Polyvagal theory in therapy worksheet

What is the theory behind Polyvagal theory in the therapy worksheet?

The Polyvagal Theory is an innovative viewpoint connecting autonomic function to behavior. Within the context of the phylogeny of the vertebrate autonomic nervous system, this perspective includes an appreciation of the autonomic nervous system as a “system,” the identification of neural circuits involved in the regulation of the autonomic state, and an interpretation of autonomic reactivity as adaptive. The Polyvagal Theory promotes a level of research that pushes researchers to develop a comprehensive grasp of how brain systems control biobehavioral activities.

How will the worksheet help?

Positive micro-moments known as glimmers commonly occur in daily life but go unrecognized by most people. Humans are formed with a bias against negativity in order to preserve their existence. This means that you often overlook the pleasant moments that coincide with moments of dysregulation because you are physiologically programmed to give more attention to bad events than to positive ones. Unnoticed things include things like meeting a kind face, hearing a calming sound, or observing anything pleasurable around you. Seeing a glimmer, stopping to take it in, and then starting to look for more is a vital step in forming your system.

How to use the worksheet?

A set of instructions are given in order to find glimmers in your day-to-day life. Follow the steps and practice them every day to get the true purpose of the activity, which is to build the habit of seeing glimmers (positive experiences) every day in your life.

Polyvagal theory in therapy worksheet

  1. Decide in advance how many glimmers you’ll search for each day. Pick a starting point that feels manageable. Watch for a single glimmer if you’re not used to seeing glimmers. Set a new objective when you discover more glimmers.
  2. Look for glimmers in the things you do every day. Glimmers occur frequently, but because they are little moments, you must be alert to spot them.
  3. See, pause, and enjoy your flashes. Make it simple to recognize a glimmer when it occurs. You might highlight the situation by just stating “glimmer” or making a slight movement (perhaps your hand on your heart).
  4. Follow your glimmers. Make a daily glimmers journal or a running to-do list.
  5. Seek out glimmers with particular people at particular times in particular places. Find out how your glimmers typically manifest.
  6. Talk about your glimmers. You may send a friend a text message with your glimmers, incorporate a nightly family discussion about your glimmers, or give your therapist a list of your weekly glimmers. Choose a strategy that works for you.

Track your glimmer count chart

DateDayNumber of Glimmers


Dana, D. and Porges, S.W. (2020) Polyvagal exercises for safety and connection: 50 client-centered practices. New York: W.W. Norton & Company. 

Porges, S. W. (2007). The Polyvagal Perspective. Biological psychology, 74(2), 116. 

Porges, S. W. (2021). Polyvagal Theory: A Science of Safety. Frontiers in Integrative Neuroscience

You can download this worksheet here.

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