A final (for now) therapeutic strategy that is useful for overall mental health and tinnitus management in particular is Polyvagal Theory. At the heart of polyvagal theory is the vagus nerve, the tenth cranial nerve and the longest nerve in the body. The vagus nerve is responsible for the parasympathetic part of the autonomic nervous system. If you recall from the discussion of mindfulness, it is the sympathetic nervous system (SNS) that is implicated in fight or flight. Specifically, when we encounter a stressor the sympathetic nervous system, activated by the hypothalamus, regulates the body to increase heart rate, dilate coronary arteries, dilate bronchial tubes, release glucose from the liver, and perform a number of other functions that prepares the body to engage in battle or flee. By contrast, the parasympathetic nervous systems (PNS) slows down physiological processes and is responsible for returning us to balance once the SNS has been set in motion—the yin to the SNS’s yang. Polyvagal theory proposes that there are two distinct branches of the vagus nerve that are responsible for different parasympathetic functions of the vagus nerve. There is a ventral component that is responsible for bringing us into connection with others. As well there is a dorsal element which shuts down the functions as a way of responding to a threat (for example, when an animal who is threatened plays dead).

Put simply (and you probably need it put simply after that last paragraph) our nervous system is in one of three states: a sympathetic state of fight/flight, a dorsal shut down state, or a ventral state of connection. You can probably go through your day and identify examples of each. You sit and have breakfast with your wife before going off to work, savoring the quiet of the morning, the aroma of the coffee, and the shared intimacies of the conversation—a ventral vagal moment. On the road, the stress mounts as you find yourself stuck in a traffic jam and cut off by crazy drivers, causing your hands to clench the wheel and your heart rate to increase, a sure sign of fight or flight. At work, a backlog of tasks along with a notification of even more demands on your time push you precipitously close to a dorsal shut down state.

Actually, we enter different states of our nervous system not just a few times but probably hundreds of times a day. It is the psychological equivalent of touching your face in that most of the time we are unaware of the changes, which may be slight and subtle or deep and noticeable.  Importantly, the point is not to remain in the connected state of ventral vagal as much as possible and avoid the other two. This would not only be impossible but unadvisable, since there are times we require the sympathetic energy in order to rouse ourselves and times when the suppressing nature of the dorsal can be of use. Rather, the goal is to develop an elasticity, an ability to move between the states. This requires first that we identify where in our nervous system we currently are, which is why mindfulness is a useful adjunct to polyvagal work. Once we are able to recognize the state of our nervous system, we want to develop strategies to extricate ourselves from the sympathetic or dorsal states as well to increase our ability to linger in the ventral state.

There are some general strategies that can be recommended to anyone as a way to the goal of what we might call polyvagal flexibility. To take just one example: breathing exercises are a time-tested way to help extricate us from a sympathetic fight or flight state. By exhaling for longer than we inhale, we activate the parasympathetic nervous system, which can control and calm us when we are in a state of fight or flight. However, most of the ways we manipulate our nervous system will be specific to the individual. What works for me might not work for you, and what works for me in one situation might not work in another.  I might get out of a dorsal state by going to the gym, or meeting up with a friend, or taking a walk in nature; I might be able to remove myself from sympathetic by recalling a favorite passage from a spiritual work, diverting myself with a hobby, or when all else fails, counting to ten, while just stroking my wife’s skin or petting my dog’s hair may bring me to a ventral state. In fact, there exists a good deal of research on practices that enhance our ability to enter and remain in the state of ventral vagal. Many of these are dealt with in the area of positive psychology that we have already discussed.

By developing more and more strategies to extricate ourselves from sympathetic and dorsal and to remain in ventral, over time we begin to reshape our nervous system, spending less time in the states that often undermine our well-being (destructive sympathetic and dorsal) and more time in the state (ventral) that supports it. This is especially important for those with tinnitus because, as Polyvagal theorists remind us, story follows state. That is, the state that our nervous system determines the story we are telling ourselves: both about our lives in general and about our tinnitus in particular. Our tinnitus looks and feels very different to us when we are feel connected with others than it does when we are under the stress of fight and flight or in dorsal collapse.

Resources

Deb Dana is responsible for bringing the polyvagal theory into the therapy world. Although she has published several books intended for therapists, she recently released book aimed at teaching the principles of polyvagal theory to the general public. That book is called Anchored: How to Befriend Your Nervous System Using Polyvagal Theory.  You may also enjoy the book Breath: The New Science of a Lost Art by James Nestor.