Polyvagal theory, restated by its author in 2025, and what its clinical claims rest on
Stephen Porges's 2025 review restates polyvagal theory and extends it to trauma, pain, autism and schools. The clinical studies it cites are small, and 39 physiologists answered it in 2026: untenable.
Suggestive but preliminary. Not settled. how we score evidence
Caveat on this rating: Its author wrote it, and it answers its critics in its own pages. A 39-author evaluation of this paper (Grossman et al. 2026, same journal) calls the theory untenable; Porges replied in the same issue. The clinical evidence it cites for the Safe and Sound Protocol is one single-arm study, one single-child report and two preliminary controlled trials.
The paper a lot of trauma and nervous system content on social media traces back to, written by the man who proposed the theory in 1995.
What the paper says
Porges describes the autonomic nervous system as a ladder of three states. A "ventral vagal complex" supports calm and social engagement. Under threat the body moves to sympathetic fight or flight, and under greater threat to "dorsal vagal shutdown". A process he calls neuroception is said to detect safety or danger below awareness. Respiratory sinus arrhythmia, the rise and fall of heart rate with each breath, is used as the window into the ventral vagal state. From there the paper extends the theory to trauma, chronic pain, gut disorders, autism, ageing, schools, workplaces and the design of institutions, and calls for a "science of safety".
On criticism, it says critics "often conflate anatomical homology with functional equivalence", and that the charge of unfalsifiability "is misguided".
What the clinical claims rest on
For the Safe and Sound Protocol, a filtered music program, the paper cites a single-arm study without a control group (Heilman 2023), a report on one ten-year-old child (Rajabalee 2022), and two 2014 trials against control conditions whose own title calls them "preliminary findings". It says the protocol's effects "validate" the theory's clinical relevance.
The other direction
In 2026 the same journal published an evaluation of this exact paper by 39 physiologists, anatomists and evolutionary biologists, many of them cited in polyvagal writing. They conclude "major tenets" of the theory "are not supported" and that it is "untenable". Earlier critiques in Biological Psychology (Grossman 2023; Neuhuber and Berthoud 2022; Taylor, Wang and Leite 2022; Doody, Burghardt and Dinets 2023) make the same core points. Porges replied in the same issue that the critics attack "a reconstructed proxy of the theory". Both are in this library.
Disclosures
The paper states "Funding: None" and "Competing interests: None." In a separate 2025 paper Porges writes that the Safe and Sound Protocol and a second listening program "are distributed by Unyte Health". We found no journal record of whether he is paid by the company, so we do not say that he is.
What this does not show
That stress responses are real and measurable does not depend on this theory. Nothing here says a person should stop a therapy that helps them. The question is which claims have evidence behind them, and how strong it is.
Source
Polyvagal Theory: Current Status, Clinical Applications, and Future Directions — Porges SW (2025)
Indexed peer-reviewed journal
Read the source: https://doi.org/10.36131/cnfioritieditore20250301
DOI: 10.36131/cnfioritieditore20250301
How this was scored
- Study design
- Narrative review
- Funding
- No external funding
- Published in
- Indexed peer-reviewed journal
- Sample size
- not recorded
- Preregistered
- not recorded
- Conflicts disclosed
- not recorded
- Independent of proponent
- not recorded
- Retracted
- No
Read the full scoring rubric, including what it can't tell you.
Published October 2, 2026.
Questions
How strong is the evidence behind this?
veisund rates this source "early signal". Suggestive but preliminary. Not settled. It scores 41 out of 100 on our published rubric. One caveat travels with that badge: Its author wrote it, and it answers its critics in its own pages. A 39-author evaluation of this paper (Grossman et al. 2026, same journal) calls the theory untenable; Porges replied in the same issue. The clinical evidence it cites for the Safe and Sound Protocol is one single-arm study, one single-child report and two preliminary controlled trials. The score is calculated from recorded facts about the source — study design, funding, publication venue, sample size, preregistration — not typed in by an editor.
What is the source for this?
Polyvagal Theory: Current Status, Clinical Applications, and Future Directions — Porges SW (2025). Published in: Indexed peer-reviewed journal. DOI: 10.36131/cnfioritieditore20250301. The full source is linked on this page so you can read it yourself.
Who paid for this research, and does that matter?
Study design: Narrative review. Funding: No external funding. Independence from the proponent is not recorded. Industry sponsorship is one of the most reliably measured biases in medicine, which is why funding carries real weight in the score rather than sitting in a footnote.
Is this medical advice?
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.