything you can, even if it feels like nothing, and have patience and compassion for yourself. Creating a mindfulness and/or exercise habit can be added to any situation at any age or any health level. It certainly can be helpful (and recommended, especially at first!) to consult a doctor, OT, or trainer if you have specific issues or need their support to get started. But paying attention to your own body, your own mind, your own schedule, your own pacing and rest needs, is not something anyone else can do for you. Find what works for you. Start small. Start where you are. Do your best and leave the rest. 

THANK YOU BETHANY!