Why The Polyvagal Theory Is Untenable: An international expert evaluation of the polyvagal theory and commentary upon Porges, S.W. (2025). Polyvagal theory: current status, clinical applications, and future directions. Clin. Neuropsychiatry, 22(3), 169-184

Paul Grossman¹, Gareth L Ackland², Andrew M Allen³, Gary G Berntson Berntson⁴, Lindsea C Booth⁵, Gordon M Burghardt^{6

7}, Julie Buron⁸, Vladimir Dinets⁷, J Sean Doody⁹, Mathias Dutschmann^{10

11}, David G S Farmer¹², James P Fisher¹³, Alexander V Gourine¹⁴, Michael J Joyner¹⁵, John M Karemaker¹⁶, Sahib S Khalsa¹⁷, Edward G Lakatta¹⁵, Cleo A C Leite¹⁸, Vaughan G Macefield¹², Benedito H Machado¹⁹, Robin M Machado⁵, Clément Menuet²⁰, David Mendelowitz²¹, Davi J A Moraes²², Winfried Neuhuber²³, Matteo M Ottaviani²⁴, David J Paterson²⁵, Julian F Paton Paton¹³, Peter R Pellegrino²⁶, Rohit Ramchandra¹³, Julia Shanks¹³, James S Schwaber²⁷, Kalyanam Shivkumar²⁸, K Michael Spyer¹⁴, Edwin W Taylor²⁹, J Andrew Taylor³⁰, Tobias Wang³¹, Song T Yao³, Irving H Zucker³²

Affiliations

¹ Emeritus Research Director, Department of Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland.
² Translational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary University of London, London, UK.
³ Department of Anatomy & Physiology, University of Melbourne, Melbourne, Victoria, Australia.
⁴ Emeritus Academy of Psychology, Ohio State University, Columbus, OH, USA.
⁵ The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Victoria, Australia.
⁶ Department of Ecology and Evolutionary Biology, University of Tennessee, Knoxville, TN, USA.
⁷ Department of Psychology & Neuroscience, University of Tennessee, Knoxville, TN, USA.
⁸ Department of Fundamental Neurosciences, University of Lausanne, Lausanne, Switzerland.
⁹ Department of Integrative Biology, University of South Florida, St Petersburg, USA.
¹⁰ Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, OH, USA.
¹¹ Center for Sleep Disorders Research, Louis Stokes Cleveland VA Medical Center and Case Western Reserve University, Cleveland, OH, USA.
¹² Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia.
¹³ Manaaki Manawa - The Centre for Heart Research, Department of Physiology, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand.
¹⁴ Centre for Cardiovascular and Metabolic Neuroscience, Neuroscience, Physiology & Pharmacology, University College London, London, UK.
¹⁵ Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
¹⁶ UMC, University of Amsterdam, Department of Medical Biology, Systems Physiology, Amsterdam, the Netherlands.
¹⁷ Semel Institute for Neuroscience and Human Behavior, UCLA Geffen School of Medicine Los Angeles, CA, USA.
¹⁸ Department of Physiological Sciences, Federal University of Sao Carlos (UFSCar), Sao Carlos, Brazil.
¹⁹ Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.
²⁰ INMED, INSERM, Aix-Marseille University, Marseille, France.
²¹ Department of Pharmacology and Physiology, George Washington University, Washington, DC, USA.
²² Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil.
²³ Institute of Anatomy and Cell Biology, Friedrich-Alexander University, Erlangen, Germany.
²⁴ Department of Neurosurgery, Azienda Ospedaliera di Perugia, Perugia, Italy & Marche Polytechnic University, Ancona, Italy.
²⁵ Burdon Sanderson Cardiac Science Centre and BHF Centre of Research Excellence, Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK.
²⁶ Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE, USA.
²⁷ Department of Pathology, Anatomy, and Cell Biology, Daniel Baugh Institute for Functional Genomics and Computational Biology, Thomas Jefferson University, Philadelphia, PA, USA.
²⁸ University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, Los Angeles, CA, USA.
²⁹ School of Biosciences, University of Birmingham, Edgbaston, Birmingham, UK.
³⁰ Physical Medicine & Rehabilitation, Harvard Medical School, Boston, MA, USA.
³¹ Zoophysiology, Department of Bioscience, Aarhus University, 8000 Aarhus C, Denmark.
³² Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, NE, USA.

PMID: 41768017
PMCID: PMC12937499
DOI: 10.36131/cnfioritieditore20260110

Why The Polyvagal Theory Is Untenable: An international expert evaluation of the polyvagal theory and commentary upon Porges, S.W. (2025). Polyvagal theory: current status, clinical applications, and future directions. Clin. Neuropsychiatry, 22(3), 169-184

Paul Grossman et al. Clin Neuropsychiatry. 2026 Feb.

. 2026 Feb;23(1):100-112.

doi: 10.36131/cnfioritieditore20260110.

Authors

Affiliations

¹ Emeritus Research Director, Department of Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland.
² Translational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary University of London, London, UK.
³ Department of Anatomy & Physiology, University of Melbourne, Melbourne, Victoria, Australia.
⁴ Emeritus Academy of Psychology, Ohio State University, Columbus, OH, USA.
⁵ The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Victoria, Australia.
⁶ Department of Ecology and Evolutionary Biology, University of Tennessee, Knoxville, TN, USA.
⁷ Department of Psychology & Neuroscience, University of Tennessee, Knoxville, TN, USA.
⁸ Department of Fundamental Neurosciences, University of Lausanne, Lausanne, Switzerland.
⁹ Department of Integrative Biology, University of South Florida, St Petersburg, USA.
¹⁰ Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, OH, USA.
¹¹ Center for Sleep Disorders Research, Louis Stokes Cleveland VA Medical Center and Case Western Reserve University, Cleveland, OH, USA.
¹² Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia.
¹³ Manaaki Manawa - The Centre for Heart Research, Department of Physiology, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand.
¹⁴ Centre for Cardiovascular and Metabolic Neuroscience, Neuroscience, Physiology & Pharmacology, University College London, London, UK.
¹⁵ Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
¹⁶ UMC, University of Amsterdam, Department of Medical Biology, Systems Physiology, Amsterdam, the Netherlands.
¹⁷ Semel Institute for Neuroscience and Human Behavior, UCLA Geffen School of Medicine Los Angeles, CA, USA.
¹⁸ Department of Physiological Sciences, Federal University of Sao Carlos (UFSCar), Sao Carlos, Brazil.
¹⁹ Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.
²⁰ INMED, INSERM, Aix-Marseille University, Marseille, France.
²¹ Department of Pharmacology and Physiology, George Washington University, Washington, DC, USA.
²² Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil.
²³ Institute of Anatomy and Cell Biology, Friedrich-Alexander University, Erlangen, Germany.
²⁴ Department of Neurosurgery, Azienda Ospedaliera di Perugia, Perugia, Italy & Marche Polytechnic University, Ancona, Italy.
²⁵ Burdon Sanderson Cardiac Science Centre and BHF Centre of Research Excellence, Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK.
²⁶ Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE, USA.
²⁷ Department of Pathology, Anatomy, and Cell Biology, Daniel Baugh Institute for Functional Genomics and Computational Biology, Thomas Jefferson University, Philadelphia, PA, USA.
²⁸ University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, Los Angeles, CA, USA.
²⁹ School of Biosciences, University of Birmingham, Edgbaston, Birmingham, UK.
³⁰ Physical Medicine & Rehabilitation, Harvard Medical School, Boston, MA, USA.
³¹ Zoophysiology, Department of Bioscience, Aarhus University, 8000 Aarhus C, Denmark.
³² Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, NE, USA.

PMID: 41768017
PMCID: PMC12937499
DOI: 10.36131/cnfioritieditore20260110

Abstract

Thirty-nine highly acknowledged experts in the areas of the physiology and the evolution of the vagus nerve and of vertebrate social behavior (many whose works have been cited in the polyvagal theory [PVT] literature as supporting the theory) were invited by the first author to participate as co-authors of this article. They were asked to evaluate the PVT and comment upon an overview of the theory written by its author (Porges, 2025a). All those invited, save one, accepted and co-authored the paper. The dissenting scholar was "unfamiliar with the PVT." This article specifically appraises--based upon the current state of knowledge of autonomic function and vertebrate evolution--several major elements of the PVT, as described in Porges (2025a) and elsewhere. These include: 1) the validity of PVT assumptions that respiratory sinus arrhythmia is a direct measure of the extent of central vagal drive to the heart; 2) PVT characterizations regarding the neuroanatomy and functions of two major brainstem vagal nuclei, the ventrally situated Nucleus Ambiguus and the Dorsal Motor Nucleus of the vagus nerve; 3) PVT assertions regarding the evolution of the vagus nerve; 4) PVT claims about the specificity of mammalian social behavior in relation to nonmammalian vertebrates, and 5) PVT interpretations of earlier seminal physiological literature. All co-authors agree that major tenets of the PVT are not supported by past or current knowledge and, in several instances, are inconsistent with the broader evidence base. Since the topics addressed constitute fundamental premises of the PVT, we conclude that the PVT is untenable, because it is not defensible based on existing neurophysiological and evolutionary evidence. The psychological elements composing the superstructure of the PVT are primarily derived from earlier psychological literature and are neither clarified nor strengthened by PVT constructs that lack evidence. This article does not intend to address alternative explanations about relations between vagal function and psychological processes, although such explanations do exist.

Keywords: autonomic nervous system; parasympathetic; polyvagal; respiratory heart-rate variability; respiratory sinus arrhythmia; vagus nerve.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None.

Figures

**Figure 1.**
Diverse constraints and influences upon respiratory sinus arrhythmia (RSA) when employing RSA magnitude as an index of cardiac vagal tone

**Figure 2.**
Neuroanatomical and physiological factors involved in determining types of respiration-related heart-rate variability (HRV) in vertebrates

See this image and copyright information in PMC

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Why The Polyvagal Theory Is Untenable: An international expert evaluation of the polyvagal theory and commentary upon Porges, S.W. (2025). Polyvagal theory: current status, clinical applications, and future directions. Clin. Neuropsychiatry, 22(3), 169-184

Affiliations

Why The Polyvagal Theory Is Untenable: An international expert evaluation of the polyvagal theory and commentary upon Porges, S.W. (2025). Polyvagal theory: current status, clinical applications, and future directions. Clin. Neuropsychiatry, 22(3), 169-184

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Abstract

Conflict of interest statement

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