The title almost sounds like the start of a joke, right? Four people enter a pub – depression, anxiety, the Vagus nerve and craniosacral therapy. During my Craniosacral education we studied the Vagus Nerve, learning the theory and practicing the different vagal tones by doing hands on work, feeling for the dorsal and ventral branch of the Vagus Nerve. At the time for me, the theory was mostly words on paper about Stephen Porges Polyvagal theory. This is not a light subject matter to begin with and as my course and study materials were conducted in German…well let’s just say Stephen Porges “Die Polyvagal theorie: die phylogenetische entwicklung des Nervensystems” got filed away in the “one day – too hard” basket of my brain.
Many years later and firmly established in my own clinic, that one day came, when a Psychiatrist started to refer some of his clients with various diagnoses like: Insomnia, Anxiety, Depression and Fibromyalgia to me. This psychiatrist advocates non-medicinal treatment in finding alternative ways to help his clients through TMS, neurofeedback and stimulating the Vagus Nerve, in my case, through Craniosacral Therapy. As I treated his clients, I started to notice various similarities. All had an under-activated dorsal branch of the Vagus nerve, a compression at the Cranial base and different parts of the brains that would be overactive, i.e. over fire on a neural level. I knew I had to revisit Stephen Porges Polyvagal theory and as it turned out, it also confirmed a piece in my own personal journey.
The Vagus Nerve and the differences between the functions of the ventral and dorsal branch of the Vagus Nerve have great implications in the healing of our physical, mental and emotional health. In this blog I will mainly focus on the Dorsal Vagal Nerve, as a chronic activation of dorsal vagus circuit is accompanied by depressive feelings as in loss of interest in activities and surroundings, digestive problems, reduced energy, not being active, sad and/or being anxious. Working with the Dorsal Vagus Nerve through CST, has a great potential for treating people with Depression, Anxiety and Insomnia.
In previous blogs I have written about the Autonomic Nervous System (ANS) and its 2 key branches the Parasympathetic nervous system (PNS - rest and digest) and Sympathetic nervous system (SNS - fight and flight). They should ideally go up and down during the day in a balanced rhythmic way. The Vagus Nerve is part of our PNS and is one of the 12 Cranial Nerves (Cranial Nerve X) that regulates most of our bodily functions for our health, relaxation and emotional well-being (75%), i.e. stabilising our heart rate, breathing & digestion.
The Vagus is the largest ANS nerve, starting in the brainstem at the base of the skull and going through the neck into the chest and abdomen regulating many of our organs, from the heart, to the lungs, to the gut. In below picture you can see its pathway into our organs, where the fibers of the Vagus Nerve act as a surveillance team of our internal organs sending the information up to our brainstem for processing and actioning.
New Model - Polyvagal
Polyvagal as a relative new model (1994) states we have the SNS – fight and flight but that the relax and digest Vagus Nerve has 2 branches (in the classic ANS model the assumption is one vagus nerve). Polyvagal states that there are 2 separate distinct vagal nerves that originate in 2 different locations and have 2 different neural pathways. They are:
Ventral Vagus Nerve
When there is a threat or stress in our environment, we rely on our VVN to establish a sense of safety and connection, this can be through conversation, a call for help, making eye contact, a calming voice etc. This will send signals down to our heart and lungs, slowing down our heart rate and deepening our breathing. It is also referred to as the Social Nervous System and in essence functions as brake – Vagal Brake – having a calming and soothing effect on our nervous system. If the social nervous system fails to resolve the stress and it remains active in our body, then we will automatically resort to the older biological response of fight/flight.
Dorsal Vagus Nerve
When the fight/flight mode fails to resolve the stressor, we then subsequently resort to our oldest biological primitive ultimate emergency response through the Dorsal Vagus Nerve. A sudden extreme surge in dorsal vagal activity can for instance happen when we are faced with great danger. It is a defensive strategy that helps us cope in a traumatic event, or with prolonged extreme stress or danger, real or imagined and can bring our body in a state of “immobilisation with fear”. Much like a cockroach playing dead when he knows his time is up and senses a human being with a spray in their hand (Very much a Sydney thing:).
“A chronic activation of dorsal vagus circuit and its physiology is characterised by depressive feelings. For example, loss of interest in activities that were once pleasurable, loss of appetite, overeating, digestive problems, reduced energy, sad, anxious, problems remembering, making decision and also fibromyalgia. Diagnosis of depression are usually accompanied by a state of activation of the dorsal branch of the Vagus nerve. If the transition into a dorsal state has involved a sudden surge in dorsal branch activation, via a shock, a shutdown results. In a dangerous situation, it is a natural reaction to dissociate from one’s own body from the here and now, and to shut down physically, emotionally and mentally”. (Stephan Rosenberg, 2017).
It is exactly in these words that I found the missing piece of my own personal puzzle. In a previous blog I have written about my own physical and emotional trauma. I was certainly displaying symptoms of depression after the trauma and had many other symptoms including insomnia, anxiety and digestive problems. I was given the label of Depression and heaps of chemical pills. I felt I was not depressed in the classic sense of Serotonin deficiency and I did not want a different pill for every one of my symptoms. I intuitively knew but did not have the knowledge at the time that my answers did not lie in the medical chemical world. It seemed like a valued but incomplete model, as the primary innate biological forces that controlled all of my symptoms seemed to be overlooked, disregarded and not worked with. I now understand that there was a huge activation of my Dorsal Vagus Nerve – partly due to the physical head trauma and partly due to the shock and trauma that accompanied it and therefore pills and classic talk therapy did not work for me, as it did not address nor rebalance my Vagus Nerve, its pathway into my organs and digestive system or my Trauma.
Symptoms of Dorsal Vagal State – Shock/ shutdown
The body is truly amazing and in my humble opinion quite undervalued in the western medical conditioned ‘machine-like’ approach. We don’t always have to take out parts, replace parts or fill it up with chemicals to suppress symptoms. We can work with the body, feel the body, regulate the body, regulate the nervous system, reset its physiology, get nerves to fire under their threshold in many ways, and here through the Vagus Nerve. I witness this every day in my practice and am always humbled by the body’s innate power, it’s infinite wisdom and the body's capacity to heal. The below symptoms are designed to keep the basic functions going as it can override less important functions in the body, in times of stress or emergency. The problem lies, when we stay in that very state that was initially only designed to save us and when chronic, will turn against us.
Physical and emotional symptoms of Dorsal Vagal activation:
Craniosacral Treatment for Chronic Dorsal Vagal Activation
The basic goal of CST treatment is to lift the client from a chronic Dorsal Vagal state into activation of Ventral Vagus Nerve. During a CST treatment and with our subtle movements and it’s subtle as we listen, feel, touch and work with the most delicate structures of the body, we aim to:
The positive effects of craniosacral therapy are cumulative. Over time our ANS becomes more resilient each time we can restore a state of our social nervous system following activation of the dorsal vagus branch. The long-term goal is to encourage the ANS to return naturally, on its own from a state of dorsal stress to a state of social engagement, were we feel physically and emotionally safe. Healing the Nervous system does take time, but with time and for me personally with skilled hands-on craniosacral work for all my physical and emotional symptoms, I was able to shift back into the Ventral Vagal state, into a state of social engagement - my Social Nervous System where I was able to reconnect, relax and feel immense joy and happiness again.
As Stephen Rosenberg writes in his book – Accessing the Healing Power of the Vagus Nerve: “prior to Polyvagal, depression and depressive behaviours issues lacked a physiological model in terms of the nervous system. Perhaps why it is difficult to find effective treatments for conditions like depression. With Stephen Porges Polyvagal theory we have a clear focus on relationships of the ANS, the emotions and the behaviours”.
The Vagus Nerve is responsible for our health and essentially controls our entire rest and digest and all the associated organs. So, depression, anxiety, the Vagus nerve and insomnia walk into a bar, ordering craniosacral. All having a healthy drink together around a communal table, working together in harmony, in a balanced rhythmic way, with no side effects or hangover. What are you ordering?
My next blog will focus on the VVN – Social Nervous System and the implications for our physical, mental and emotional health through Craniosacral Therapy.
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The base of all my blogs is: ‘would my mother understand it’? – I purposely leave out jargon and aim to simplify as best as I can. My aim is not to confuse with All there is to know about anatomy like the enteric nervous system. Great detailed information and recommended reading for people who like to know more:
Tinnitus is an internal noise or a hyperactivity in the central auditory system normally experienced as a ringing noise in the ears, coming from within the person. In some cases it is temporary and goes away over time. Unfortunately for others the ringing noise can be constant and impact their daily life. Tinnitus can be experienced in one or both ears. It can make different sounds and can vary in intensity. Tinnitus can be brought on by many different causes including dental trauma, loud music, TMJ (jaw problems), a physical trauma, long-term work stress, trauma or anxiety. Tinnitus is much more widespread than generally known with around 25% of Americans and around 20% of Australians suffering from it.
Tinnitus is considered a neurological/audiological condition but has eluded medical treatment and scientific understanding so far. Initially, sufferers consult an Ear Nose and Throat (ENT) specialist, audiologist and/or a neurologist. In the majority of cases (around 80%) no known cause is found. If nothing specific is found, then sometimes medication is prescribed like Valium or Amitriptyline but thankfully more and more mindfulness meditation. Sufferers are often told by their doctors that not much can be done, to shift their focus, unscramble the picture and mask the sound. At best the brain will adapt and learn to live with it.
However if we view Tinnitus as not just being about a "hearing/ear" problem but a nervous system problem with a whole body reaction, we might be a step closer in bringing relief to Tinnitus sufferers. I believe there is a largely untapped potential in understanding the variables, common threads and biological nervous system responses in Tinnitus sufferers and approaching it in a new light. This calls for a treatment model that not only incorporates the physical body and the Craniosacral system of the physical body but also the mental and emotional body and this is exactly the strength of Craniosacral Therapy.
Craniosacral Therapy views Tinnitus oa as a signal where the adrenal flight and fight response seems to be manifested through the auditory system as noise in the ears, leaving a certain hyper vigilance, which keeps the brain active. This leaves your system so sensitive that you actually hear your own internal noises like ie: nerve impulses, structural movement and/or fluid movement, as well as the external noises. In my personal Craniosacral practice, Tinnitus clients, describe their ringing as: cicadas, kettle boiling, a high pitched dog whistle, the pinging of a microwave, humming of a fridge or as a high frequency. Often, but not always clients symptoms appeared in or around a major event in their life, or related to an echo of past difficult experiences. In these circumstances I usually find, that whatever the trigger was for the tinnitus to occur, it usually is the last overwhelm of previous layering challenges to the clients long suffering system, that breaks the "donkeys" back, like in the kids game Buckaroo. The last suitcase may have triggered Buckaroo's back to buckle but many other suitcases were loaded on top first.
Tinnitus is about our nervous system and brain as our brain continually scans our inner and outer world for threats. When any threats are detected the stress response automatically fires up. As you go through life the brain acquires expectations based on your experience and in particular negative one’s. When situations occur that are even remotely similar, the brain automatically applies its expectations to them, if it expects pain or loss or even just the treat of these, it pulses fear signals, creating hyper vigilance, keeping the brain active (Buddha's Brain-2009). Most of the time these seems to happen subconsciously as people are not aware of how their bodies respond in their day to day life, to stress or threats and how this can manifest as ringing in the brain.
A new scientific study at the University of Illinois (July 2017) seems to validate this. Using MRI, this new study found that tinnitus is in the hearer's brain. They found that chronic tinnitus is associated with changes in certain networks in the brain. A tinnitus patients brain seems to be not truly at rest even when they are resting, as the brain stays more alert. This could also explain why sufferers also feel tired more often.
I personally view Tinnitus more as a Syndrome than a condition as the whole central nervous system is on high alert and tinnitus is just one of the many side effects of this whole body reaction with everybody's Tinnitus being different. Some clients may have a slight hearing loss but not all clients with hearing loss have tinnitus, some clients have neck and shoulder problems and then again some have TMJ issues and/or temporal bone(s)/muscular dysfunction but the common denominator seems to be (unconscious) anxious and/or unprocessed stressful times and patterns lodged in the body. Some people may be aware off of this, some totally unaware but in all cases it has not been dealt with on a bodily level. I find looking at our evolutionary biological stress pathways and the structures involved around Tinnitus very insightful. Let me break it down: (Please view My blogs on our biological Stress Pathways, TMJ and our 3 Brains for more in-depth background information).
The strength of Craniosacral Therapy is that it addresses all of the above: working structurally around the auditory tube structures i.e. temporal bones, cranial nerves, intra-oral work, TMJ - jaw, neck & shoulders, releasing any tissue and bone restrictions, resting the brain & the meninges (brain tissue). Craniosacral is known to resettle the Nervous System, so stored tensions can be released, decreasing “the fight and flight” hyper vigilant sympathetic nervous system and increase the "rest and digest" parasympathetic system, lowering the tone of the Vagus Cranial Nerve. Craniosacral therapy sees symptoms as a signal of the body and unpacking any issues and unconscious thought processes that may have contributed to the onset off their Tinnitus can be very helpful, Having more awareness means you can make a choice. The body tends to hold tension and emotional conflict deep inside until it feels safe and is ready to process it.
UK based Julian Cowan Hill is an ex-Tinnitus sufferer. He found his cure in Craniosacral Therapy and has since become a CS practitioner himself. He has written a book about Tinnitus “From tyrant to friend" which I recommend. It is a handy practical little book, packed with information and a Wellbeing Matrix with levels and exercises to go through. He also has You Tube videos that people find helpful. Simon Baker (an ex DJ with hearing damage) is also an ex Tinnitus sufferer and has also become a CST practitioner himself and is a Professional Tinnitus advisor with the British Tinnitus Association. A link to one of his articles: https://djmag.com/content/hearing-damage-djs-guide-preventing-tinnitus
Tinnitus treatments are about regular treatments rather than a one quick fix. It is a gradual process, as it is about regulating and rewiring the nervous system and brain, learning to switch off the whole central nervous system. Grooves and patterns are often hardwired and they take time to change and integrate, to build a new road. My advice would be that if you do suffer from Tinnitus, try Cranio earlier at the onset of your symptoms. Cranio is one of the best therapies around for settling the nervous system, treating TMJ, resting the brain and cranial nerves and clearing any unprocessed shock, becoming less hyperactive and if applicable uncovering any unconscious emotional conflict. My clients that develop the best results are the ones that don't expect to be just fixed but are prepared to put in the work as well by adopting a multi-disciplinary approach and new life style regimen through diet, meditation, exercise and unpacking any issues. For some clients, the ringing in the ear becomes less intrusive and they don’t focus on it anymore, some clients find the noise has backed off and even forget about it and some clients make a full recovery. As Julian Cowan Hill says: "The state of your nervous system is very changeable and reversible, as the nervous system is a fluid, constantly altering state of balance, when the right conditions come along, it changes". He should know, he cured his.
Keep up to date with news, research and my upcoming book with oa Tinnitus case studies.
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