Safe and Sound Protocol
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What is Safe and Sound Protocol? Who Does it Help?
Safe and Sound Protocol (SSP) is a listening therapy based on the principles of Polyvagal Theory that supports nervous system regulation. SSP is just one more tool in our toolkit that can be used to support children and adults to improve emotional regulation, social engagement, sound sensitivity, and auditory processing.
SSP can help shift our central nervous system states and our internal responses in order to positively impact anxiety, depression, trauma, ADHD, sleep issues, and some of the physiogical stress symptoms experienced by Autistic children and adults.
SSP can be supportive for children and adults who:
- are highly responsive / reactive to things “going wrong;”
- work hard all day “holding it together” and often experience meltdown or emotional distress when they are at home in the evenings;
- have a narrow “window of tolerance” and struggle coping with environmental stressors;
- feel “on edge” a lot of the time;
- need lots of reassurance and emotional support from a caregiver or loved one to feel like they are “okay” (for example a child that physically clings to caregivers or an adult that often seeks comfort from others in a way they find distressing);
- experiences “explosive” outbursts or meltdowns; or
- has sensitivities to sound or auditory stimuli.
Your therapist will assist you in determining the right amount of time for listening at home. Some children and adults will enjoy listening every day and other may only be able to tolerate at-home listening 3x per week.
Typically, people listen at least 2+ times per week for about 10-20 minutes. You can create a calm and quiet space at home, with a trusted adult available in the space for children. Adults can provide eye contact, physical contact, and nonverbal supports to their child during the listening process.
Both children and adults may enjoy engaging in an activity like coloring, building legos, using play doh, using a sensory box, or just snuggling up on the couch during their listening sessions. Some people may need additional proprioceptive input, like sitting on a yoga ball or swinging in a hammock, rock in a rocking chair, stretching or yoga, or engaging in other calm movements.
What is Polyvagal Theory?
Polyvagal Theory was developed by psychologist Stephen Porges. This theory helps understand how the nervous system influences social behavior and internal processes, as they relate to how we engage with and interpret the world.
The nervous system develops gradually over time and is foundational to the body’s ability to process outside information via sensory information, attend to and respond to that information, and use it to support deeper learning and behavior. The nervous system is the body and brain’s way of finding balance for internal and external states that helps us function at our best. This balance can be disrupted, often creating challenges with physical health, mental health, connecting with others, sleep, learning, energy levels, and more.
If a nervous system is dysregulated, a person’s sense and experience of internal or external information can be skewed. Their nervous system may interpret their environment and the people in it as threats to respond to and struggle to experience safety and balance.
The autonomic nervous system (ANS) helps regulate important body systems like body temperature, heart rate, blood pressure, breathing, and digestion. The ANS relies on the largest nerve in our bodies, the vagus nerve. The vagus nerve is the longest nerve in the body and branches from the brainstem to the stomach. It’s often thought of as the brain-body connection and helps us interpret internal and external information.
There are three different physiological states that the vagus nerve can lead us to, depending on cues of safety or danger in our environment. The ventral vagal state is where we hope to be most of the time. In a ventral vagal state, we are able to connect with others, be present and grounded, feel joy, and experience ease and openness. Our sympathetic state is an alert state where we feel uneasy or distressed. This is our fight/flight state and may show up as panic, fear, anger, or frustration. When in this state, our environment is perceived as dangerous and overstimulating. Then, we have our dorsal vagal state where we may feel shut down, numb, and very disconnected from others and ourselves. In this state, our nervous system immobilizes us to protect us, it is our freeze state. These various states have internal or health impacts as well as external impacts.
Polyvagal Theory has two additional principles: neuroception and coregulation. Neuroception explains how connections in our ANS register every moment via our senses, whether a person or situation is safe, dangerous, or a threat without involving the thinking parts of our brain. Our neuroception tunes into three types of input: inside the body, outside the body, and the nervous system. Lastly, coregulation describes how our nervous system looks for and needs others to feel safe enough to connect and form relationships with. Co-regulation begins before babies are born when they are turning into voices heard in the womb and the internal state of their parent. Coregulation continues to develop when a baby associates calming voices with smiling faces and a felt sense of safety after birth and continues as children develop and look to their parents to assess for safety. Another way to describe co-regulation is when a calm and supportive person offers their calm by remaining steady in tough moments, to a child as a way to help them soothe. Coregulation leads to self-regulation and emotional wellbeing.
How Does Safe and Sound Protocol Work?
SSP helps to influence the nervous system with specially filtered music that is heard by the auditory neural network, including a branch of the vagus nerve. The SSP music is filtered to bring frequencies to the range of the human voice, which activates the social engagement system and supports a sense of safety, helping the nervous system return to a more balanced state.
To support best practice and the effectiveness of SSP, we want to ensure listening is done with the nervous system in the ventral vagal state. It is important that the listener has a felt sense of safety before listening by setting up the environment, activities, and ensuring the listener has a good co-regulation partner or is able to attune to themselves for independent listening. We consider that less is more. Shorter sessions may be helpful for new clients building a therapeutic relationship or who have more complexities impacting their nervous system. Context, choice, and connection are how our nervous systems determine safety. Children, families, and individuals will be given the why, what, and how for listening to support context. While we will make a listening plan, we are always prioritizing the nervous system’s needs and the listener’s choice, all while connecting during the listening.
Completing the SSP includes listening to at least five hours of music by planning for listening sessions multiple times per week for optimal effectiveness. A listening plan will be created to support in-office, and at-home listening in some cases. Listening sessions are done with a personal pair of over-the-ear headphones. How long listening sessions are depends on a person’s nervous system and ensuring they stay within their window of tolerance during listening. Families can expect to learn more about the nervous system states, emotional and behavioral regulation, mindfulness, and attunement as they engage in SSP. During listening, individuals may engage in low-intensity calming activities or movement. Listening sessions should be completed in calm spaces where individuals feel safe and comfortable. While listening, an individual or their listening partner would want to be attuned to the listener, ensuring they are regulated and feeling comfortable. At any signs of dysregulation, the music is paused until the listener can return to a regulated state or decides to stop listening for the day. Families are encouraged to monitor changes in regulation, social engagement, sleep, and eating so that listening plans can be tailored to ensure the listener stays within their window of tolerance and is successful with SSP.
Case Example
A 12-year-old Autistic child who is impacted by attention deficit hyperactivity disorder and anxiety has practiced mindfulness and regulation skills by engaging in therapy for nine months. She’s committed to dealing with less anxiety, and she and her family want her to be able to access the tools she’s learned through therapy more easily in the moment.
Her parent reports the child getting stuck on worries, struggling to communicate needs and feelings to others, needing a lot of time to regulate and feel calm again after being triggered. She struggles with making friends and connecting with others. Sometimes, her ways of thinking limit her ability to take care of herself. She may become overwhelmed and unable to shift from it without a significant amount of reassurance from her parent.
The family learns more about SSP and the child likes music. We have conversations about what type of music she likes, and what SSP playlist she might choose. We sample the music and find what feels right. We think together about what she can do before, during, and after listening to ensure she’s feeling regulated and create a listening plan with those details written out.
We plan for her first listening session to be five minutes long in the office. Her parent has already made an account with the listening platform, filled out pre-listening assessments, and downloaded the SSP app on their phone. The child’s parent is walked through using the app, doing the volume test, and understanding how to start and pause listening. The child puts on her headphones and starts using kinetic sand. We’ve created a thumbs up signaling system for nonverbal check ins. She has access to pausing the music at any time.
She decides to play the music and is successful in her first listening session. While listening, her parent and the therapist are using kinetic sand too, modeling deep breathing, showing smiles and relaxed faces to offer co-regulation.
After listening we complete a mindful check in to talk through any thoughts that popped in her head or sensations she had while listening. While she was listening her breathing, facial expressions, and movement were monitored for signs of stress. Throughout listening, which this family did in their own home as well as the office, the child was eager to listen, she reminded her parent, and she honored her listening plan. Each week at therapy sessions, we checked in about sleep, eating, connection with others, emotional states, and any barriers to listening. As those things were talked through and known to be stable, we decided to increase the length of listening sessions. Throughout listening to SSP, the child and her parent reported improvements the child’s self-expression and communication with others when upset, less getting stuck on anxious thoughts, and an improved ability to access the tools she’d learned in therapy. She was experiencing fewer gastrointestinal issues related to anxiety and exploring friendships more.
I am Interested in Learning More About SSP! How Do I Get Started?
If you would like to schedule an intake with a SSP provider, please contact our Intake Team by calling 828-532-6717 or emailing hello@flourishasheville.com.
