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Neurophysiologists claim core premises are incorrect in polyvagal theory.

Porges responds that critics misunderstand what the theory actually claims.

Further research and discussion is needed to settle the debate.

There is an interesting controversy resurfacing in the trauma psychology community around Stephen Porges’ polyvagal theory (PVT). The debate has been going on for years, but a recently published paper has brought it back into focus.

I'm writing this for clinicians, particularly those of us who have used PVT as a lens in our work and are now wondering what to make of the renewed push from neuroscientists to reject PVT. What does this debate mean for those of us who practice?

PVT was always ambitious. It was an attempt to weave together evolutionary biology, neurophysiology, observable behavior, and clinical wisdom into an arc about how our nervous system states drive our behavior in the world and with one another. PVT was a bold contribution in a scientific arena where entire careers can be devoted to testing a single mechanism to increasing degrees of confidence.

For many clinicians, PVT has been meaningful.

Neurophysiologist Paul Grossman, along with 38 researchers, recently published a critique outlining scientific objections to some of PVT’s proposed neuroanatomical mechanisms. They conclude that PVT’s core neurophysiology claims do not hold up under scrutiny; therefore, it’s not a viable psychological theory and should not be taught as such.

Porges has formally responded. He welcomes empirical challenges and criticism of his theory, but he argues that the published criticism is so full of straw man arguments and misrepresentations of PVT that the authors undermine their ability to legitimately critique the theory.

As far as I know, Grossman et al. have not responded to the rebuttal.

The debate has reached an impasse. Both sides believe rigorous measurement is important, but don’t agree on which measurement strategies would constitute a real test of PVT’s claims. Grossman continues to critique based on what he believes are narrative overreaches and inaccuracies of anatomy, while Porges tries to get across that an accurate read of the theory doesn't rely on such claims.

As this discussion continues to develop, and I hope it does in meaningful ways, I am not ready to abandon PVT. And this isn’t due to blind loyalty or sticking my head in the sand. I have two questions.

First, is the critiquing side giving PVT a fair shake? Despite Grossman et al.'s confident declaration that PVT is "untenable," I’m not convinced they have proven their case. A more congruent back-and-forth between these two sides is warranted, and one that addresses Porges’ concern about theory misrepresentation.

Second, what exactly is being called into question when it comes to PVT’s clinical insights? PVT’s value has been orienting my attention toward certain aspects of behavior and relationship and the learning and clarity that has ensued in my clinical work as a result. PVT has been like a map that has guided me competently through complex terrain.

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PVT served as a useful and reliable guide in my work. It led me, time and time again, to the realization that people in their worst moments aren’t irrational; they’re missing safety and therefore dysregulated. It taught me to think deeply about dysregulation within a relational field. It gave language to patterns I was already seeing, and that language expanded my capacity to intervene.

If it turns out that the map was wrong all along, then it might take a while for us to actually tease out what the failings of the map were and what consequence it has on clinical understanding. If some street names weren’t accurately labeled, it might not change the map much at all. But if the map was referring to a flat earth and the earth is actually not flat, then I’ll want to know what the alternative is.

What also belongs in this discussion is the idea that clinical “knowing” comes from a different place than experimental science. Clinicians look to neuroscience to illuminate what we see in the work we do. We seek language and biology that help us make sense of what we observe in the therapy room. But we are not looking to neurons and synapses to build our understanding of people and behavior.

Our “knowing” comes from practice.

For example, clinicians know trauma. Not in the way you can know about T-cell activation or nerve binding. But in the way you know a language you’ve spoken for 17 years. I have spent that long sitting across from people studying their nervous systems shifting in real time. I’ve watched their breath change, their pupils dilate and open, and their posture collapse or expand.

When I hear those coming from the hard science perspective that trauma is not well understood, I get the need to speak from humility and scientific precision. But as a clinician, I bristle. My colleagues with decades more experience than I have will tell you the same: We understand it well enough to help people heal. We wouldn’t mind coming across a perfectly mapped neural circuitry, but we are not waiting on one to do the work.

Clinical knowledge is experiential and iterative. We employ pattern recognition built over thousands of human encounters, refined over time, and cross-referenced within the community of practitioners. It isn’t precisely scientific, but it is valid knowledge.

That said, neuroscience frameworks are but one input into our understanding of people and our world. It can be a powerful one if it can help us organize reality and shape our understanding of what is or isn’t possible.

Clinicians also choose to use a variety of frameworks irrespective of scientific rigor. Some use the chakra system. Others use cognitive behavioral therapy. I would argue that an appropriate framework isn’t one that is scientifically proven; it’s one that a clinician can use to sharpen their skill, attune to their client, and intervene effectively.

For me, PVT is one such useful framework, and it remains so.

However, I caution against clinicians claiming authority in areas where we aren't experts. When I wrote I Want to Connect, which draws in part from PVT, I intentionally avoided the dorsal vagal and ventral vagal terminology. It did not feel authentic for me to speak as though I were a neurophysiologist. I have never looked at a nerve through a microscope. My authority comes from clinical experience. Instead, I used more everyday language that refers to these concepts.

Hopefully, PVT will continue to be challenged, narrowed, or rejected. That is how science works. And this will evolve my clinical perspectives when it comes to stress, trauma, and social behavior.

But I’m not convinced that the current generation of criticisms has engaged the discussion of PVT accurately enough to move the needle. Because of this, and because PVT continues to add value to my clinical work, I am grateful for and will continue to use it.

Grossman, P., Ackland, G. L., Allen, A. M., Berntson, G. G., Booth, L. C., Burghardt, G. M., Buron, J., Dinets, V., Doody, J. S., Dutschmann, M., Farmer, D. G. S., Fisher, J. P., Gourine, A. V., Joyner, M. J., Karemaker, J. M., Khalsa, S. S., Lakatta, E. G., Leite, C. A. C., Macefield, V. G., … Zucker, I. H. (2026). Why the polyvagal theory is untenable. Clinical Neuropsychiatry, 23(1), 100–112. https://doi.org/10.36131/cnfioritieditore20260110

Porges, S. W. (2026). When a Critique Becomes Untenable: A Scholarly Response to Grossman et al.’s Evaluation of Polyvagal Theory. Clinical Neuropsychiatry, 23(1), 113–128. https://doi.org/10.36131/cnfioritieditore20260111

Porges, S. W. (2026). Critiques of Polyvagal Theory: A Comprehensive Analysis. https://www.polyvagalinstitute.org/criticaldiscussionofpolyvagaltheory

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