From Sound to Safety: Understanding the Safe & Sound Protocol with Stephen Porges and Karen Onderko
- Justin Sunseri, LMFT
- 13 minutes ago
- 39 min read
Have you ever felt like you've exhausted every avenue in your quest for relief from anxiety, depression, fear, or panic? What if there were a gentle way to guide your body toward safety using something as fundamental as sound?
I interviewed Dr. Stephen Porges and Karen Onderko, deeply discussing the Safe and Sound Protocol - what is it? Who's it for? What's the evidence? And what about the skepticism about it?
Stephen Porges and Karen Onderko have co-authored a new book called Safe and Sound. You can purchase a copy here. (Please note that if you purchase through that link, I will receive a portion of the sale at no extra cost to you.) If you like, you can watch the book review first.
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What is the Safe and Sound Protocol?
Karen: The Safe and Sound Protocol, and we call it SSP, is a evidence-based and non-invasive therapy that involves listening to music that has been filtered to prioritize the frequencies of human voice. So this auditory input allows our nervous system to be receptive to cues of safety and to downregulate defense. So voice is such a sound in particular, but voice, sound generally, but voice in particular is just salient, sensory input. And as humans, we're so driven to connect and our voices are such an important, um, vehicle for that connection. So, um, using the auditory system to, um, to access safety in the nervous system was the way that Dr. Porges, uh, chose to create a, a therapy.
Justin: So it's all about sound and how that impacts safety. You mentioned that there's, or in the book it mentions that there is three different versions of SSP or three different filtration pathways. What does that mean?
Karen: SSP has three pathways, and they relate to how the music, the underlying music is filtered. The original SSP-SSP Core is the first of those frequency filtration pathways, and it involves, all of them involve five hours of listening to music. Though it doesn't take five hours to complete SSP, it take, it can take months to complete SSP, uh, but the point is that throughout those five hours of listening, the music is the filtration of the music shifts. So, at the very beginning, in hour one, at the be- you know, early stages of your listening- you're really just receiving distilled, uh, cues of safety in the frequency range that focuses on, on the human voice in particular a mother's voice, a mother's lullaby. You know, those sounds that we, we hear when we're first, well, when we're in utero and when we're first born, that, uh, lead to us feeling welcomed and loved and embraced in the world. That sort of, um, biological, uh, exp expectancy to come into the world in a welcoming way. So those are the first sounds that we hear. And hopefully we hear them, not, not everybody does, and this, if they don't. This is a really nice, uh, substitute.
What is the evidence for the Safe and Sound Protocol?
Karen: The evidence- and there are, uh, in the book we cite at least six different studies, and another study has just gotten funded by the Department of Defense, which we can talk about later. But, uh, the evidence, uh, shows that SSP can, um decrease auditory hypersensitivities, decrease sensory sensitivities generally, uh, increase calm feelings, uh, reduce anxiety, reduce depression, um, enhance sleep. And what am I forgetting, Steve?
Dr. Porges: Well, um, it changes autonomic tone, but that was early research and now there's more will be coming out. So, uh, Justin, in the beginning it was really just my own research, but for the past, let's say decade, it's been outta my hands. And the community is now doing research including a large contract or grant with the Department of Defense. And people have used it and mixed it within clinical work, as you know, but now they're documenting how it accelerates intervention strategies or outcomes.
Justin: Tell us a little bit more about that. So I know that it, and we'll, we will get into this, it has lots of potential benefits and I really wanna touch upon that later on. So it's, is it just someone who's a provider saying, "Hey, it helped," or is there, are we talking about randomized controlled-
Dr. Porges: Yeah, let, let, let me jump in and also bring you back a step and say, there's two different types of evidence. 📍 There's evidence on the theoretical model and the neurophysiology that documents what this is supposed to do. And then there's a sense validation of what it is doing. And the validation for what it's doing is coming from controlled studies. Like- so it's a laboratory, like some of the work was laboratory, but some of it's actually controlled clinical studies, uh, within people's clinics and institutions. Um, and there's also of course, case histories and that's the other, uh, what Karen and I call real life experiences. And you start collecting, let's say a few hundred of those and you start saying, well, something's happening here, especially if the symptom clusters start to match the features of what the laboratory research is showing.
Justin: Gotcha. So it's not just a bunch of people who are passionate about this saying, "Wow, this is curing everything." This is, we're, there's also some, you know, white coat laboratory stuff going on.
Dr. Porges: there, there's more than that as I often say, is everything does something. You know, build the expectation, you'll get the effect. And that's not necessarily wrong because the human interaction, connectedness supports body changes and that's fine. But what we're talking about is literally- visualize a compass. We know what this does. So we're really targeting the symptom changes based upon the theoretical model. And so what you start seeing is this, uh, engagement in what I call the ventral vagal complex and the cluster of features that come from that spontaneous engagement, hypersensitivities on multiple dimensions, which was almost a sur I would say, a positive surprise for me 'cause auditory was certainly, but then it became visual as well. And ingested people are now eating more different foods, literally, eating drops down. So the model is really being expressed in the clinical feedback from the different, uh, I would say portals of research where we have laboratory, which is gonna be more targeted towards randomized controls. We have it researched now with inter- interbedding, interweaving it into clinical treatment versus standard treatment. And we see, uh, basically trajectory changes. And then you have in the sense, uh, the self-reported clinical observations, uh, basically, uh, coming from both the, uh, Unyte dashboard where they're doing the assessments and other forms of people collecting data.
What is the Music of the Safe and Sound Protocol?
Justin: Obviously music's a big part of this. What is the music, what are people listening to? You've mentioned, um, filtration and distillation, but if I put headphones on or earbuds in with and listening to SSP, what am I gonna hear?
Karen: Well, you are gonna, you are gonna decide what you wanna hear, and there are five different choices, selections of the underlying music that you can select. There's a classical, uh, selection. There's a, um, music from the seventies or so. Uh, there's a children's playlist of, you know, kids' songs and, you know, songs from movies that they know. There is a, uh, groove playlist that is instrumental.
Justin: What, so what music would not fit into SSP like this? This type of genre absolutely does not fit into what we're looking for?
Karen: I mean, it's so personal, isn't it? Like what kind of music, uh, affects state, but I would say like rap music or heavy metal music is probably not what you want to have as your underlying.
Dr. Porges: I'm going to give you, uh, so think of music literally as the vehicle that's conveying the stimulus or the challenge. So ballads and melodic music, uh, and even classical music, uh, you can modulate, uh, filter the music to, in a sense, signal this notion of engagement and disengagement in a sense, it's the voice of- a prosodic voice, uh, a mo- a mother's voice with intonation. Well, in classical music, it's really violins and flutes and clarinets. And again, in songs, there's always the lead singer and the ballad in the modulation. But- given- that being said, when I was actually developing it in the laboratory, I had, uh, literally families with kids who said they wanted to, uh, they didn't wanna listen to this, uh, Disney type music. They want to listen to N Sync- which is getting pretty close to, uh, grading sounds in my ear. And I said, fine, we will process your, your, your CD. And it was effective. Now point is that you can get these frequency modulations, uh, off of most music. You can do that. But if you keep the music, the natural form of the music in the range of a mother's voice, it's going to be more effective. So your question is a great question, but it shouldn't be meant that you can't get effects. The issue is when you, when we develop the SSP, it was really leveraging what we knew to optimize the effectiveness of it.
Justin: I am guessing that some types of music or pieces or genres are gonna naturally gravitate more toward the prosody, the coagulation aspect of it, and you're enhancing that versus heavy metal and rap, which are more mobilizing, but toward deeper, um, mo uh, flight fight kind of activation.
Dr. Porges: Yeah, if you looked at the acoustic features of the music, it would give you real hints. And if you knew what like the acoustic features of a prosodic effective mother is, the answer becomes in front of your eyes. Now, you start understanding that, "Yeah, why do I like that music?" Because it does modulate within that frequency data. It pulls me in. And so when you learn the lesson or the rules, you select the music that you can work with the, the easiest.
Justin: So it is with music, I tend to feel like we, we, we are pulled toward what speaks to our state, uh, sort of matches it. So I like heavy metal music a, a lot. Uh, but there's also times where I really like more folksy calm, and there's other times where I just want silence. There's other times where I want more somber, you know, more that speaks to my shutdown state. So what, the music you're describing, it sounds like it doesn't really match the state. It's more like there's an intention, there's a goal to self-regulate.
Dr. Porges: Okay. Now, um, I'm looking at you, listening to you, and I realize there are people who don't wanna go into a calm social engagement state, and their life is really all about staying mobilized, energetic, and, and active. They may use the word engagement, but not really in a reciprocal level. They're, they're doing that. And they tend to develop strategies to keep in that state. Now, when a child, and this is really where this whole, uh, I would say intervention came from, which children don't, it's not, so, it's not that they're selecting to be out of tune. They're basically due to something in their history. They're-, they're in a sense outta tune. So they don't have enough experience to say, I want elect to be calm. So what we're saying is we can, in a sense, allow them to sample that experience.
Justin: Gotcha. So the music that you're gonna, that one would listen to, it sounds like it's repurposed commercial music that's been out there already. It's not like you guys are in the, you know, you're, you're creating your own music and playing the violins and singing and whatnot. You're repurposing.
Dr. Porges: Some of the music for that's on the platform has been composed, uh, for them. Uh, but the, the bit is, so if we were to step back and say, what type of music would you work with? And, uh, the issue is melodic, prosodic. For me, it's the history of folk music. It's like the Chieftains and Irish music. It's melodic, it's narrative, it's storytelling, it's very engaging. Joan Baez, Joni Mitchell- but that's my, I'm, I'm dating myself, but what it is, is it, the words were less important than how they were being projected.
Justin: So what do you do with the words of the music? Because there's narratives within these pieces, right? So what happens to that?
Dr. Porges: That's the cultural aspect. That's where people want certain playlists, and that's, that's actually a business set of decisions. So what would I do with it? I would, my own- Karen has heard me say this before- I think everyone should literally choose their own playlist. I think it should be totally individualized, culturally, and totally individualized, and let the processing of the music that they like, lead them into the state of engagement.
Justin: So when someone, um, listens to the music, what should they expect? Are there, is it all safety all the time and bliss or other things?
Dr. Porges: Safety is not a constant state. Safety is part of a range of engagement, disengagement, and re-engagement, as we call that co-regulation. But the body is like saying, "Oh, I'm coming towards something and then I am, in a sense, feeling a loss and I want to come back." So it's not a constant state, it's a neural exercise. And so SSP was developed to be a neural exercise of that whole ventral vagal complex. So it can't be a steady, uh, frequency band has to be modulated. Our whole body responds to changes in stimulation. If we live in a constant stimulation, we're no longer really alive or functioning.
Karen: But we were talking about how, um, the music changes over the total five hours of listening that is, you know, laid out for someone. And at the very beginning there is, there are longer phases where you're hearing more of the, you know, the, the, the frequency range of a mother's voice, a mother's lullaby. And so, people, some people are feeling something, feeling safety or, or focusing on that range of frequencies for the first time. And it's actually quite profound. Um, kids have given their parents their first hugs after hearing this music. And it's, it's very a visceral experience. So your body goes along with the music feeling the sense of safety and openness at certain points. And then sometimes those frequencies go away. And so you do experience something of a loss. And when Steve talks about a neural exercise, it's that. We're, we're practicing traveling between states. We have an anchor now in, in safety and what feel, what that feels like. So we have sort of a signpost for getting back there. And the more we shift in and out of that state, we're really practicing resilience and balance. And even the pathways are becoming myelinated. Uh, so that. We can travel those pathways more easily.
Safe and Sound Protocol and Neuroplasticity
Justin: Karen, what does that mean? "The pathways are becoming myelinated."
Karen: So the, um, pathways in our brains that, uh, that allow us to experience emotions and thoughts and feelings and behaviors, um, are neuroplastic and we can become in a habit of having, for instance, anxiety and we can get stuck, stuck, not broken, uh, in, uh, a loop of being anxious. And when we, uh, can pull ourselves- but, but because the brain and the nervous system are neuroplastic, we can shift out of a state of anxiety by practicing safety, by cultivating a sense of safety and experiencing that state, moving between those two. And the, um, pathways in our brains are myelinated when there's more frequent use of those pathways. And by that we mean that there's a, a fatty coating that, uh, uh, coats that sheath, uh, which coats that pathway that makes traveling along it much more quick and easy.
Dr. Porges: We're not gonna be able to, in a sense, measure this or easily measure this. this And so it carries with it more of a metaphor of how the system is actually becoming, uh, more flexible. And that is, you know, and like, uh, when we demyelinate, we can demyelinate from starvation and for lack of stimulation. So we know that stimulation, especially early experiences, aid in terms of nerve nervous system, myelination. So this is what's happening- we're becoming more fluid, our ability to move states change. And that's why I like to coin it as a neural exercise. As opposed to, let's say headphones that filter out sounds or only allow certain sounds in there would be more of a prosthesis, a sense accounting for what might be thought of as being neurodiversity. And I like to think not of is as neuroplasticity as much as the fact that we can shift state and when we shift state, then that neuroplasticity, those exercises start to improve the fluidity of how we move back and forth from states.
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Neural Exercises, Building Safety, and the Safe and Sound Protocol
Justin: You know, in, in reading the- your work, Dr. Porges, you've used the word neural exercise a lot. I feel like, where I think that in reading this book, this is the first time where it really hit me that we were talking about is, um, I call it, when I talk to my clients, I call it putting the reps in. It's not like you just get to safety and you're done. You practice it, you build it just like anything else really. If you wanna lift heavier weights, you gotta show up and do a little bit, and then you work your way up and eventually get to where you wanna be. And so with, with this book, there seems to be more care or attention placed onto that. The, that the fact that it's incremental and there's small changes, and part of that evidence was sounds like from the practitioners who said things like "safe before sound." And we do little pieces, we titrate. It's not just, here's a bunch of safety for you, but here's the amount of safety you can handle. And then we kind of pull away from it, come back to it, process it, build on it.
Dr. Porges: Well, first of all, uh, Karen had this, these wonderful relationships with the providers and that led to actually the interactions and interviews with the clients. So this becomes the important part. One can structure a theory and a model, but how it gets embedded in a person's lives- I mean, I really, uh, lean on Karen and give her, uh, the pat on the back for in a sense, getting that information out.
Karen: So, as an example, children were very receptive to the amount of cues of safety that were embedded in the music through the filtration and, um, when we expanded the, when we released SSP into the world of therapists, and now it's worldwide, um, and all kinds of therapists. Initially it was pediatric, um, OTs and, uh, PTs and speech language, uh, people. But then the trauma world heard wind of this and trauma therapists, psycho psychotherapists, uh, were interested in it and started using it their clients. And the, the same filtration in someone with a complex trauma background, uh, was, uh, was not received in the same way. So cues of safety to them were cues of, uh, vulnerability or, um, if they had, uh, a trauma that was interpersonal, they could be reminded of that experience. And even a little bit of that, of input could be too much. So therapists started to titrate and, um, have shorter and shorter segments of listening, and tried to find that sweet spot where someone could accept, accept that input, and then take a break. And so this concept of sort of mi- titration or even micro ti- titration really took hold. Uh, and it very, you know, each client is different. Each setting, each time you meet with your client is different. Um, so it's always shifting. There's no one way of delivering SSP and even with your, same client, there's no one way of delivering.
Dr. Porges: The, the therapist or the provider, what I learned, they really need to be truly Polyvagal informed. And what does that mean? It means they have to be aware of the state that their client is in. And they can't think of this as a tool that works the same on everyone. So by looking at people's faces, by listening to their voices, uh, and seeing the muscle tone in their body, they have to be able to infer with physiological state their clients are moving into. Because many clients, especially those with trauma histories, are really numb too much of their body. And may miss their body's own reactions. And so the therapist has to really be, in a sense, almost a parental figure to the client in monitoring their titration of this stimulation. Personally, I was really quite shocked 'cause I had years of experience with in more of a pediatric group in neurodivergent, and I never saw anyone react adversely. I just saw people just whoosh and become engaging. Uh, but when the trauma group started use this, I mean it took me on a journey of, I would say, understanding what it is to be traumatized and what it is to be traumatized for many of those, especially those with complex trauma, is that the trauma was inflicted by someone with whom they had trusted. And often the trust was almost on a biological level, like a parent. And so the body's natural response to a parent or to a caregiver is to be accessible. But now that accessibility has led to injury and the body learns, learns very well, and we can even say from our friend, Bessel Vander Kolk- the Body Keeps the Score. But in understanding this from a poly vehicle perspective, the body learned that accessibility was a portal to injury. It was vulnerability. And so the music always worked. This was the paradox and the irony- that even when they were getting adverse effects, it was working. Because happened was they listened, they became accessible. The internal bodily feelings, inter interoception, percolated upward to the cortex. And they said, "I know what that feeling is. That's the feeling that occurs before I get injured. I'm out of the room." And literally they start to tell us those things. And so we learned a lot about the accessibility versus vulnerability dimension, and we learned that the nervous system really is on a journey. It wants to be accessible. But these associations of accessibility, visceral accessibility with injury are just powerful. And that's why they're in therapy. So they're in therapy because of exactly what's getting triggered. And now we gave them a neural exercise, which downregulated their vulnerable vulnerability reactions.
Karen: So, so that led to therapists really understanding how to titrate, um, because when they saw that reaction where suddenly the story was evoked and they were out of their body, uh, then of course the therapist would stop the music and they would, you know, process and integrate and, uh, help that person come back, come back to their body. Um, but then they, people began to realize why wait for that? Let's take a shorter segment of listening, and before that happens, let's see what, you know, let's see how that can be helpful to this person. And what people have really come to understand is that what's so nice about, um, SSP is as a bottom up therapy, it doesn't require any cognitive processing. You don't have to talk about your story. It's not top-down in any way. In fact, the, the focus isn't on the story at all. The focus is on state. And what a gift to someone to learn more about their state, to understand more about their autonomic tendencies, and to let their body go through this experience without, without having to bring the story in.
Trauma narratives and the Safe and Sound Protocol
Justin: So, there's not necessarily any trauma narrative sharing?
Karen: I mean, it's not to say that there isn't trauma narrative that is shared, and sometimes, you know, something will up during the listening that will be processed. But in general, for people who have avoided, um, say Cognitive Behavioral Therapy because they are avoiding talking about their story, this is a really nice alternative for them. And in fact, after going through SSP with a more safety infused into their system, they may act, they may be ready then for cognitive therapy afterwards.
Justin: What about the person that says, "I, I'm supposed to talk about my childhood and what I went through and my parents like, what are you talking about, Karen? I, I have to purge these things from myself." What about that person?
Karen: I mean, I think a sensitive therapist will wanna listen, but also they'll wanna get back to the work and they may encourage to say like, "No, let's, let's, rather than the story, let's get back to state." And that's what's lovely actually, is that it really is so state driven and, and you can process so much through your state.
Dr. Porges: Yeah. the part that I think is important about this discussion we're having right now is that it places the emphasis on the feelings or the individual's physiological aware awareness of their physiological reactivity. if we step back and ask, really, like in the whole area of trauma and about being locked into different states of defense and leading to addiction or anxiety, whatever terms we wanna use to describe these adaptive strategies that people are using, what we realize is that they have numbed their body. And all the therapies are about is really a journey of re-embodiment. the SSP is a tool for that reem embodiment. And so when you get embodied and you feel your body, then the narratives start taking on a different meaning.
Ventral Vagal Safety can lead to Defensive Activation
Justin: So, from SSP, it's not all first hugs and smiles. There are other things that kind of crop up is what I'm hearing. And in the book, all the vignettes, lots of examples of, it's not just bliss. There, there are other things that kind of surface. When I described this to my client, I don't, I'm not an SP provider, but this concept, what I share with them is that you, you finally achieve some level of safety. And so the rest of your body, the stuff that's sort of stuck in there is like, thank you. Now pay attention to me. And it starts to surface and, and bubble up. Is that, is that an apt metaphor for how SSP works?
Dr. Porges: You're really saying that we're giving permission for the different parts. I'm gonna move into that model to express themselves because they're not gonna take over as the dominant feature because you have a place to go to, you know, that you can be safe. That means you can hear, when you hear your body, when you feel your body, you no longer are using all your- for instance- neural energy to suppress bodily feelings. And there's a paradox here is that we, we come from a culture and society that thinks that attending and mental effort is really the, the premier experience. We should have to work harder to do better, to be more productive, but we're doing that at great expense of the inhibition of our brainstem mechanisms that serve our foundational survival processes. Uh. Basically our autonomic state. And what we need to do is enna- enable the autonomic nervous system to move back into states of homeostasis, to support health growth, restoration, and sociality. And so that's really what this process is, is giving the resource. And so Justin, the res- the resource enables people to move outta that safety zone, but with a tremendous sense of, uh, anticipation that they are capable moving back into it.
Justin: It helps them access safety, which then opens up potential to self-regulate...
Dr. Porges: But remember in the beginning, for many people, they don't know what safety feels like. And so it's a curiosity that they're being led on this journey and that curiosity for a traumatized individual triggers fear, uncertainty. And so what SSP provides is really this neural exercise of moving in and out of uncertainty with predictability
Justin: The predictability being the co-regulation aspect of who you're working with and the actual musical
Dr. Porges: ...actual prosodic content of the, of the sounds.
Who is the Safe and Sound Protocol for?
Justin: Who's SSP for Who should be seeking out SSP? Um, we'll start with there. And I guess after that would be, who's it not for? If anybody. The book covers a lot of different presentations of people seeking help. What do you think?
Karen: Well, SSP is a nervous system therapy, and it, it can support, um, all kinds of conditions and symptoms, um, that relate to the nervous system. And maybe let's forget about diagnoses. Uh, because really what the SSP can do is to help infuse safety into the nervous system to allow for more co-regulation, more openness, uh, less defensiveness, and more availability. Um, and that is, you know, safety is the beginning of all healing. Um, so, but we can also talk about who does benefit from SSP, and that's worthwhile too. So, uh, the early earliest, uh, people who experienced the SSP were children on the autism spectrum, and that was, uh, that was a very successful attempt where Steve had the idea that rather than addressing reactions, um, andbehaviors, let's look at the intervening variable between, uh, between a stimulus and a response, which is our autonomic state, and basically created SSP in fact, with, uh, children on the autism spectrum in mind. Maybe it's worth saying something a little more about that origin story, Steve.
Autism and the Safe and Sound Protocol
Dr. Porges: Well, it, it was, I mean, it's a whole different perspective. When I was doing this work and was actually starting in the early nineties, or even late eighties. Um, basically behavioral modification was the tool to treat autistic kids. So it was all in the observable. And if you ever interact with autistic kids who are being conditioned, I mean your heart just is in great pain watching this 'cause you can feel what they're doing. They're trying to control a visceral reaction. I, I was really kind of interested in is if you could change the child's state with the reaction to the stimulus, would it be different? Because I could see that the physiological state was very important. Now this reason I was asking that question was that my research from my dissertation onward, and if we're talking about decades, was all about looking at heart rate variability, which is really vagal regulation as the intervening variable of people's reactivity in the world. And so it was the idea that you need a more vagal regulated state that created literally a resource for buffering. And this later became things like what Dan Siegel talks about, window of tolerance and other derivatives of that, which really are saying our physiological state mediates how we react to the world. And that was really what the motivation was. Could I create a stimulation system that was easily administered to children? I will also tell you when I first developed this, and I was dealing now with hypersensitive, hyperactive young, uh, autistic individuals, and I was actually running 'em in quartets four of at a time with their parents. And I was starting to see reciprocal play behavior amongst these kids. And then one totally, uh, previously dysregulated child who couldn't even have headset on. He was so sensitive, ran into this sound attenuating chamber I built, which had speakers in it and said, with his limited vocabulary, one word- "Safe." So you start to see it being broadcast back at you and you, and the other one was, I was working with a 42-year-old adult autistic individual whose parents described him as the most nicest, most selfish person they had ever met. Now, what do they mean by that? They meant that everything, they interpret, every interaction with him about that was about him. He never asked them how they felt. No reciprocity. So, I I actually, uh, ran him through the five one hour sessions and, uh, by the end of the fifth hour, I walk into the room. He turns, looks towards me, puts his hand out to me, makes direct face-to-face eye contact and says, "Good morning, Dr. Porges." Now, the other most interesting thing was I wanted to get his sense of his own feelings, you know, which is really what we're talking about. So I said to him, I said, "John, how do you feel?" And there was dead silence. As he's starting to try to figure out what are these feelings. And then he comes up with this very interesting way of saying "Relaxed," and, and a big smile came on his face. He had figured out that he was relaxed, and this was novel to him.
Karen: I think both those stories, um, also point to something that is worth making sure we say in the, in this conversation, and that is that how it's delivered and the, um, approach that the person has, the therapist or whoever's delivering SSP, uh, with that person. So the fact that Steve had already created a little cave with blankets around it so that a child who couldn't put headphones on could go inside this special place and they were cared for and they could experience it in that way, they know that that was, that, you know, that was someone really wanting to help them. And the same with John, you developed a really nice relationship, which is so clear through those, um, videos that you have of him. Um, and so that's a really, uh, important point that the therapist themselves has to have really an attuned relational presence. And that is, um, so key and, and really, I don't know if it's half or if it's a quarter, but it's a very important or three quarters. Uh, it's a very important input into the experience of, uh, doing SSP.
Dr. Porges: So one other side story. Um, we talk about what the, what treatment of autism was in the late eighties and early nineties. And the children were really, they all had like, uh, ABAs, uh, specialists working with them, with M&Ms and Cheerios as feedback. And one child went through the SSP when it was called the Listing Project Protocol in my lab. And the mother calls me up and says, "I'm having problems with the ABA teacher." I said, "How's he doing at home?" "Oh, doing great at home." And I said, "What's going on with the ABA teacher?" And that is he was asking the ABA teacher too many questions. He was actually engaging her and it was disrupting her behavior.
Justin: Wow. Very, but a lot of engagement though. That's great.
Dr. Porges: Yeah. And with John, the 42-year-old, I saw videos of him with his father, and his father is trying to create this dialogue. And then John says, " Oh, tell me about you. How are you doing?" And it was like, I was like, uh, what we learned, and it took me decades to learn this, because we start thinking that children on spectrum are not contingent- meaning they don't follow our directives. But if we watch the videos, we realize they're almost a hundred percent contingent. But the contingencies tend to be negative. Neurotypical children are not a hundred percent contingent. They change the flow. So if the dialogue is, I'm talking to you and you're responding, you'll stop it and you'll ask me a you'll do a break and you'll do this transition. That's what co-regulation is about.
Safe and Sound Protocol and Co-regulation
Justin: Karen, you, you mentioned earlier about the importance, I'm- I'm glad you started assigning at a percentage, although I'm not gonna hold you to it- but the percentage of co-regulation of the provider and or, or the parent in the room with the music. So it's not just music, there's the co-regulation aspect of it is really significant as well. Can you elaborate on why that is helpful along with the music?
Karen: Well, I mean, co-regulation is a cue of safety. You know, when you talk about in your, uh, I think you call it four pathways of healing, you, you say find safety, cultivate safety in your world. And you talk about humming and being in nature and, and walking and all the ways and co-regulation, uh, all the ways that you can begin to feel safe again in your, in your own body. And so that happens with the therapist, but on top of that experience, there is this, um, psychoeducation component of it. So, Polyvagal theory in and of itself is so, um, hopeful and, um, forgiving. And I think that clients do experience the benefits of Polyvagal theory just purely, uh, by being with their therapist. And then that just kind of infuses and bleeds into the experience of SSP and moves back and forth. And, um, yeah, I, I feel that that's a really, it's a really important component and it's really important that that therapist is also themselves in a ventral vagal state.
Dr. Porges: Well, that, Karen, that's the point about like the ABA or the behavioral technician. They're not in a ventral, they were doing the behavior and the, the point is the behavior in the person, they're always broadcasting the autonomic state. That's what it is to be Polyvagal informed. You acknowledge that. So when a therapist uh, is in a sense Polyvagal-informed is sensitive to the state of the child or the client or themselves, then the whole dyadic relationship changes.
Skepticism of the Safe and Sound Protocol
Justin: I want to, let's, let's zoom out as far as what a, a session looks like and let me preface this- i, I am always skeptical about pretty much everything. Okay. And I hope you don't mind me bringing a little bit of skepticism, but I want to, I wanna question something here . Uh, there's the music, there's co-regulation, some of these vignettes involved being outside a horse, a grieving ceremony. There was just all kinds of stuff that cue safety. So at what point or how does the SSP add to, or is foundational to all this? What's the, is there like a dividing line amongst all this? How do we know it's not just another thing being added on that is not the main mover, you know what I mean? But is integral to the process?
Dr. Porges: Let, let me try to be a little helpful on- it's not a standalone therapy. Let's just start there. It's a tool to change the state of the individual or to create an opportunity for that state to be changed. So, it fits in with any- virtually any other form of therapy that is respectful of the other individual's presence and feelings. So, it can be viewed as an, it's, it can accelerate the effects of treatments of others. So the, your question is both very interesting. It's profound and in general it's viewed as unanswerable. Okay. Let me give you credit for what it is. However, there is a way of answering it. And the question is, if you do therapy the way you normally do it with and without SSP, do you get any differences? And that is actually a paper that's almost ready for publication that was being done at a psych clinic where they did practice normal practice and practice, uh, uh, treatment with SSP. And the trajectories are very different with extraordinary large statistical size of effects. I mean big. So the, the trajectory is different and that is actually the project. The same type of protocol is being used by a department of defense funded research grant because it's not that this is treating the anxiety or the depression or whatever to trauma effects it's helping the therapist accelerate the impact of therapy because you're changing the state of the client, making the client's nervous system more accessible.
Karen: And in all those cases, or the examples that you just brought up, that accessibility allowed for, for instance, someone to, uh, spend time with a horse, which other otherwise might have been scary or uncomfortable. Um, when you were talking about the grieving ceremony, the, the, uh, young, the older brother in that family, uh, was able to just be silly and kind of mimic the, um, you know, the, uh, wings of a bird. And without, you know, without SSP, that wouldn't have been, that would've been possible.
Justin: it, it really helps well shift state and open up someone to benefit from these other interventions. It compliments them, but it also sounds like it really bolsters them. But non SSP even I was, I was experimenting with different things in my therapy room. So besides the environment of the room, sometimes I would have soft music playing in the background. And I would ask my clients, just tell me how you feel about this and some of them would say that really helped me stay calm. Like it just helped me sort of focus. So I guess that without that, I, I see that same person without that little intervention. And they're still them and we still talk but with that little addition, it's, they said, it just helps me to sort of focus a little bit better. I've also experimented with like having a visual on a, my computer monitor of nature, just sort of, you know, expansive sort of, and people will say, I just, I like looking at it while I talk to you. It just helps me open up. So, SSP has probably an enhanced version of, of these things. It's really triggering that safety state.
Dr. Porges: You know, l let me build on what you're saying. There are certain modulations of sounds that our nervous system can't reject, and that's why it triggered in the traumatized individuals, that vulnerability. It's wired into us. It's how we talk to our pets, how we to our babies. So there, there is a study that I did with my, my, when I had my active lab, and that was looking at the intention, the, uh, intonation of a maternal voice, uh, in, in its relationship to its calming ability on the baby. So are these frequencies being modulated more or less? And looking at the baby's heart rate changes and distress behaviors, using Ed Tronick's still face paradigm. So the mother is interacting, freezes her face. The baby gets dysregulated and then the mother comes back and talks to the baby to try calm the baby. The baby's heart rate was a, virtually a linear relationship to the prosodic features of the mother's voice. And so was the reduction of stress in terms of, uh, uh, this, uh, basically behaviors that were stressful occurring. But the point I'm making is that that was the core feature of what's in SSP, and so the kids calm down autonomically and behaviorally when there's intonation in those frequencies. That's what SSP does.
Why not Safe and Sight or Safe and Smell Protocol?
Justin: Why music? Why not the Safe and Smells Protocol or the Safe and Sight Protocol?
Dr. Porges: I'm gonna cut you short on that one. Jason. I'm gonna say, aren't you listening to what I said? The issue is the pattern of our nerve- our nervous system is wired to look at vocal intonation. And I'm gonna ask you, do you have kids or do you have pets and or pets?
Justin: Yes and yes.
Dr. Porges: Okay. And the answer is, uh, what kind of pet do you have?
Justin: Two dogs.
Dr. Porges: Okay? How do you talk to your dogs?
Justin: Um, when I'm not irritated, I do the, uh, higher pitched, you know, the prosodic kind of voice.
Dr. Porges: Yes. And their reaction to both forms almost immediate. And so when you use a more melodic voice, or like when I talk to my cat who's sitting behind me, uh, they know because that's phylogenetically embedded in social mammals is to have that modulated sound and it's cross species. And you, the example is cross species. It's not that the cat or dog has learned, but they may get, when they get traumatized, it may, it's the same history of humans. It's someone that was, uh, they, they were accessible to someone and they were hurt and therefore, wham, they're closing that door.
Justin: SSP, the, the sound is really speaking to the mammalian aspect of,
Dr. Porges: That's right. And we use the word safety, that's the word that's been used all through this podcast, but we can easily put- exchange it with the word trust, and then it starts taking on a different ecological validity. If I can trust the source of those sounds, what happens to my body?
Karen: And sound is our medium of connection between each other. And as such, it's very salient. Um, Nina Krause has written a terrific book about sound and hearing in the brain, and it's called Of Sound Mind. And in her book, she, she cites that Helen Keller- well, first of all, she talks about how, you know, that game that people play with. Uh, if you had to lose one of your which one would you, you know, which one you lose? Well, um, sight is at the top of the list. Uh, but it, but really sound should be at the top of the list. And what, um, Nina talks about. me. To keep, no, yeah, yeah. To keep, yeah. What, what would be the last sense you'd want lose? It turns out that Helen Keller was talking about, um, uh, blindness sight is the, is the sense that everyone wants to keep. What she said was- blindness disconnects us from things, but deafness disconnects us from people.
Dr. Porges: The, the, the going with this is that I have friends who have worked in institutions of the deaf and institutions of the blind, and I ask them questions very much related to what you're describing. Are the blind emotionally dysregulated, frequently? And the answer is no. But are the deaf, yes. And in fact with deafness, that's why the sign language is actually trying to use the face plus the hands because the face is that other part of our portal of presentation. But the issue is- it's not- there's not equivalence, and that's your point, Karen. Our nervous system sees patterns of sound as connection and trust.
Justin: So the sound aspect is just, sounds like it's the most salient, the most mammalian-
Dr. Porges: In what we're, okay. So in my world- which is the linkage between autonomic nervous system and social interaction- sound is literally, or at least the mechanisms that enable us to interpret or extract sound are linked to how our autonomic nervous system is working. So when we get under stress, we lose that capacity to really even pull in some of these prosodic sounds. So if you've ever been in a heated argument, it's very difficult to get this back down.
Justin: Oh yeah. I remember the first time I presented about Polyvagal Theory years ago was, um, at a school with the teachers and whatnot. I was just very raw putting it out there, and after I was done I could not hear accurately. And I remember that kind of lasted for a while and I picked up my son from school, very prosodic. He's, you know, my son and happy to see him, but he's in the back of my car talking. I have no idea what he is saying. And I was aware of it in the moment of like, oh, I'm in that state where I can't really hear anything.
Karen: Yeah, that's so interesting. Well, we know that our state affects our own prosody- the way our, we speak the melodic nature of our voice, but it also affects our capacity to process prosody; to hear prosody.
Dr. Porges: Yeah. But we're also emphasizing, but something about our culture and our culture really emphasizes that it's the words that are important and not how we express those words.
Is the Safe and Sound Protocol a cure-all?
Justin: I will wrap it up with a general question. If someone reads the book- it begs the question of, is this really a cure-all? I'd love to hear your thoughts. There's 13 case studies. I went through the first, I read all of them, but I just went through the first four to list these. So in the first four alone, um, SSP addresses or helps address anxiety, flat affect, sensory, defensiveness, poor sleep, reduced social engagement, food restrictions, maladaptive self-soothing techniques, grief, chronic pain, muscle tension, jaw clenching... I'm gonna go and on and on that, that I haven't even finished half of what the first four case studies addresses. Someone's gonna read this and, and it has to, it begs the question like, really, is this a really a cure all for all these things? So I'll- take it away.
Dr. Porges: I am gonna start because I'm not gonna let this slip away. What if I said, if you're relaxed, none of those things would really bother you? Would I be accused of presenting a cure-all? If I said, when your autonomic nervous system is in a state of homeostasis, the naturally emergent properties are to feel safe and all these problems disappear, uh, that would, in a sense give you the target of what you should be aiming for, and now how are you going to get some information to enhance that regulation? And that's what SSP is. So it's, if we think about in your mind and how you articulate the question is critical here, you're seeing the outcomes and you're saying input outcomes, that's not what this is about. It's- it's a input into an underlying regulatory system. And when that system is more in homeostatic regulation, what are the emergent properties? Different lesson to be learned. We're not treating depression. We're not treating anxiety. Uh, they're downstream. They're being manifest because the autonomic nervous system is in this state of dysregulation.
Karen: You asked earlier what, um, diagnoses are appropriate, you know, respond well to SSP. I mean SSP, what it helps to do is alleviate dysregulation, and when you alleviate dysregulation, all those other symptoms can be addressed.
Dr. Porges: So with that, Karen, let me kind of like tell you part of the journey, which I never really shared with you. So I start to ask this big question- are there core features within most of the diagnoses? And are this, this pathophysiology, diagnostic, or pathologizing really a waste of time? Are their core features? Many of the core features are sensory; hyperreactive, hypersensitive. They're downstream of a nervous system that is under a state of threat. So I have now collected data on a couple thousand people using survey tools. And so when people's autonomic nervous system is dysregulated based on the body perception questionnaire, the linkage with the hypersensitivities on all sensory dimensions is high- dysregulated autonomic nervous system; hypersensitivities across the gamut. Now this becomes important because when we start looking at dimensions or disorders like autism, if you take the sensory system off the table, what percentage of autistic individuals are no longer autistic? All of them, because it's one of the core features. But it doesn't mean that this gets rid of autism, gets rid of the type of autism that would be derivative of a dysregulated autonomic nervous system. And Justin, as the therapist in the room, uh, there are many people when their physiological systems get destabilized, they're exhibiting features of being on spectrum.
Justin: So when someone says, "I have this disorder, will SSP help me?" The response is, "Are you dysregulated?" That's really what we're asking is, and so, "Yeah, we can help you out."
Dr. Porges: Or let's say, or how do you feel? Do you feel calm ever? Do you feel peaceful? Or, I have a better projective test. And that is how do you deal with stillness? Do you think stillness is where you wanna go to? Or is stillness really get you really anxious? And that tells you something about this accessibility, vulnerability. So you have this dialogue on the aspect of stillness. Immobilizing. And what you'll find out, of course, is many people with the histories who will come into therapy, stillness is the frightening state. They don't wanna be there. It's falling into a great abyss. They wanna get out of that, and that's why all this is going on. Not why it's, but- the issue is that tells you if that they can't deal with stillness. Maybe SS P is a good first thing to work with.
Justin: I love- with my clients- I like getting to that point, which is, I know you do all these things to make yourself feel better. Um, but if I took all those things away from you, how would you feel if you just had to be immobile without stimulation? What happens internally and they say, " Oh no, I don't want, Nope. That's where the fear or the anxiety or the whatever spikes."
Final thoughts and kindness
Dr. Porges: Well, I wanna say that this was a really a wonderful journey for, for me with Karen. And this is something that we started together when SSP was being initially launched and we started to get this wonderful feedback from clinicians and from even clients at times about life changing events. And I would get these emails, I said, "Karen, here's an email, we gotta keep this together because this is an interesting story to tell." And Karen has been with me from that very beginning and she's become a great- not become- you are a great storyteller.
Karen: Well, there were great stories to tell and we told a lot of them in this book, and I, I do hope that, um, the book doesn't come across as some sort of an advertisement. That's not our goal. Um, but the stories are so compelling that we can't not tell some of them, you know? And we hope that the message, the overall message, is one of hope and the possibility for change. And, and we hope that as many people as possible hear that message.
Dr. Porges: Yeah. Sense of optimism that this is accessible and we can become more of who we are.
Justin: It doesn't come across as an advertisement. I, I was a little bit worried about that when I, when I got it, I was like, oh my gosh, this is just gonna be, but no, it, it's not. And I love the, the case breakdowns, the discussion of what's happening autonomically. I thought that was really helpful. So I like that, a aspect of it a lot to hear, you know, the conceptualizations.
SSP on the community level
Justin: Let me ask one more kind of facetious, but kind of serious question at the same time. Let's say that, um, a certain city, any city in the world says, you know what, let's, let's, we're gonna install these speakers around the city that pump in SSP music in the background, and people will passively receive it as they exist. Would that just cure the whole city's- would, would everyone be happier? I'm honestly wondering.
Dr. Porges: Um, okay, there. I thought about- the reason I'm gonna jump into this, and I'll also tell you about the pilot study that I did do on something like this, and that was in a preschool classroom and watched the preschool behaviors. I had three classrooms, uh, this is a couple decades ago, and I had one classroom which had the music without the filtering, one classroom with the filtering and one without any music. So the, basically what you have are kids in a preschool room sitting around or moving around, and when the music came on, they quieted down just to play music. But when the SSP came on, they gathered towards the speakers in groups. Okay, now- that was really my idea is- can I create a more social world? Now- but your question is really, we live in a real world in the real world, we're confronted both with social cues and threat cues, and we have to be very careful in saying we are going to stay in this world of social engagement in the world that we're now living in now, which has a lot of threat cues. We need to be aware and we need to seamlessly respond into defensive modes and respond back to safe modes when the cues and context are appropriate.
Karen: And just to add on, you know, your, uh, your goal of wanting society to be calmer and people to be more relational- um, I get that. Uh, but the, the way to do that is for more people to alleviate their own dysregulation because while dysregulation is contagious, so is regulation. And so we all, we all can be part of this project.
Justin: Agreed. I love it. I think the, the microcosms like a, a school classroom, like what a great way, what a excellent opportunity to start pumping in a little bit more safety to help increase that distress tolerance, hopefully the vagal brake.
Department of Defense research grant and SSP
Justin: Do you mind commenting real quick on the Department of Defense thing? What can you share the Department of Defense study? you before we wrap it up?
Dr. Porges: A, a colleague of, of ours, uh, J Kolacz, who's a professor at Ohio State University, uh, got a Department of Defense, uh, grant, to actually study this. So he was my postdoc and now he is continuing on this journey. He's quite a remarkable, he is very, uh, a scientist. And, and, and you know, I think that project, it shifts it from- because of the sufficient resources to do a good study- it changes it into from, let's run a few people here and there. Let's get a little pod to, in a sense, a true random controlled trial that in a sense will create a good, a good practices. When the military funds these types of projects, it has a lot to do with redeployment.
Karen: My, under my understanding is that they will be using the SSP along with, uh, another therapy, uh, to determine if veterans and individuals, they'll have different groups, um, can reduce their hyper vigilance, their anxiety, and their, um, improve their sleep as a result of the group that includes, um, SSP. And, and an award like this is so, uh, monumental and such a great step. And honestly, it's important to thank all of the people who came, you know, research as a team sport. And there was so much research that led up to this point and so much real world evidence. So we can thank all SSP providers, all of the researchers, all of the clients. And, and we, we really would like to thank the clients who are in this book who at a vulnerable time in their lives shared their story with us. So we're really grateful to them, their therapists and every, everybody who played a part in this book 'cause we really appreciate it.
Outro to Stuck Not Broken episode 254
Justin: Huuuge thanks again to Dr. Porges and Karen Onderko for sharing their time and their deep knowledge of the Safe and Sound Protocol and the nervous system. a couple of key takeaways for me are how SSP acts as a neural exercise. It helps the nervous system practice moving into and out of safety.
It builds resilience- that capacity that we talk so much about here on the podcast and the students who learn about this in the Unstucking Academy- we, we spend a lot of time on building that capacity. SSP is not about forcing someone into a state of eternal and unending happiness and and bliss.
That's not the goal, but more about gently accessing safety sometimes for the first time, and using that as an anchor to stay connected to the present moment, even when uncomfortable things pop into the body, which they probably will.
I also really appreciate the emphasis on SSP being a tool that is used along with co-regulation from a safe other. It helps to make the nervous system more accessible or, or open or receptive to connection and to healing rather than a, a standalone cure-all. That- that is not the goal of it.
Your next steps:
I hope you got a deeper understanding of SSP. I know I absolutely did. Maybe your next step is to reflect on the question that I put forth during the talk- If I were to somehow remove all of your coping strategies, what would happen? How would you feel? What would your body do?
If you'd react in a defensive manner, like anxiety or panic or fear would spike, that suggests that you could probably benefit from more safety in your system. If you answered that you could exist in stillness and stay connected to the present moment. It sounds like you have a lot of safety within you already, so make sure to maximize that and mindfully connect with your inner felt experience of safety.
Author Bio:
Justin Sunseri is a licensed Therapist and Coach specializing in trauma relief. He hosts the Stuck Not Broken podcast and authored the Stuck Not Broken book series. Justin is passionate about the Polyvagal Theory and proudly serves on the Polyvagal Institute's Editorial Board. He specializes in treating trauma and helps individuals get "unstuck" from their defensive states.