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Additional Information on Safe & Sound Protocol (SSP):  Frequently Asked Questions

 

1.  What is the SSP?

Check out the official site for a great overview here: https://www.whatisthessp.com/

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The SSP is an innovative intervention designed to improve an individual’s functional abilities by reducing bodily stress response, hearing sensitivities and improving the ability to process human speech. The SSP exercises the neural pathways associated with regulating behavioral state and social engagement. These are aspects of the Autonomic Nervous System (ANS). Just as the brain is plastic and can change based on experience, the ANS is also plastic. The SSP has been shown in peer-reviewed research to significantly increase vagal regulation of the heart – a vital component of ANS regulation. The vagus nerve is involved in the neural regulation of the face, head and viscera (organs). In mammals, the neural regulation of the autonomic state is integrated with the neural regulation of muscles involved with listening (middle ear) and vocalizing (larynx, pharynx).

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From an evolutionary perspective, there are 3 neural circuits that form a response hierarchy. The newer circuit is social and reflects a well-regulated state that supports visceral organ homeostasis, as evidenced by good eye contact, relaxed facial tone/expression, and prosody of voice. Individuals relying on this newer circuit respond well to human communication and are able to block out background noise to focus. The older circuits are associated with the flee (fight or flight) response or the freeze (shut down/collapse/pass out) response. Individuals relying on these circuits are more in-tune with lower frequency sounds (like background noise, which historically was needed in order to hear predators) and tend to be programmed to prioritize detecting danger from their environment.

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When the middle ear muscles are inactive, lower frequency sounds like background noise are perceived much stronger than human voice and the nervous system is signaled to be in defense throughout. Patients are often easily startled and sensitive to background noise while having difficulty engaging in conversations, making eye contact, hearing people when there is background noise, or understanding the entire meaning behind certain phrases. The middle ear muscles are primarily fast-twitch and they fatigue easily. Illness, fever, and aging also reduce the function of the middle ear muscles.

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When the middle ear muscles DO work and contract properly, the background noise can be dampened, the nervous system throughout the body is less aroused or waiting to go into fight or flight/freeze mode, and the listener is better able to focus and perceive human speech (higher frequency sounds) properly.  The muscles of the middle ear are also innervated by the same nerves that are responsible for controlling the movement of our face and Jaw and providing sensation of our face.   In some cases, through association of these shared neural pathways, these more complex areas of our the body involved in fascial expression, mastication, and fascial sensory can also be positively influenced to improve function through activation of middle ear muscles.

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Other potential benefits of improving vagus nerve tone though middle ear muscle activation include improvements in heart rate and blood pressure regulation, sweating, digestive function, eye contact, voice intonations, memory and concentration, adrenaline rushes and adrenal dysfunction, understanding of human language and body language, ability to express oneself verbally or physically, insomnia, anxiety and depression, sensory stimulation to touch/sound/sight/taste, diversity of food choices, breathing, and much more.

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Some people react to a history of chronic stress or physical trauma by going into a perpetual state of fight or flight, while others respond with a dissociative freeze response, where they are numb. This response is how the body helped them to survive historically, but it is no longer necessary or useful once the person is removed from the situation and is actually safe. Over time, either one of these dysfunctional states, while never a conscious choice, can contribute to chronic system-wide health issues.

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The SSP is not about the particular content or back-story of trauma or fixing an injury, but rather, it’s about honoring the body’s natural response. The body has done what it’s needed to do to survive and adapt, and the SSP enables patients to move into a state of parasympathetic - “rest and digest” – a time for thriving, healing, and not just surviving. The SSP is an invitation to help release healing and give the body the rest and the nervous system re-set that it deserves.

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While virtually all patients who respond to this treatment have experienced some form of nervous system dysregulation or trauma (often considered minor or not even recognized by the patient), the SSP does not actively engage in conscious focus of trauma itself.  The SSP is a springboard for future growth, nervous system recovery, and not a standalone tool.

 

2.  Who is appropriate for this treatment?

Many types of clients benefit from the SSP. The majority of the research behind it has focused on individuals with autism spectrum disorders, but clinical improvements in many other conditions have been noted, such as

• Long Haul Covid

• Facial Neck, Head Pain

• GI problems

• Muscular tension due to sound sensitivities

• Autonomic Nervous System Dysregulation

• Immunosuppression 

• Hyperactive Nervous System due to Neurological/Autoimmune Disease

• Myofascial Pain Disorders

• PTSD, Anxiety, Depression, trauma histories

• Auditory hypersensitivities

• Dysautonomia/POTS

• Multiple chemical sensitivity

• Mast Cell Activation Disease

• Adrenal fatigue/dysfunction

• ME/CFS (myalgic encephalitis/chronic fatigue syndrome)

• Chiari malformation, intracranial pressure issues, and ECF leaks

• Mood dysregulation

• ADD and ADHD

• Motion sickness; vertigo

• Misphonia (a strong reaction to certain sounds, such as dripping water, chewing, tapping)

• Auditory processing disorder

• Sensory processing disorder

• Emotional regulation difficulties

 

3.  What activities are appropriate while listening to the SSP?

Some patients relax with comfy pillows and blankets. Children and adults may use art therapy, coloring books, drawing, non-stressful simple board games, stress balls, puzzles, silly putty or play dough, or kinetic sand while listening. Children may also like to look at picture books or play quietly with blocks, bubble or other toys. Avoid electronic toys, loud activities such as instruments, competitive games, or overstimulating activities. Some patients find that essential oils infusion is calming during the experience, but only try this if it’s something you regularly use and know that you tolerate well.

 

4.  What types of environment is best for the treatment?

A calm and quiet environment is necessary for success with this treatment. Phones must be silenced and put across the room or outside of the room. Patients should wear comfortable clothing and the room should have a feeling of privacy and soft lighting. Remove as much background noise as possible, such as fans or air purifiers. Make sure the room is at a comfortable temperature. Have water nearby and consider a snack beforehand so you’re not hungry.

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5. What does the music sound like?

The music playlists consist of an adult playlist, child playlist, and instrumental. The child playlist consists primarily of Disney soundtracks. Because both playlists incorporate sounds at the frequencies that train the middle ear muscles, patients can choose whichever playlist they would like to use for the duration of their program. The music sometimes sounds funny, and sometimes it will sound very quiet. When it gets quiet, keep listening, and it will eventually get louder. Do not adjust the volume on the device after you’ve started your session for the day.

 

A few other tips: It’s important to always use the volume test track to set the volume before the beginning of each session.   Also make sure your headphones are on correctly

 

6.  Can I use my own over-the-ear headphones instead?

Yes, you can use what you have at home as long as not noise canceling headphones.

The SSP relies mostly on mid-frequencies that are effectively delivered through inexpensive headphones.  

 

 

7.  Can I exercise or sing while listening?

Physical exercise (even walking) is discouraged during the listening as it can shift the nervous system state. Patients should be sedentary/completely relaxed during the listening sessions.

However, it’s strongly encouraged that patients continue their exercise or physical therapy routine at another time during the day, without the music. Singing, use of wind instruments, and breathing exercises are also encouraged during the day, in times when you are not listening to the SSP music.

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8.  What happens if I fall asleep during treatment?

If it’s short (like one song) you can continue the listening program for that day. It may be a good idea to repeat the entire session if you fell asleep for most of it.  You want to avoid using at night right before bed. Picking a time in the morning, day, or evening where you can be relaxed and attentive is preferred.

 

9.  I have epilepsy. Can I try the program?

Individuals with a history of seizures must be on a medication to control the seizures and be seizure-free for one year prior to beginning the SSP.

 

10.  I had tubes put in my ears, or I use hearing aids. Can I try the program?

Yes. Individuals with these histories can use the headphones. Hearing aids may need to be taken out if the patient is getting frequent feedback issues. Cochlear implants should be left powered on with the headphone ear cup placed over the implant microphone as much as possible.

 

11.  I have a cold, sinus infection or ear infection. Can I still proceed?

It’s best to wait until all symptoms have resolved before starting the SSP after any type of illness.

 

12.  What sensations/symptoms can occur during the treatment?

Whatever happens during the experience of SSP is information and can be looked at as positive. There is no “right” or “wrong” response, but it is important to monitor your body when using to make sure appropriate levels of delivery are practiced. Some patients do not experience any symptoms at all. Many patients find that they feel fatigued after listening to the music on day 3, and this is a sign that the middle  ear muscles are being activated. Some patients can experience signs of autonomic nervous system responses, such as elevated energy levels, nausea, dizziness, sweating, heart rate changes, flushing, etc. while others do not notice anything at all. Some people also note tickling or itching in their ears. If these symptoms do occur, they tend to resolve in a number of seconds to minutes when the treatment is paused.  You will be provided additional information prior to using SSP by your provider.

 

13.  How should I handle symptoms when they occur?

This program is not “no pain no gain.” LESS is MORE. We need to honor our body’s responses to it. There is no value in “pushing through” symptoms in order to reach a certain number of minutes of treatment. You, as the recipient of the listening program, need to be in tune with your own body in order to decide when to pause the music. This will be covered during your first day of training with SSP by your provider.

 

Typically, if symptoms arise during listening, often pausing and standing up, walking around the room, and getting a sip of water is enough to calm the nervous system. Sometimes gentle movement or breathing exercises can also help bring the system back into a state of rest and digest. After a few minutes pause, most patients are able to resume the music.

 

In the case where someone experiences more prominent or persistent symptoms, it is encouraged to stop the delivery of SSP for the session and contact your provider. The 5-day/1 hour per day frequency is not black and white, and it’s ok to modify the length of session. Symptoms do not mean the program is not working; rather, they are an indicator that the treatment is influencing the nervous system.  All of this will be further reviewed on your first day in more detail as well.

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14.  What should I keep in my SSP program log?

For patients doing an SSP home program, it’s sometimes helpful to keep a log of each day’s session. You can write down the volume level you listen at for tracking to note changes as you go.

 

For all patients, make sure to keep a log of symptoms or changes noted both during the treatment as well as the other times of the day. Take particular note of your overall energy level, sleep, appetite, digestion, concentration, tolerance to noise, and level of alertness or irritability.

 

15.  Do I need to repeat the protocol?

Some patients find that they get added benefits when completing the entire program again after 3 months. Typically, the program benefits continue to come to light over the 6-8 weeks following the first listening experience. Some patients may then decide they want to repeat it, usually between 8-12 weeks following the end of first program. Some scenarios may also warrant a repeat of the protocol, such as when the patient realizes they’ve had an ear infection during treatment, when they’ve undergone stressful life events during the week of treatment, or when extenuating factors have prevented them from completing the full program the first time.

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