Next Group Therapy starts February 6th. Learn More.

A recent study has found that repetitive Transcranial Magnetic Stimulation (rTMS) is effective in treating depression. The results showed that the majority of patients experienced a significant reduction in symptoms, with some even achieving complete remission.

Are you interested in Group Therapy? Groups offer a safe space for sharing ideas, helping others who are going through similar struggles and can promote social skills and group accountability. Click to read more.

The combination of TMS (Transcranial Magnetic Stimulation) treatments and Ketamine Infusions is gaining national attention as a powerful way to alleviate Treatment Resistant Depression. For more information or to schedule an assessment call or text us at 330-754-4844.

Polyvagal Theory

Lilian White, MD, ABFM

Why is polyvagal theory important? State of our nervous system determines how safe we feel “How safe we feel is crucial to our physical and mental health and happiness.”

Understanding trauma and its physiological effects: Feeling safe allows us to live a full life (i.e. generosity, empathy, growth, taking risks, etc.)

What is polyvagal theory? Vagus nerve Sympathetic and Parasympathetic systems Not necessarily good/bad New dimension of freeze (dorsal vagal) Relationship to trauma

How can we apply polyvagal theory to everyday life? (Disclaimer) Co-regulation Infants and moms/parents Play Breathwork

Resources: Our Polyvagal World book Accessing the Healing Power of the Vagus Nerve book The Polyvagal Theory book Clinical Applications of Polyvagal Theory book Select References: Books as above Vagal tone in infants: Massage for vagal tone in infants: Massage for infant vagal tone, weight gain, gastric motility: Kangeroo care and vagal tone infants: Free play and vagal tone in children: Improved pain threshold, digestive motility: Reduced HRV and burnout: Antibiotics and reduced vagal tone: Deep slow breathing and vagal tone: Vagal tone and endometriosis: Vagus nerve and cardiovascular health:


[Music] hello and welcome to the Ascend Health show I’m your host Nick angelist I’m a nurse anesthetist and the owner of Ascend Health Center in faon and I’m here with Dr White from empowered Health DPC how are you doing today doing great thank you loving the sun yeah it’s a lovely day so now all of you know that we’re not filming this in January so I want to ask you today about uh poly vagel Theory because we’re going to talk about the nervous system and a lot of this I consider myself an expert because of my anesthesia background but this is one of those shows where I want you to be the expert because you have many more practical tips than I would since a lot of my tips involve an anesthesia machine and a lot of medications fair and that’s something about our culture too like a lot of times patients will gravitate toward like well what’s the cool thing that you have for me yeah and sometimes you’ll probably tell them well why don’t you just go play outside some right sometimes it’s the basic stuff sometimes it’s the cool mechanics so yeah a little bit of both that’s good well why don’t we start with like what’s the very basics of getting people better cuz obviously no one comes to you unless they’re somewhat sick or feeling a little off so what’s like the most basic thing that they can do yeah absolutely um in terms of the poly vagal Theory or helping people feel better from a nervous system standpoint um it can be as simple as you mentioned in kids playing outside there’s actually been studies where they looked at kids playing outside and that helped um them feel better at Baseline um it can also help with emotions and regulating emotions in kiddos um all spectrums of age even in infants it can help with weight gain um it can help them to digest things better wow um and elderly adults they’ve studied it in helping with anxiety so it really affects all ages and is that because and we’ll get a little scientific here for a second uh and then once I confuse myself we’ll go so we have the sympathetic nervous system which is your fight ORF flight and your parasympathetic nervous system which is your rest and relax and during play a kid is going between the two very quickly and it’s effective because normally when you’re just watching TV shows uh I know from uh my step kids like there’ll be a slow part and they’ll wander off to go do something else um because it’s like action all the time completely sympathetic nervous system overload dopamine surging but in play your very boring Parts like playing hide-and-seek I can’t find them this is lame and your very exciting part it’s like I found them this is great so is that part of it where your sympathetic compare sympathetic learn to layer and turn off and off quickly yeah and I think the idea is the sympathetic fighter flight is not bad necessarily we need it to be able to play and run around we need our heart rate to increase for that um but it’s that important part of going back and forth we don’t want to stay stuck there okay yeah and I think that’s a lot of times I know in natural medicine they actually call it being stuck where uh the theory there is that okay we need your switch then is your parasympathetic working when your sympathetic should and vice versa and probably you mostly see the sympathetic working too much right yeah I think that tends to be um easy for us to kind of fall into a little bit more um and then there’s also maybe we’ll get into more of it later but that kind of freeze state which can also be sometimes harmful as well right okay great so why don’t you explain a little bit what poly vagal theory is sure yeah uninitiated yeah it’s kind of a longer term but really when you get down to it it’s just the idea that safety and our environment and how our body feels safe can impact our nervous system and therefore our body and our health in general um so we want that nervous system to be nice and healthy so we can feel safe so they really are bir directional so how we feel and our health can really go hand in hand Yeah in our last show we actually were talking about the the mental health component of knee pain which sounds completely ridiculous but then I mentioned that well the alternative is you cut open the knee and put something titanium inside so maybe it’s worth looking into a before you go for surgery for sure so I think that’s a lot of what you’re saying that uh as a primary care doctor you’re looking at well what’s the gentlest way that we can restore you back to health yeah absolutely I think you know certainly there are so many ways we can help patience and there’s levels of evidence some things are really strong evidence and some are low evidence but really a nice place to play in is something that’s likely very helpful but has a low risk of harm that’s a nice place to to make recommendation right and so sometimes that does require some effort by the patient but again there aren’t as many risks involved right yeah exactly and we see that with uh Psychiatry at Ascend as well since primarily that’s what we’re doing we’re taking Insurance here’s your medicine come back and see us we a lot of like well wait it’s it’s not time to go to this med yet or are these side effects worth it for the mental health benefits and often that is a challenge in medicine that okay this is so much better now but now I have a problem with this um and gain the body to react less through poly vagal Theory would help with that too almost allow you to your body to accommodate uh not necessarily medicines but to accommodate change really yeah absolutely yeah our body is is dynamic and we want to keep it that way and and and also complex for sure yes okay so uh but the one part about the parasympathetic nervous system is it’s mostly the the Vagas nerve which is the largest nerve in our body and correct me if I say something wrong cuz I I try not to I try not to refresh myself on cuz that way otherwise I’d like get really excited and talk too much no worries it’s it’s a problem here on this show it’s a real problem you’ve got a lot of knowledge to share I love it so why don’t you tell us a little bit about the Vegas nerve and how that interacts and even ways to control it that might be a good start sure yeah absolutely um I think it’s kind of fun to go back to I love words so the word Vegas or veal nerve comes from the Latin word for wander ing so you may think of the English terms like Vagabond or vagrant so people that wander um so our vagus nerve wanders through our body it connects to our ears it connects to our vocal cords our heart our lungs our digestive system so it really does wander in a lot of places and therefore its impacts are pretty wide ranging um when we think about how do we impact it it really goes back to um or back to our anatomy okay so the vas nerve is we think about it as one nerve but really it branches into two branches um the first Branch or a branch is the ventral branch which is a fancy word for our belly so this I like to think about as kind of like a puppy belly so a puppy’s feeling good they roll over onto their back they want you to pet their belly um so they’re feeling pretty good they’re feeling more social so that’s very much activated when we’re feeling social we’re feeling safe we want to engage more with people um and our vus nerve responds in that way so our ear with our vagel tone is actually tuned to hear um voices better when we’re in that kind of social state of that belly Vegas nerve activating whereas the other branch of our Vegas the dorsal Branch or the back of our Vegas Branch um that’s a little bit more I think of like a turtle shell so that’s that freeze State okay um so that’s maybe when um you think of like a possum gets really scared and they play dead um they’re scared to death so to speak um that’s where that that freeze State comes in and that can come into play when people are feeling maybe traumatized or unsafe at work or throughout daily life um that vagal dorsal part of that nerve can be activated sure um so then the next part is okay but how do we get things to that belly part how do we feel good right how am I a puppy instead a turtle yeah yeah exactly um so that puppy part can be um a lot of different ways to go about it um one way we mentioned before for kiddos is playing so allowing more free time for play um going to early in life for infants um we think a lot when I’m working with moms and babies actually a mom’s vagal tone how well they’re feeling can actually impact how baby’s vagal tone or baby’s nervous system is um so helping moms to feel safe helps babies to feel safe which makes a lot of sense yeah absolutely um and then that like we said plays a role with helping babies gain weight easier helping them to digest better um and their emotional regulation in general um when we get to kind of more older adults or people that are kind of um in our aging like middle age older um there are a lot of different techniques that we can kind of use to hack our Vegas system to some degree and it’s and it’s a good way to do biohacking because that’s something I’ve run into a lot having a Kine Clinic patients are like well I’ve read about all of these things KY can do for me something like no uh we still need you to have a medical diagnosis that K would be appropriate for so biohacking is fine if we’re talking but what you’re talking about some low-risk activities that you can do to enhance your health but a lot of times as a culture we chase the shiny things it’s like no this could actually hurt you I’ve done that with like supplements and like no this is really great for me it’s like but is it really or is it some mental thing that I need to get over of like being 110% so all right my tent’s done continue no I love that yeah yeah no I think that’s a great um great advice right we want to make sure ideally we’re doing things that are low risk of harm before we doing things that are potential high risk for harm and sometimes you need those things and it is a good attitude to have of like let me make my health even better yeah especially when we’re talking about these type of activities as opposed to random chemicals so right yeah we want to optimize our health so we’re able to do those social things engage in life when we feel safe we’re able to take risks in business or take risks in our career we’re able to um enjoy life have empathy with others when we feel safe we’re able to have access to a lot of these other states of feel and being which is really cool part of the human the human State yeah like the therapists at my office actually make sure that their own mental health is doing really well because otherwise I know uh they won’t be effective for their patients if they’re worried about their own safety if they have their own issues uh and it’s you know we’re always told as providers like well you just have to like get past that and take care of the patient and that’s great advice uh shortterm but long term it’s like a terrible way to live your life as I’m sure we both know yes yeah itudinal is looking in the Long View is important right yeah um there are some other ways that I like to talk about improving veal tone for adults um we can go through some of them if you’d like um one of them is kind of called the basic exercise so that comes from Stanley Rosenberg who’s an osteopath um I think we’ll have it in the show notes but he wrote a book called accessing the healing power of the Vegas nerve um and he goes through applying osteopathic principles to to help with um our nervous system tone or vagel tone um so one of them is the basic exercise that’s in there I can put a link in the show notes or if you want to we can go through it it takes about a minute or so we can do it right now sounds really fun might as well learn something here so a lot of times and again if you’re watching this at home always ask your doc before you do things that you’re not sure about in terms of safety um but usually when massage in clouded arteries or whatnot yes exactly so be safe um so usually we I’ll have patients laid down if they’re in their office or at home but we’ll do sitting up here so I’ll have people interlace their fingers behind their head and it just kind of um in that um ball of your head there that back of the head just kind of cradling it like a hammock MH um and then just gently allowing the shoulders to relax in looking forward just taking a couple deep breaths in and out at your own pace and then as you’re ready just just continuing to have the head look forward and then turning the eyes to look toward the left and just continuing to take

gentle deep breaths continuing to look toward the left and typically

after about 30 to 60 seconds as people are breathing in and out they may start to feel their face relax a little or their shoulders or they may feel the desire to swallow or yawn

and if it gets to about 30 to 60 seconds and they haven’t felt one of those things yet then they can kind of do it on their own so maybe they swallow or [Music] yawn and then once that’s happened or they’ve done that they can turn their eyes back toward the center take a couple deep breaths in and out and then turn their eyes toward the left and just repeating that taking some gentle deep breaths in and out continuing to look toward the left and they may feel like swallowing or yawning or maybe their face just feels a little softer or maybe they’ll swallow Yan on their own and then they’ll look back towards the center for another breath in out and then they can relax their hands and may feel may feel a little more relaxed or a little tuned down um typically I’ll recommend that just a couple times a day for patients usually in the morning or the evening just is kind of a nice way to bookend the day right and I can tell patients now too when they call with anxiety like look about minute 13 in this video this is what you yeah yeah there you go I think it’s it’s a really just nice tool I had a I used it with a patient the other day in the office who was experiencing some trauma um and she just kept yawning afterwards she just felt so much more relaxed it was really cool to see in action well I think part of it too is that we need to tell our brains like it’s okay to be in a state of relaxation because again our culture often doesn’t encourage you to be on it for your job you have to be on it for the kids you always have to be going and 100% it’s like well no that’s not helpful at all especially not long term right I mean even when uh some coaching soccer again and I told them we just had our first practice like listen I might yell at you uh during a game from the sidelines don’t listen to what I’m saying if you hear me or parents yelling at you it means someone’s open it’s either you or your teammate or the person you’re supposed to guard so don’t listen to the words just know what that is because I that’s what said about the sympathetic nervous system it’s not conducive for learning like oh I I need to pass it to the fullback and then cut toward the goal it’s like no if you hear screaming here’s what you need to do don’t pay attention to the words I’m saying to you yeah I love that you’re like applying it in everyday life that’s so great yeah and that’s cuz again like even for this is terrible but I friend in anesthesia school he was like you know what I would have a beer and then I would take my test cuz otherwise they like oh I’m going to miss this what if it’s a what if it’s c what if it’s B so I’m not recommending that as a for cuz we will see that like it’s the stereotypical like well once I have my glass of wine for the night then I can tone down and long term it’s it’s not appropriate but you see the idea of like wait if I can channel into like this rest and relaxed part of my life so and is it more unique to Americans cuz when I go to Greece and visit my relatives we’ll go out for lunch and an hour and a half in I’m like we done like we do something else now like no this is what we do we sit and talk and enjoy ourselves yeah it’s like a different pace of Life yeah for sure I think they’ve seen that with some of the like Blue Zone studies yeah I think you’re right so so part of this is forming new habits and not giving into the peer pressure of like how everybody’s living their lives mhm like being okay with not being 100% all the time yeah and like finding you know like you mentioned we reach for external things to help with our nervous system like maybe substances or drugs or medications and sometimes those things are needed in terms of meds but these are some nice bodily ways to kind of go from the outside in to tell our nervous system hey it’s safe you can relax now um work is over or whatever well maybe a way to think of it too is so when we first started our clinic in 2019 we mentioned we have holistic Psychiatry and pain management and then I would tell patients better they’re like eat better they like I failed seven drugs you think an avocado is going to fix this for me so I realize well no we actually do need a a strong medical intervention but then once we’ve started that you’re going to improve quickly and then you really need to incorporate all these things that you ignored before because you thought people were being rude to you for saying that you need to pray more or do more yoga or whatever so it is sort of that interlay so that you don’t need quite as many as we said like high-risk interventions where there could be side effects yeah yeah it’s a nice um in terms of like integrative or functional medicine it’s just another tool to add to the toolbox it’s another option to add and you’re still uh studying for some more functional medicine certifications right how’s that I took Myer certification exam so I’m just waiting on that and I’ll be all finished yeah which is so nice it’s been lovely just doing family medicine and adding in some functional medicine as people need it I think it’s just been really ideal way to practice Yeah CU so sometimes you’ll prescribe medicine because it’s appropriate and then other times you’ll say well why don’t we try this exercise first or this habit change or whatnot yeah yeah exactly and it’s very much patient driven I always tell patients I I’ll make recommendations and we I’ll work with you but I never tell you you have to do anything these are all options and we’ll find what works best for you but um it’s just nice again to have more tools in the toolbx to be able to offer care right and I think part of that too is letting patients know what they’re in for I mean that’s really why we do this show cuz prospective patients of a send Health Center watch it and then think uh he’s weird and random isn’t for me and that’s perfectly fine it saves both of us some time and effort sure yeah it does a good fit I was talking about this with the mun that you want to fit well with you feel like you’re you fit well with whoever’s taking care of you or at least well enough to to be able get some therapeutic benefit right and and it’s a challenge too because on the one level there’s trust which is absolutely necessary but then there’s also competence and sometimes as patients it’s like well I really trust them and they’re okay or man they’re really good but although sometimes I also say look look this provider is is very rude but they’re also very smart and that’s why they don’t bother with a bedside maner obviously it’s best to have a combination of both yeah I think I agree I do I give that warning sometimes too I think yeah good to good to let patients know what they’re in for and yeah people have different styles and that fits well for different patients right there’s as many different types of patients as there are types of doctors I think so and so a lot what you did with the exercise earlier you know there’s vagal nerve stimulator there’s other ways I mean part I assume partly the way that works is because you’re stretching the smooth muscles of the eye which and I could be wrong but you’re stretching smooth muscles to the eye which sends a signal to your Vegas turn like okay it’s time for us to take over yep yeah it engages your social interactions which goes back to the Vegas tone and I mean I’ve seen extreme versions of that in surgery where they’ll pull on those muscles and then I’ll see no heart rate for 10 seconds so I think that’s so you like very much have seen that in action that’s so interesting they’re like you will see a vagal response then I’ll say when will the heart start and I I tend to so this is because I’m perhaps not sympathetically tuned enough that’s usually how I asked like when will their heart start up and so I probably have some to grow to get my sympathetic nervous system going yeah no I think sometimes you got to have the funnel on to do the job so yeah so is is part of it for patients learning when to kind of take the funnel off because we’ve already mentioned a lot that we’ve we’ve said you can’t really learn while you’re in a sympathetic state that you yeah you need this rest and relaxed State you learn which makes it sound like you should always be eating when you’re learning honestly like being in that I’m safe I can learn I can form new habit yeah no both are super important and when we think about that sympathetic figh ORF flight mode we actually don’t have access to some of that frontal part of our brain as much we’re not able to think more critically um so for some people like when we think about advertisements and kind of the fear and some of those it it can play well into well into advertising people may not be thinking as deeply um which just kind of an interesting um application of it I was reading something the other day and I’ll try to make this very quick since yet another CH how Coca-Cola noticed uh a generation or two ago that no one was drinking Coke in the winter so by making Santa Claus red and this and I drinking a Coke like they actually changed the culture where even Christians now celebrate Christmas more than Easter and it was cuz Coca-Cola realized there must be some way that we can incorporate Coca-Cola with winter so our sales don’t slump interesting so there’s so many things that we think are like this is the way we are it’s like nope somebody’s selling me something right yeah that plays a role too yeah so as providers can we encourage patients that know we’re not selling you something for example you’re doing direct primary care and you don’t take insurance right no so it is something where it’s like look you’re you know you’re not using the Groupon for a restaurant you don’t like that’s usually how I describe Insurance just getting what you need and then you’re leaving yeah is that more of how we’re saying like you know because of the insurance model we’re often forced into these weird situations where the patient doesn’t know what’s going on they don’t know how much they owe what they’re paying um very transparent right and your model probably also allows like well here’s how much it is is this worth it to you and people can make conscious decisions about their health which is really important regards of what they decide right yeah I think transparency is super key I keep everything on the website and I think too it’s um patients knowing what they’re what they’re signing up for right like being able to have more time with a physician like the insurance model often times they do a little bit with time billing but for the most part it’s minute visits it’s quick visits in and out whereas when you have your own practice like I do it’s I can spend a couple hours for a new patient an hour and a half to an hour for follow-ups whatever patients need we’re kind of we can Flex it well why don’t we talk just for of the few minutes we have left at least of one system with poly vagal Theory and what we’ve we’re saying about the parasympathetic nervous system and that is digestion because that is one of the number one systems where our medical system can’t solve it within like a 10-minute visit it’s so complex like you mentioned the the puppy belly there’s serotonin that’s released in the gut so what’s something that we can take away from this uh conversation with the parasympathetic nervous system and digestion for sure yeah um all often especially with patients with digestive issues like IVs Etc um I’ll have them do gentle deep breathing before a meal that just gets them into that more rest and digest mode so when they do go to eat things are moving a little bit easier because it’s often coupled with anxiety depression like a lot of times those are all inter woven mhm okay yeah so no no you’re great yeah I think that’s a great great line um yeah especially with IBS we see that so commonly right anxiety IVs digestive issues um but yeah just gentle deep breathing before a meal can be really helpful or as they’re able to throughout the day um so a lot more mindfulness about your digestive system too rather than just blindly like reaching for things while you’re doing something else yeah yeah there’s also some cool apps like one’s called nerva so it’s gut directed hypnotherapy so it gets into that idea of our nervous system resting to be able to help with IBS specifically sure yeah so it sounds like the poly vagal Theory uh for digestion a law that is um not being distracted so maybe putting your phones away while you’re eating just focusing on the meal and letting your system focus on uh digestion yeah so a lot of times our brains are firing in all these directions and obviously the brain’s the only organ that tells us things uh directly so it’s like nope sorry brain this is stomach’s time yeah take the back seat right now it’s stomach’s time to digest food and do so appropriately and you can go back to all you’re thinking afterwards right yeah exactly I think that’s a good way to put it so how can patients reach you if they’re interested in learning more having be their doctor um yeah they’re welcome to go on the website and check it out I’ve got most of the information on there and then I do offer free meet and greets for a few minutes over the phone so they’re always welcome to call and see if it’s a good fit for them okay great and you’re in Rocky River correct yep great do you do some teleah health too is it all in person cuz you know by the nature of what you’re doing allow of it is more personto person spend time with patients yeah I usually like to see him in person just for the first visit but I do offer phone and video followups so I can always do that for patients that are a little further I have some that are more homebound so we do some more video visits okay great and Ascend Health Center we’re in Fon uh it’s the same thing where first visit should be in person so we get to know each other better and then from there um whether it’s Psychiatry counseling a lot of that can be uh tell Health as well well I mean since I do ketamine infusions you really can’t do that T Health the trans magnetic stimulation and some of the other things we do um but I I think it is important to meet people where they are you know sometimes we we tell patients like no this type of visit won’t work over the video camera we need to see you and then other times like nope you have a quick question and it’s too complex for us to answer without really getting into what’s going on so you know here’s a tell Health Link or whatever yeah that’s nice very flexible yeah well thank you so much for coming on the show today yeah thanks for the invitation this is fun absolutely and thank you all for watching today

Powered by Paranoid Hosting™. 'Cause you never know...