SAFE & SOUND PROTOCOL (SSP)

This protocol was developed by Dr. Stephen Porges, based on his Polyvagal Theory, SSP is a 5 hour sound-based (auditory) intervention calming the physiological and emotional states. This is derived from 4 decades of research on the relationship between the autonomic nervous system and socio-emotional processes.  SSP was designed to reduce stress and auditory sensitivity, enhancing social engagement and resilience.  This intervention can boost or accelerate other therapies such as counseling, occupational therapy, speech therapy.  

Our brain and body’s first priority is to keep us alive, when our body or brain feels or perceives a threat, our nervous system moves into states of defense (fight, flight, or freeze). When a nervous state remains in a chronic state of defense it affects the way we feel, think and connect with others. This can adversely affect our health and how we experience the world around us.  Our emotional and physiological states are important to how we approach various circumstances.  When we have better regulation, therapeutic outcomes are improved. The regulation or calmness brings balance to our physiological and emotional systems allowing the client to feel safe.  This intervention is known as passive, meaning that the client can benefit from just listening as long as the client feels calm and safe, focusing on the music. However, this intervention isn’t passive! Shifts are happening within the autonomic nervous system and within the vagal nerve systems. It is highly recommended that a parent or caregiver be present while the child listens and that they are actively engaging in activities together. What a great opportunity for families to have uninterrupted time with their loved ones.

SSP brings the client from a state of hyperarousal (fight or flight, defensiveness, cautious or nervousness) to a feeling of safety or calmness.  What you hear and how you hear it, influences how the body responds to situations.  Listening is connected with the vagus nerve, our body’s internal control center for processing and responding to cues and signals from our environment.   SSP is designed to stimulate the nervous system by exercising and systematically challenging the auditory system with specifically processed or filtered music.  This intervention uses prosodic music that has been filtered to train the middle ear muscles to focus on the frequency found in human speech…which leads to improved connection, communication and therapies. The music trains the auditory pathways by focusing on the frequency of human speech.  At times, sometimes the music may sound quiet or difficult to hear – this is due to the filtering that occurs and that lower frequencies have been eliminated.   

As the client learns to process speech-related frequencies they improve the functioning of two cranial nerves.   First, the Cranial nerve VII helps focus on the human voice and tune out irrelevant frequencies.    Cranial nerve X enables autonomic nervous system regulation.     When the client’s hyperarousal state (fight or flight) is decreased, their social engagement system can work properly.  In essence, SSP aims to calm the child’s nervous system so that the client can be more socially engaged.

Studies suggest that attention, state regulation, and the ability to engage socially are improved. Following the SSP Protocol, ideally, children will be better able to focus in school, therapy, and daily life as they experience a calmed emotional and physiological state.    The research of various clinical trials shows that many neurodevelopmental and mental health conditions share common behavioral features such as compromised social engagement system, over-aroused autonomic nervous system, and auditory hypersensitivity or difficulty filtering out background sounds or noises in order to tune into the human voice.

The state of calmness or self-regulation allows clients to have a better ability to listen, stay focused, and engage with others socially. These clients are able to take in and process what is needed to keep up with social situations. The polyvagal theory shares its the perception of difficulties that our children have with social interactions and processing speech. It states that when the child’s emotional state is stressed, the nervous system is working overtime to regulate or settle down.  This then affects the client’s ability to notice or learn details that accompany social interactions such as reading emotions or processing language.

SSP is a researched-based intervention showing significant results in the following areas: 

    • Social & emotional difficulties
    • Auditory sensitivities
    • Anxiety & trauma-related challenges
    • Inattention
    • Stressors that impact social engagement

Since the release of Dr. Porges’s original Safe and Sound Protocol (now SSP core) the research, experiences, and insight of the Safe and Sound Protocol community has contributed to adding more support for families.  

  • SSP Connect (Classical) –  Provides a gentle and “safe” introduction when needed.  The playlist consists of classical music curated to be calming, grounded. For more sensitive clients, or those with this is a highly dysregulated nervous system, this is the recommended first step
  • SSP CORE – the traditional 5-hour listening protocol 
  • SSP Balance – families can begin 8 weeks after SSP core. This is largely unsupervised and can be used at home.  Used to extend and integrate the gains from SSP.  Same playlist as SSP CORE, but filtered differently with a lighter frequency modulation algorithm. Can also be used as ongoing daily support for clients who need it, many find it calming and grounding. This is also used as a “warm-up” before the SSP CORE booster.

Highlights:

  • Based on Dr. Porges’s Polyvagal Theory
  • Music is processed or filtered specifically to re-tune the nervous system
  • Non-invasive
  • Enhances or accelerates other therapies
  • Areas of focus: 
    • Social Communication: Social Engagement System – For example, better facial expressions or eye contact, understanding of speech, reciprocal interactions, decreasing oppositional behaviors, and social withdrawal.  Improvements have been shown in behavioral state regulation such as hypo/hyperarousal, anxiety, meltdowns, distractibility, and impulsiveness. 
    • Physiological State: Autonomic Nervous system – minimizes emotional or mental stress, improving the ability to regulate behaviors. The improvement has been seen in vagal regulation, such as digestion, sleep, and state regulation. 
    • Sound Sensitivity, and auditory processing – improvements on the SCAN-3 (a measure of auditory processing) and one’s ability to decipher human speech from background sounds and hearing in both ears. Clients have seen improvement in following verbal commands and decreasing speech/language delays.  
  • Has two components
    • Structuring a safe context in which it’s given – which is managed by the provider or caregiver – for the intervention to be effective it is necessary for the client’s nervous system to be in a state of safety
    • Delivering acoustic features that serve as a neural exercise – which is provided by the provider

Changes occur from day one upwards to 2-3 months after the protocol has been completed.   While some families see changes right away, other families report they see changes over the course of 2-3 months, as the individual begins to engage and relate differently, o in new ways. Their therapists will report seeing tremendous gains in OT, PT, Speech, and mental health therapies.  While SSP isn’t a magic wand or a “cure-all” it CAN create changes and improvements.

  • SSP Intake – $125 
  • SSP Connect
    • Minimal support – $75/month (Unlimited access to SSP Connect protocol) 
    • With monthly session included – $125/month (unlimited access to SSP Connect protocol)
  • SSP Core – $650 for 5 hours
    • $65 a listening session with an SSP provider (1/2 hour of listening at a time, could be longer time with provider 10 times)
  • SSP Balance
    • Minimal support – $75/month (Unlimited access to SSP Balance protocol) 
    • With monthly session included – $125/month (unlimited access to SSP Balance protocol)

 

Please note: Insurance will not typically cover the cost of the SSP program, but will allow families to use their FSA or HSA cards. 

SSP can be administered by a professional who has participated in the training.  Our office has two people who are qualified to do this. (Jennie or Sherine) Please note: This protocol is not meant to replace other forms of therapy, it is designed to be used in adjunct to other therapies. 

Our office had the opportunity to participate in the beta version of SSP. ILS has shared on their website:  “Given the current health crisis and the need for physical distancing, we have accelerated the release of the digital version of SSP delivery to make it available as soon as we could. What we are providing now is a “beta” version. Beta means that, while we are confident of its functionality, it is still in its early stages without some of the features expected in the final version.”  

Now, the full 3 phase digital version has been launched to all providers. During the intake appointment, the clinician will discuss how the technology works, expectations and logistics. There is an app, Clinician can create and manage accounts through the app. They are able to view, track and access the process. 

What is needed for the Remote/Digitial version: 

  • Internet to access the app
  • Device to access the specific app.  An account will be set up for clients through an App that can be downloaded to the device.  Once the app is downloaded and activated, clients will also download the playlists.  
  • When listening, clients must wear circumaural (over the ear) headphones.  If there is a noise-canceling function, clients must be able to turn that off.  SSP headphones or those recommended.  (ILS Adult Here, ILS Children here, here or here)  ILS is very clear that ear buds, on-ear or noise-canceling headphones are not recommended. 

Interested clients would need to contact our office for an intake session. During this virtual SSP intake session, the parents or caregivers will go over what SSP looks like, how to prepare for SSP, complete rating scales, etc.   After the intake session, the parent and child (or the adult client) will need to commit to 5 hours of listening. 

For scheduling the 5 SSP hours we try to schedule around the same time each day or every other day to assist with scheduling in the office.  While the initial research on the effectiveness showed to be effective doing 1 hour a day for 5 consecutive days, current research is showing that there are other schedules that can be just as effective. Your therapist can help find a good fit. 

The person having the SSP intervention is accompanied by a safe another person. This can be a parent or guardian, spouse, etc.  During the intervention time, the two will not engage in any verbal conversation, but they may choose to engage in a number of creative activities together.

Your clinician can provide support through the protocol:  

  • Preparation for what to expect 
  • Determining the best pacing, and adjusting the plan as needed 
  • Preparing for, noticing, and supporting changes 
  • Offering engagement and activities during the protocol
  • Offering engagement and activity suggestions for in between listening sessions 

After a listener has completed their days, the parent or caregiver will be asked to complete rating forms shortly after.

Please note: not every client is a candidate for remote delivery of the Safe and Sound Protocol.  Some clients, especially adults with trauma history, would need a personal presence of a therapist for safety and best results. Those that would not be a good fit for distance / remote SSP are living in an unstable household, history of trauma, experienced a negative life event such as death, divorce, or job loss. Other reasons could be a recent head injury, or medical instability, self-injury behaviors, and/or suicidal thoughts. 

Articles or Extra reading: (click on link)

ILS Website  

Safe and Sound Protocol –  Another provider’s blog post 

Vagus Nerve Stimulation Dramatically Reduces Inflammation 

Autism Coach’s description of the vagus nerve and why it’s important

A parent’s personal story

Life Work of Maine’s case study 
https://www.lifeworksofmaine.com/blog/2019/8/3/the-safe-and-sound-protocol-eighteen-months-on

 

Videos:

What changes can you expect?

Presentation by Heather MacDuffie

 

Parent testimony:

 

SSP can be administered by a professional who has participated in the training.  Our office has two people who are qualified to do this. (Jennie or Sherine)

Not every inquiry for delivery of the Safe and Sound Protocol is appropriate. 

Safe and sound protocol is not an appropriate intervention if the followig occur: 

  • Currently living in an unstable household (unsafe)
  • History of trauma, and not currently working with a trauma therapist 
  • Lack of stabilty in day to day
  • Recently experienced a negative life event such as job loss,divorce, death of a loved one
  • Lack of a support system 
  • History of disassociation 
  • Ongoing substance abuse
  • Currently self-harming 

We have exciting news!  Jennie has been hand-selected by ILS/UNYTE to be a member of their national Social Impact team. Jennie is looking for 15-20 foster or adoptive families in the St. Louis region who would like to receive the Safe and Sound Protocol free of charge as part of their social impact project.  

These families will be a part of a cohort that will include a virtual orientation for SSP in June, the ability to participate in all 3 SSP pathways, free access to our office’s Parent Hub, and support from our office.

To qualify:

  • Must reside in Missouri
  • Caregivers must be willing to fully participate 
  • Must be either a foster child/adolescent or have been adopted 

Ready to feel calmer?

Frequently Asked Questions

What age can SSP be used with?

In our office we can use SSP with anyone over the age of 18 months, to adults.

Can my child only complete part of the protocol?

This is not recommended. Families will not see the benefit of the protocol if they do not complete the entire 5 day sequence.

What are some of the areas that can be improved?

Symptoms of:

  • Social & emotional difficulties
  • Auditory sensitives
  • Anxiety and trauma related challenges
  • Inattention
  • Stressors that impact social engagementAdditionally, areas or issues that have shown improvement or success:
  • ADD/ADHD
  • Down Syndrome
  • Mild TBI
  • Misophonia
What are characteristics of common clients?
  • Difficulty in regulation behavioral state
  • Difficulty listening and following directions
  • Speech & language delays
  • Sound sensitivities (including misophonia)
  • Difficulty with giving or understanding facial expressions
Can the protocol be repeated?

Yes, it can.  Some families might do another round of the protocol in 3-4 months.

Is it true that you can have stomach issues during or after SSP?

There is a possibility that some clients might report physical symptoms during or right after the protocol. While this isn’t uncommon, this is not a regular occurrence with all clients.  Some adults will report some bowel changes or feeling gassy.  Children might report their tummy doesn’t feel well.   Typically, turning down the volume helps relieve symptoms.

Essentially, when the nervous system perceives a threat, it produces too much stomach acid.   When stressed, our bodies release adrenaline, cortisol and histime (along with others…).  While not completely understood, the enmetic system has connections to the vestibular and stomach systems both of which are involved in Safe and Sound Protocol.  We also know that when we are feeling anxiety our bodies produce histamine which might be what the reflux or nausea could be a result of.

Quick stress lesson:
– When our body is under stress, stress hormone cortisol is released, which calls the nervous system into action.
– Hypothalamic-pituitary adrenal is stimulated by the nervous system which puts the body into ‘fight or flight’ mode.
– Our bodies, stressed, feel like they are under attack, all resources are poured into conserving energy – which shuts down areas such as digestion.
– ADDITIONALLY, the sympathetic nervous system is triggered; releasing neurotransmitters (adrenaline, noradrenaline and dopamine) which sharpens the senses and put your body on high alert.  The sympathetic nervous system also triggers histamine into the bloodstream.

Can the protocol make behaviors worse?

With some clients, there may be an uptick in negative behaviors for a short time.  While this is not uncommon, for parents this can be scary. The child is most likely experiencing emotions bigger than what they have experienced before.    Many times children who have never been in a settled state feel different, not knowing how to feel given that their bodies and brain have to learn the new normal.  As time passes, these children eventually  settle into their new state. Suggestions could be increasing physical movement such as going to the playground.  Another suggestion would be remaining conscious of how calm and connected the caregiver is to the child, the co-regulation piece is very important.  

We also encourage families to experience the protocol when the children are not under alot of stress…avoiding yearly triggers, beginning of the school year, etc.

Can I listen to the music at the same time as my child?

Yes, and No.

The short answer is that it “IS” possible to utilize a slitter and use allow both the child and the parent to listen simultaneously.   When doing the protocol together, professionals have seen positive results.    On the other hand, for many clients this may not be a good idea because each person is dealing with their own emotions, and at times, the person listening may need a “safe” or regulated person. We would not want the child to be the “safe” or “regulated” person for the adult. This is the case, with many families.

Is this protocol appropriate for those who have experienced trauma?

Yes!

In the case of early childhood stress, the middle ear does not become attuned to human vocalizations; child’s ear focuses on low frequency sounds, of which are associated with danger.  As we will notice, these children are distracted by background noises and do not respond to the human voice and miss out on social engagement opportunities.

Recent advances in the area of brain interventions for toxic stress and trauma have led to innovative treatment strategies.   One of which is the Safe and Sound Protocol.

Can SSP fix my child's learning disability?

Many people wonder how SSP will impact their child’s learning disability.     Each child’s response is unique.  It can be hard to separate the social impact of the disability from the disability itself.  Learning is partly a social process, thus improving the social engagement system, this can help some kids who struggle to learn.  For example, while SSP cannot “fix” the disability itself, it can lesson the times they shut down when they are confronted with a challenge or decrease the emotional reactions that the child might have to  the way they approach school or academics. Some children we have seen improvement in their ability to stay on task with an assignment, or their regulation when completing an assignment.

Can you expand the science behind SSP?

Most families want to know more about the science behind the intervention. The Polyvagal Theroy states that in mammals the regulation of the autonomic nervous system centers around listening and vocalization.  Mammals are different than reptiles because 2 bones in the ear are detached allowing us to hear low amplitude and high frequency sounds in the human voice.  The bones in the middle ear are a direct entry to our autonomic nervous system.  Muscles (Stapedius) in the middle ear provide input to the brain through vegus nerve stimulation.  When the stapeduius muscle is weak the brain struggles to attend and interpret sound & facial cues, as well as other dysregulation issues.   These are outside of our conscious control.  SSP exercises this muscle increasing the range of input the client can take in. When the way we take in sound is distorted, it disrupts the entire autonomic nervous system, interfering with the social engagement system.

The Polyvagal Theory addresses the origins of the difficulties some children have with social interactions and processing speech. The theory continues that if the child’s emotional state is stressed or confused, the nervous system is working overtime on trying to calm down. This heightened behavior state makes the child unavailable for noticing or learning the subtleties that come with social interactions such as reading emotions and processing similar words correctly.

Which cranial nerve is effected?

The music trains the auditory pathways by focusing on the frequency envelope of human speech. As the client learns to process these speech-related frequencies, they improve the functioning of two cranial nerves that are important for promoting overall social behavior.

  • Cranial Nerve VII (Facial Nerve) helps clients focus on human voice and tune out irrelevant frequencies.
  • Cranial Nerve X (Vagus Nerve) enables self-soothing and autonomic regulation.
Why is the effect stronger in adults than children?

It has been noticed among practitioners that some adults who have completed the protocol can experience some intense emotions for a short time after SSP.   The thought is that these adults feel emotions or begin to process  in a way that they are not used to experiencing prior to SSP.  SSP can be beneficial for children AND adults, however it’s not always the best option for an adult to do it alone without support if they have a trauma background.  After SSP clients will notice that changes take place in their social engagement system,  the ANS is more regulated, and the individual can start to process their world in a different way, as well as their past experiences or traumas.  As one can imagine this can be overwhelming, which is why there is a therapist available to help provide support.   While parents or caregivers will more likely be able to provide or seek out support for their children, many times adults will not have the supports or will attempt to push through.

If my child does not like a song can we skip that portion of the music

Short answer: no.
Longer answer: They do not want people to skip over songs because each song is an integral piece to the protocol. The special modulation to the music is what makes this different, and should not be altered.

We've heard that SSP can be useful with clients who have experienced trauma, is that true?

In our experience, yes.   Porges explains through his Polyvagal theory that individuals who have experienced some sort of trauma have difficulty connecting with others and forming relationships. As we know our physiological state dictates our behaviors. Additionally, clients who have experienced trauma have nervous systems that are on alert or heightened, assuming danger is near. They are constantly in a state of arousal and struggle to regulate.    SSP has been helpful in both of these areas, both allowing clients to be in a state of calm, which effects their ability to connect with others and regulate their own emotions and behaviors.

What types of therapies does SSP help with?

Safe and Sound Protocol can increase the effectiveness of counseling or psychotherapy, occupational therapy and speech therapy.

Who is my practioner and what do they do?

The Practioner is the clinician who faciliates the entire process.    The Clinician meets with the client’s family (in person or virtually), provides the equipment in office (or access virtually), determines the best course of action or treatment plan for the client and their family, as well as directives of what to be doing during SSP sessions.    There should also be pre & post evaluations. At Step By Step Counseling Jennie Wilson is our practioner or clinician who has been through the training and is qualified to administer the protocol.  She is a Licensed Professional Counselor, National Certified Counselor, Registered Play Therapist Supervisor, Autplay certified and EMDR certified.  She is passionate about SSP and promoting it to anyone who could benefit from it.