Safe and Sound Protocol: A Portal into Healing

What if we told you it is possible to retune your nervous system, just like a guitar, so you can feel more alive and have a greater capacity for life? Weird right? Sounds like woo-woo pseudoscience, and we thought it was until all of us at Hilltop utilized the Safe and Sound Protocol. It was so powerful that everyone who works with us is reporting feeling less anxious, less fearful, and eager to make changes with less struggle.

What is the Safe and Sound Protocol?

Safe and Sound Protocol (SSP) is a research-backed neural exercise using highly filtered music to help the nervous system to become more comfortable with shifting states. SSP improves people’s ability to become more social, engaged, and responsive to their emotional and physical needs. SSP can benefit individuals experiencing sensitivities to sound, light, physical touch, tastes, and smells. Originally the protocol’s creator, Dr. Stephen Porges, a neuroscientist, intended for the intervention to be helpful for individuals diagnosed with an autism spectrum disorder. Unknowingly, Porges stumbled upon a therapeutic intervention with a wide application, benefiting various populations. SSP can help individuals who have experienced trauma, disordered eating, substance abuse, trouble focusing, social anxieties, chronic pain, ADHD, Parkinson’s disease, gut issues, abdominal pain, Prader-Willi Syndrome, vagal nerve dysfunction and much more.1 2 3 4 5 How can this be? A music intervention that helps an umbrella of unrelated symptoms physically and psychologically? SSP targets the Autonomic Nervous System, specifically the ventral vagus nerve, a communication highway in the body, essential to our health.

The Science Behind Safe and Sound Protocol

The Autonomic Nervous System is central to mental, emotional, and physical health. The Autonomic Nervous System (ANS) is like an intricate spider web, connecting through different parts and structures of our body. The ANS network touches our muscles, tissues, organ systems, and exocrine and endocrine glands as it takes information from all these structures and sends the data to the brain, where the brain makes meaning (our thoughts). It keeps us safe from danger by engaging the sympathetic part of our nervous system so we can fight or run away when we sense a threat and allows us to digest and rest by engaging the parasympathetic part of our nervous system.  

A component of the ANS is the vagus nerve, which is associated with the ventral vagal complex. When the vagus nerve is accurately online, and we are in a ventral vagal state, we can play, be present in life, connect, feel safe enough, feel emotions, learn, and be present without fear. Healing physically and psychologically happens when we are in the ventral vagal state, which combines the parasympathetic and social engagement systems in our ANS. 

 The accuracy of the vagus nerve impacts many physical and psychological challenges. If we have a dysfunctional vagus nerve, we can have various symptoms ranging from diarrhea, social anxiety, raging to collapsing patterns, chronic overwhelm, sleeping issues, using external crutches for relief (like drinking, over or under-eating, etc.), and inflammation (which can trigger chronic diseases and autoimmune disorders), etc. If our vagus nerve is functional and can send accurate messaging to the brain, our physical and psychological symptoms in the body soften or dissipate, and our nervous systems can heal faster. A proper vagus signaling system makes us more aware of our internal sensations, understand our emotions, able to come into a relaxed regulated state, and advocate for our wants and needs. 

Safe and Sound Protocol Mechanisms

SSP acts as a portal directly into the vagus nerve, inviting the nervous system to shift into a ventral vagal state. SSP’s algorithm, through filtered music, sends potent safety cues to our nervous system. When the ANS feels safe enough, it can shift into the ventral vagal and parasympathetic state, making ideal conditions to heal physically and psychologically. Our ANS cannot simultaneously be in threat (sympathetic nervous system) and healing mode (parasympathetic nervous system). That is why when we are overwhelmed and stressed out, we physically heal wounds slower, our IQ drops, 6 and it is hard to be compassionate to ourselves and others when we are in this threat state. SSP targets neural pathways in the vagus nerve, supporting the ventral vagal and parasympathetic state, which supports a greater ability to return to relaxation and develop greater emotional resilience. SSP improves flexibility to move into different ANS states and supports reorganizing the brain through neuroplasticity. SSP creates lasting changes in the circuitry relating to emotional regulation, stress response, and feeling safe enough to connect with others. SSP enables neuroplasticity to overcome maladaptive crutches, like disordered eating and addictions, and develop healthier ways to respond to stress, triggers, and overwhelm over time.

Safe and Sound Protocol Must be Used Responsibly

SSP has extraordinary healing benefits but must be used wisely since it can cause adverse reactions. SSP is not a cure-all and is meant to be paired with another modality and listened to while in connection. SSP is a portal to healing, not a stand-alone treatment. Learning how to practice along the way, one of our therapists realized what you are not supposed to do. After getting SSP certified, she was excited to try it on herself. She listened to SSP in isolation three days in a row in 20-minute increments. What could go wrong? She’s a mind-body therapist and works with the nervous system! She quickly learned that listening for three consecutive days for 20 minutes was too much for her ANS to digest. She quickly learned working with a certified professional who can monitor the process was key to the experience of co-regulation and parasympathetic healing. She found an SSP practitioner, and worked through the experience once or twice weekly for 5 to 10-minute increments. When she listened to SSP responsibly, she did not experience any adverse reactions, only beneficial ones.

Alarm bells ring in our ANS if we get too many safety cues, especially if we have a history of trauma, sensory issues, or currently going through significant life transitions, illness, or abuse. Sometimes, the ANS can be overwhelmed with safety cues, which then may be perceived as threats, so some experience adverse reactions from SSP if not done with a certified professional. When we overwhelm the ANS with SSP, it commonly has two reactions. One reaction is to have adverse physical reactions, or the other is nothing. We know that when the ANS, mind, and body have the intricate ability to numb themselves (dissociation), so the SSP modality does not stick when states of overwhelm are present.  That is why it is helpful to start SSP slowly, look out for signs of overwhelm, and gradually increase the listening time so you don’t experience adverse reactions or ANS dissociation.

SSP, when done correctly, should not feel stressful or dysregulating. In fact, initially, we might not feel anything at all. Then, after a few minutes of listening, we might notice subtle differences over time. The fog of depression starts to lift. We are more relaxed and more curious. SSP can be fast acting, but it is the small and little changes we notice (or the people closest to us who see them first), and eventually, things will start to click. Here are some signs that SSP is moving in the right direction:

  • You begin taking healthy risks
  • You can start to become more aware and interrupt unhelpful patterns
  • It’s easier to maintain eye contact
  • Healthy motivation, not a go-go-go-collapse pattern
  • You might see more detail (colors look sharper, it’s easier to hear people in conversation,
  • You notice a picture on a wall you haven’t seen before, etc.)
  • You might feel more energy
  • You might feel more social
  • You might want to play
  • You might be more talkative
  • You might feel more affectionate
  • You might be more curious
  • You might feel better physically, mentally, and emotionally
  • Chronic pain might decrease
  • You might have regular/easier bowel movements
  • Eating might not feel so hard
  • You might notice more accurate hunger cues
  • You are not as preoccupied with self-image intrusive thoughts
  • It is easier to rest, and rest feels restorative, not like a collapse

Safe and Sound Protocol Helps With Healing Outcomes

SSP is simple yet complex and helps with mental health diagnoses that we see at Hilltop Behavioral Health. SSP helps the ANS reorganize into healing but can only tolerate bite-sized sessions to metabolize. Like a dry sponge soaking up water, there is only so much a sponge can take in to benefit. Our nervous system is the same way. SSP can significantly enhance healing efficiency and outcomes when done responsibly and with the less is more approach. Below are specific ways that SSP can help common mental health diagnoses that we see here at Hilltop Behavioral Health:

 

  • Generalized Anxiety Disorder: SSP may help with fatigue, restlessness, impaired concentration, excessive worry, and future tripping
  • Major Depressive Disorder: SSP might help with mood, increasing energy and motivation, and wanting to connect rather than isolate
  • Substance Use Disorder: When done slowly, SSP may help with cravings, finding alternative coping strategies, creating more awareness around triggers, noticing internal cues of stress, and interrupt the pattern of a relapse
  • Binge Eating Disorder: SSP could help with the ability to recognize fullness cues and lessen dissociation/zoning out and interrupting the pattern of overeating, not as fixated on food, and finding other healthier coping skills
  • Anorexia Nervosa Disorder: SSP may help with less fear of weight gain, not as preoccupied with weight, calories, and food, softening the distortion of body image, lessening of food rituals
  • Avoidant Restrictive Food Intake Disorder (ARFID): SSP may help with fewer sensitivities around smell, texture, taste, and sight of food, lessening of pickiness and genuine curiosity around eating new foods, eating larger portions, less gagging or vomiting
  • Post-Traumatic Stress Disorder: SSP could help with lessening hypervigilance, avoidance, and irritability, improve sleep issues, soften flashbacks, and feel the need to connect rather than isolate

 

SSP is not limited to helping the diagnoses listed above (remember that mental health diagnoses change every few years and are just a common language for reporting, analyzing health information, and labeling systems). SSP is meant to be paired with other modalities like talk therapy, occupational therapy, somatic experiencing, bodywork, speech pathology, etc. SSP is a tool that sends safety cues to the ANS. When the ANS feels safe enough, we have more capacity to take in different interventions, like talk therapy. When our ANS feels safe enough, we have more clarity, choices, and confidence and are not at the mercy of our automatic patterns.

Safe and Sound Protocol in Practice

Every certified Safe and Sound Practitioner is different and administers SSP uniquely. Some combine in-person therapy and virtual sessions when administering SSP. As a licensed psychotherapists, certified eating disorder specialists, trauma specialists, and somatic (mind-body) therapists, we adapt SSP differently for each client. Sometimes we do SSP at the beginning of talk therapy clients’ sessions or at the end. For some, we play catch while listening to SSP together. Sometimes we combine SSP with an eye-movement modality, eating disorder CBT protocols, ACT, CPT, Brainspotting or a breathwork and movement session with Qigong. Depending on the nervous system’s needs, some clients listen directly with headphones, others with a Bluetooth speaker. 

 At Hilltop Behavioral Health, the therapists incorporate SSP differently based on their backgrounds and training. Some therapists do SSP at the beginning or middle of a session or listen together. Or, after much assessment and stabilization, the Hilltop therapist may recommend that the client listens to it remotely yet still in connection with a trusted loved one or pet at home. Hilltop Behavioral Health adapts each therapeutic modality, including SSP, to the unique needs of every client.  

Safe and Sound Protocol Opens Up New Possibilities

SSP is a new and exciting healing modality and must be used responsibly. What is so special about SSP is that everyone responds differently because every nervous system is different. SSP can be a wild card, so it can feel jarring because we don’t know what to expect. Well, that is healing, right? We know we want a different experience, yet it can feel scary at the same time. Through the healing process, we may question who will I be on the other side? Will I like myself? Will I be happier? At Hilltop, we support healthy risk-taking by being curious together. We will be with you on this wild ride of healing. Hilltop will support your unique healing process by matching your pace and at your side. 

[1] Porges, S. W. (2021). Polyvagal Safety: Attachment, Communication, Self-Regulation (IPNB). WW Norton & Company.

[2] Sandgren, A. M., & Brummer, R. J. (2018). ADHD-originating in the gut? The emergence of a new explanatory model. Medical hypotheses120, 135-145.

[3] Kovacic, K., Kolacz, J., Lewis, G. F., & Porges, S. W. (2020). Impaired vagal efficiency predicts auricular neurostimulation response in adolescent functional abdominal pain disorders. Official journal of the American College of Gastroenterology| ACG115(9), 1534-1538.

[4] Kawai, H., Kishimoto, M., Okahisa, Y., Sakamoto, S., Terada, S., & Takaki, M. (2023). Initial Outcomes of the Safe and Sound Protocol on patients with adult autism Spectrum Disorder: Exploratory Pilot Study. International Journal of Environmental Research and Public Health, 20(6), 4862. https://doi.org/10.3390/ijerph20064862

[5] Manning, K. E., Beresford-Webb, J. A., Aman, L. C., Ring, H. A., Watson, P. C., Porges, S. W., … & Holland, A. J. (2019). Transcutaneous vagus nerve stimulation (t-VNS): A novel effective treatment for temper outbursts in adults with Prader-Willi Syndrome indicated by results from a non-blind study. PloS one14(12), e0223750.

[6] Porges, S. W. (2021). Polyvagal Safety: Attachment, Communication, Self-Regulation (IPNB). WW Norton & Company.

[7] Sandgren, A. M., & Brummer, R. J. (2018). ADHD-originating in the gut? The emergence of a new explanatory model. Medical hypotheses120, 135-145.

[8] Kovacic, K., Kolacz, J., Lewis, G. F., & Porges, S. W. (2020). Impaired vagal efficiency predicts auricular neurostimulation response in adolescent functional abdominal pain disorders. Official journal of the American College of Gastroenterology| ACG115(9), 1534-1538.

[9] Kawai, H., Kishimoto, M., Okahisa, Y., Sakamoto, S., Terada, S., & Takaki, M. (2023). Initial Outcomes of the Safe and Sound Protocol on patients with adult autism Spectrum Disorder: Exploratory Pilot Study. International Journal of Environmental Research and Public Health, 20(6), 4862. https://doi.org/10.3390/ijerph20064862

[10] Manning, K. E., Beresford-Webb, J. A., Aman, L. C., Ring, H. A., Watson, P. C., Porges, S. W., … & Holland, A. J. (2019). Transcutaneous vagus nerve stimulation (t-VNS): A novel effective treatment for temper outbursts in adults with Prader-Willi Syndrome indicated by results from a non-blind study. PloS one14(12), e0223750.

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