Feeling safe: An embodied understanding of living with a heart condition from birth.

Our book (left) is now available to pre-order (click the image) & it will be published in June (USA) & July (UK). In my chapter, I explore how The Polyvagal Theory can provide an embodied understanding of living with a heart condition from birth.  

​The Polyvagal Theory & Neuroception of Safety
Neuroscientist Professor Stephen Porges’ Poly Vagal Theory (PVT) offers an embodied understanding of our nervous system, senses, emotions, social self & behaviours. He proposes that one of the most fundamental jobs of our body’s nervous system is to keep us safe, a task he calls Neuroception. To this end, three systems have evolved over time; each controlled by a different branch of the vagus system (hence, The Polyvagal Theory).  This enables us to self regulate & respond to threat (including social threats like rejection or physical threats). 

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"Your chapter provides new information for those of us, who have studied the bidirectionality of brain and body.  As a scientist, I have frequently talked about the bidirectionality between heart and brain and between visceral states and mental function.  However, your chapter truly provides a personal narrative of these concepts that has been missing from the scientific literature and specifically from Polyvagal Theory."  Prof Stephen Porges, Neuroscientist.

Three Threat Systems
When we are safe the ‘Social Engagement System’ is enabled. In this mode, our bodies can function uninterrupted & we feel safe, calm & socially connected. The tasks of this mode include feeding, vocalizing, head tilt & turn, gaze, facial expression, voice perception & listening. We need to be in this mode to reduce metabolic demand to grow, develop, learn & heal.

When we feel under threat a different mode is activated; our fight or flight response. In this mode, our nervous system is called to action & we feel compelled to either fight or run to safety. Our body experiences a stimulating set of physiological changes, felt as anxiety, anger or blind rage. 

If we feel like our life has been seriously threatened a third system may be activated. We may respond with our most primitive mode, by playing dead (we may wonder after why we 'did nothing' when in fact our bodies did the best they could to keep us alive). Physiologically, this system is deactivating whilst psychologically we dissociate or feel ‘numb’.  ​

The Three 'modes' of The PVT

Hearts & Minds 
Our sensitivity to risk is shaped during infancy.  We know that adverse childhood events can increase this sensitivity.  The vagus nerve modulates heart rate activity in response to stress & heart rate variability can be used to measure stress reactivity, providing a marker for Neuroception. Since the heart is central to our nervous system it seems likely that cardiac anomalies may compromise the stress response, emotional regulation & the social self. This may be further heightened by medical disruptions to the biologically embedded need for safe social connection.   

We know that being born with a heart condition presents increased vulnerability to psychological difficulties including anxiety, depression & PTSD, previously accounted for by secondary factors (e.g. interrupted education, feeling different, discrimination) (Kovacs & Utens, 2015; Czosek et al, 2012; Morton, 2012; Karsdrop et al, 2007).

This embodied understanding has profound implications, across the lifespan, for those of us living with a heart condition from 'cradle to grave' which I explore drawing on contemporary psychological models including Attachment Theory, Body Psychotherapy & Neuropsychological Theories of Compassion (Bowlby, 1977; Hoffman et al, 2011; Keltner, 2010; Gilbert, 2009; Rothschild, 2000).  I also consider strategies to optimise the normal development of social & defensive behaviours (by facilitating autonomic attunement with the attachment figure), inform therapeutic interventions (focusing on safety and stabilisation) & to better humanise medical care. ​

My top five tips for improving feelings of safety & connection (in and out of hospital). 

1. Surround yourself with your people.  For me this includes those who have proven themselves to be supportive, dependable & genuine. Health problems are a great way to weed out those who aren't made of the right stuff.  A team of a few close, genuine connections is worth more than a million fake friends (& sometimes the best friends are not human - I always have at least one dog in my inner circle!).  I always try to pay it back when I am feeling better because these relationships are worth the investment.  You may also benefit from involvement in patient support groups such as The Somerville Foundation. 
2. Keep a comfort box of items that you associate with feeling safe. You can include things that stimulate different senses including items that are soothing to touch (e.g. soft socks, a cosy blanket), smell (e.g. bubble bath, favourite perfume), hear (e.g. comforting music), or see (e.g. photos of happy times, loved ones & places you plan to go to, favourite movies or boxsets).  You can also include meaningful items, a list of coping statements or goals, anything that works for you. 
3. Body techniques such as Relaxation (Visual Imagery, Guided Imagery & Progressive Muscular Relaxation), Mindfulness & Breathing Exercises all help to calm the nervous system & re-engage your 'Social Engagement System'. 
4. Research has shown that reassuring touch, vocalisations and presence can calm the nervous system. Parents & caregivers can provide a soothing presence by touching, singing & talking to their baby or child. 
5. Consistency of care can make us feel safer.  Unfortunately, to date adult care has often not evolved in time to meet the needs of the growing population of adults who were born with a heart condition.  Being an expert patient, informing yourself & your loved ones about your condition & care needs, keeping copies of your notes & demanding the care you deserve, can all help. 

Please speak to your GP or doctor if you feel like you need professional help.   

 I am always happy to share my work to benefit & learn from others.  I have presented this work at various international & national conferences & to various audiences (undergraduate students, patients & parents, medical care providers, charities).  If you are an organisation that would like to know more please just drop an email to drlizamorton@gmail.com.