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Polyvagal Theory Worksheet Body-Based Worksheets Trauma Worksheets

Polyvagal Theory Worksheet

Published: November 2, 2026 Updated: November 3, 2026

Polyvagal Theory Worksheet

Polyvagal Theory Worksheet

This polyvagal theory worksheet helps you learn what your nervous system states feel like, with the three states, space to list your cues, and ideas for feeling safe again.

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Polyvagal Theory Worksheet Overview

Polyvagal theory, introduced by researcher Stephen Porges in the 1990s, describes three states your nervous system moves between: safe and connected, mobilized, and shut down. Many therapists use it as a map, even though many scientists say key parts of its biology do not hold up.

This worksheet explains each state in plain words and helps you list the cues that make you feel safe or on alert. It also gives you space to map your own states and try ideas that may help you move back toward feeling safe.

In this worksheet, we’ll:

  • Explain the three states in polyvagal theory and what each can feel like
  • Help you list the cues that make you feel safe or put you on alert
  • Provide space to map what each state is like for you
  • Share simple ideas, like slow breathing and calm music, that may help you feel safe again
  • Explain where the science on polyvagal theory stands
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Sources

ChoosingTherapy.com strives to provide our readers with mental health content that is accurate and actionable. We have high standards for what can be cited within our worksheets. Acceptable sources include government agencies, universities and colleges, scholarly journals, industry and professional associations, and other high-integrity sources of mental health journalism. Learn more by reviewing our full editorial policy.

  • Porges, S. W. (2011). The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation. W. W. Norton.

  • Porges, S. W. (2017). The Pocket Guide to the Polyvagal Theory. W. W. Norton.

  • Grossman, P. (2023). Fundamental challenges and likely refutations of the five basic premises of the polyvagal theory. Biological Psychology, 180, 108589.

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