Safe and Sound Protocol – A Comprehensive Guide

The safe and sound protocol is a listening therapy that is growing in popularity. But what is the safe and sound protocol, how does it work, is there evidence or research to support its promises and who is it for?

In this article we take a deep dive into the safe and sound protocol to answer these questions and more. For a brief video introduction, you can watch this:

What is The Safe and Sound Protocol?

The safe and sound protocol is a music-based listening therapy that is useful in a wide range of conditions, for both adults and children.

It is based on the polyvagal theory; a new understanding of how the nervous system works. Based on his work in connection with the polyvagal theory, Dr Stephen Porges designed the Safe and Sound Protocol, previously known as The Listening Therapy, and studied its impact on adults and children with varying degrees and types of dysfunction.

The success of the clinical trials for this program led to the release of the program for use in a wider population.

The evidence behind its success comes not only from the early clinical trials, but also from the ongoing formal and informal research of practitioners and patients all around the world.

Results are impressive in such a broad population of patients precisely because this program deals with some of the most foundational aspects of our health – nervous system programming.

The Safe and Sound Protocol Works on Your Nervous System

Over the last decade there have been several prominent trends in mainstream and alternative medicine alike.

The biggest ones that have swept through my profession include gut microbiome medicine, anti-inflammatory protocols, detoxification protocols and mitochondria treatments.

While all of these are important and have their place, it is easy to forget that the nervous system is king. It takes the information gathered from the entire body, processes it, and sends signals back to each organ to modify or maintain its function.

When a person’s nervous system is not sending the right signals at the right time, no other therapy will have a large long-lasting impact on its target organ. You can eat all the fibre and take all the probiotics you want, but if your brain isn’t telling your gut to get a wriggle on, you’ll still be constipated.

The same goes in the opposite direction – you can take anti-inflammatories to soothe painful joints and muscles until the cows come home, but if your nervous system is over-emphasising pain signals, you won’t feel much relief.

On the other hand, when the brain, spinal cord and nerves are all working in concert with each other, sending the right signals at the right time, then any other issues that arise are always much easier to deal with.

When we understand this, it’s not at all hard to believe that the Safe and Sound Protocol really could help with hundreds of different conditions, ranging from food intolerances to fibromyalgia.

So how does the Safe and Sound Protocol work?

To understand what the safe and sound protocol does, you will need to understand a little about polyvagal theory.

Polyvagal theory: the critical element behind the Safe and Sound Protocol

There are going to be some new words in this section, so we’ll work through it in sequence.

Your vagus nerve is a very long nerve in your body that runs from your brain through to your colon.

Polyvagal theory suggests that the vagus nerve has 2 branches – front and back.

The first branch is called Ventral Vagal, as it primarily runs down the ventral, or front, half of your body. The ventral vagal pathway is activated when we feel safe and connected to others.

The second branch is called Dorsal Vagal, as it runs down the back, or dorsal side of the body. (If it helps you, think of the dolphin’s dorsal fin on its back.) We use our dorsal pathways when we are in a life-threatening situation. It is a basic survival response.

A healthy vagus nerve sends signals to strengthen digestive and social functions when you are in a safe situation, and it supports instinctive withdrawal and survival functions when you are in a life-threatening situation.

Finally, as you are probably already aware, when you are in a threatening situation your body has another type of reaction – the “fight or flight” response, which is governed by your body’s sympathetic nervous system.

Polyvagal theory says that in any given situation our body might be in, or respond with, one of three potential “states” or pathways:

• Ventral – signals to your digestive and social functions from a healthy ventral vagal encourage your body’s “rest and digest” elements;
• Dorsal – signals to your survival functions from a healthy dorsal vagal put your body into a withdrawn or dormant state during certain particular life events; and
• Sympathetic – the well known “fight or flight” response to a high stress situation.

Now we are never completely in dorsal, sympathetic or ventral. When I am talking about being ‘in’ these states, I am referring to which one is dominating over the others. Most of the time, we want ventral to be the dominant state. If the nervous system is not operating in a healthy manner, you might go inappropriately into a fight/flight or withdrawn response to something that actually required your body’s social or digestive functions.

Are “Dorsal” and “Sympathetic” states Bad?

Previous theories suggested anything involving the sympathetic nervous system was bad because it was associated with anxiety and anger. That view, however, is no longer generally accepted, and the safe and sound protocol is not designed to put you permanently into any one given state.

While you might want to spend much of your time in “rest and digest” (ventral vagal, parasympathetic nervous system) there are certainly occasions when you want, if not need, your “fight or flight” responses (dorsal vagal, sympathetic nervous system) ready to fire up.

Fact: if it wasn’t for dorsal vagal, women wouldn’t be able to give birth. You would also have a lot of trouble with defecation. So let’s keep it in perspective – this is a useful, necessary part of your nervous system. But aside from those 2 situations just mentioned, your dorsal vagus should pretty much stay in its box, in normal daily life.

The same can be said for sympathetic nervous system activity. It is not a ‘bad’ pathway! Sympathetic nervous system activity will help you benefit from a good shot of adrenaline to do well on the sports field, to feel the juices flowing in an exam, while you give that speech and during all forms of play – from dance to backyard hide and seek.

These states are only a problem if they are activated when they shouldn’t be.

A practical Example of How States/Pathways Work

So as you can see, both pathways have important functions even when there is no danger. But what if there is?

Enter stage left: The Tiger.

All of a sudden, life is no longer normal. How will your nervous system respond?

You see the danger, and a surge of adrenaline runs through your body. Your muscles are powered with blood, at the expense of your gut and reproductive system. You stop digesting and start running – fast! This is survival pathway 101 at its best. Should you find yourself trapped, you turn and fight that tiger with amazing strength that you didn’t even know you had. You manage to fight it off and it turns to leave. Phew! Sympathetic just saved your life.

But what if you aren’t successful at fighting off Shere Kahn? If it comes to a point where it’s clear you are fighting a losing battle, your body has another trick up its sleeve: dorsal vagal.

If this pathway is triggered you will either find yourself freezing, unable to fight back, completely limp or you may even pass out completely. Believe it or not, this is another important defence mechanism. At the most extreme end of shutdown, your heart rate slows dramatically, your breathing slows, and you appear dead.

To the tiger, you are no longer darting about acting like a prey animal. You’re actually kinda boring, and if he was just messing with you, he may shrug and walk off because you’ve ruined his fun. If he really did intend to eat you, he thinks he’s won, and he’s likely to relax his grip – perhaps even walk off a distance to wash his wounds or take a drink. And while he’s gone, you wake back up again into sympathetic mode, and take off at the speed of lightning, evading him.

Ok so that does sound slightly far-fetched and if you live in tiger country I don’t recommend you try it out – but watch your cat with a mouse sometime, and you’ll see exactly this play out many times.

(I have tried explaining to my cat many times that the mouse is in dorsal and it’s not really dead and no she should NOT drop it on the front doorstep just now – but she doesn’t listen, and the mouse gets away. Every time. I guess my cat just isn’t much into polyvagal theory.)

Anyway… now hopefully you understand what the three pathways are, and their rough functions.

The Wrong State at the Wrong Time

We encounter problems if we start going into sympathetic or dorsal states at the wrong time; when there is no tiger.

Most of the time, we should be in ventral vagal. Here we digest, we relax, we smile, we engage, talk, laugh. We feel comfortable to be ourselves with others. Ventral vagal happens when we perceive safety around us. That perception is usually unconscious.

But what if our unconscious perception instead finds threats in unexpected places?

If we are kicked into sympathetic nervous system mode, we tend to feel anxious or wound up. Often this will be accompanied by physical symptoms like acid reflux or other difficulty digesting, and a fast heart rate. Shallow rapid breathing and mind-racing can follow. This can happen to an extreme degree, as in a panic attack, or to a mild degree where we may find symptoms labelled as ADHD, anxiety, or even a sleep disorder.

If you feel anxious, jittery or panicked for no logical reason, it’s because your unconscious perception has decided that you are in danger, and you need to stay activated in fight or flight. Some people spend a lot of time in this mode, and that doesn’t feel very good!

On the other hand, other people tend to head straight on over to dorsal at the first unconscious perception of threat. This can result in feeling withdrawn, depressed, or numb. Sometimes you are unable to speak up even if you want to. For some people, they can actually feel a lack of nerve flow to their face if they are trying to communicate when they are ‘a bit dorsal’.

Dorsal responses can be short moments or long-standing patterns – months or even years of depression for instance.

Why Do These Problems Happen?

If you are reading this article, you may find it hard to believe that not everyone slips into the ‘wrong mode’ frequently. Unfortunately, many people do. This happens for a few reasons.

First, your unconscious perception can detect danger signals in your environment. These signals come in through your vision, hearing, smell, touch and even taste.

We are hard-wired to perceive certain signals as safe. Signals such as high-pitched talking (like a mother to her baby), a smile, eye contact and loving touch.

But if in your past, these things were associated with pain or fear, then the brain may re-classify them as ‘not safe’. They can then have the opposite effect.

Signals that are normally neutral, such as a picture of a bird, or the colour red, can become danger signals to us too if they become associated with painful events.

Once this starts to happen, usually as the result of trauma, we end up in a vicious circle. We unconsciously see all these ‘danger signals’ and our body reacts to them. In turn, we start to fear our own reactions. (Anyone who has had a panic attack knows what it’s like to fear having another one.) This fear increases our level of sympathetic or dorsal activation too.

The brain begins to be on high alert all the time. It is always looking for danger signals, and even starts to shut out the safety signals.

This high alert extends particularly to the ears. The brain on alert for danger sends signals to the little muscles that control the ear drums, saying, ‘Hey guys, the world is a pretty dangerous place. Could you please be listening out for danger signals for me?”

In response, the ear muscles relax and slacken off the ear drum. This allows the drum to detect low pitched sounds more easily. Those low sounds are more likely to be dangerous ones (think yelling, growling, barking, gunshot.) Once the ears are listening out for low pitches, they don’t hear the high pitches as well. So, we miss the safety signals that should calm us down – singing, people talking in a pleasant voice, birds chirping etc.

We may still hear them somewhat, but their emphasis and meaning is lost on our brain. It can become so marked that we have trouble hearing consonants in everyday speech. And the more time your ears spend in this slack, low pitch-perceiving state, the weaker your middle ear muscles become.

From here it’s hard to come back to a normal, calm nervous system:

• Your ear muscles are weakened and don’t tighten your ear drum very well.
• Your ears are programmed to listen out for dangerous sounds.
• Your nervous system therefore perceives dangerous sounds more readily than safe ones, so it reinforces its signalling of danger.
• Your other senses follow along and start to perceive more danger threats.

The root cause of all of this is essentially trauma.

Often it is emotional or physical trauma, such as a difficult birth (for mother or baby), abuse, victimisation, bullying, medical trauma or accidents. It can also be triggered by severe inflammation of the ears which leaves the muscles weak.

Our thought patterns are changed by trauma, but so are our bodies.

Until recently, there was very little hope of rehabilitating the bodily responses to trauma.

Enter stage right: the safe and sound protocol.

How Does Safe and Sound help these unhealthy body responses?

Most people find music uplifting, calming or moving.

Research demonstrates that listening to music improves mood, performance and several measures of health.

The Safe and Sound Protocol harnesses these inherent functions of music and takes them to the next level.

As we mentioned above, you can get stuck in a vicious feedback loop where the ears pay most attention to the low pitch sounds. This reinforces the brain’s perception that the world is dangerous, making the ears listen even more to the low pitches.

We can break this feedback loop by forcing the ears to listen to higher pitches – the ones that our brains are hard-wired to find soothing. This is exactly what the Safe and Sound Protocol does.

What’s the Safe and Sound Protocol Process?

What Improvements Could You See From the Safe and Sound Protocol?

Research demonstrates significant improvement in the following areas, after the SSP:

• Hearing sensitivity
• Spontaneous speech
• Listening and following instructions
• Behavioural organisation
• Emotional control
• Regulation of heart rate by the vagus nerve
• Spontaneous social behaviours such as sharing and showing affection

By the time you have finished listening to the whole SSP program, your body’s unconscious perception of sound will have been altered for the better, and the improvement doesn’t stop there.

Now, your daily interactions with others in your environment will start to do what they should have always done – help to regulate and soothe your nervous system.

This starts a positive feedback loop where social interaction helps to put, and keep, you in the Ventral Vagal state. That reinforces how good you feel, which puts you in Ventral Vagal more and more. Sympathetic and Dorsal states are triggered less and less often, and as a result your mood, anxiety, digestion and other symptoms all improve.

How Long Does SSP Take to Work?

Generally we see full benefit from the safe and sound program kicking in about 6 weeks after you finish the listening component.

Of course, this relies on you having positive social interactions with other people or pets. If you are living in an unpredictable or abusive social environment, your nervous system is not going to be calmed by your social interactions after the listening therapy.

The music can still help you to cope with these situations better, but unfortunately you will not get the same level of benefit from the program.

Safe and Sound Protocol Rental – Digital and Physical

The safe and sound protocol is delivered in 2 different ways:

• digitally; or
• with a physical system.

The Digital SSP

Most participants now use the digital system, which requires the use of a modern smartphone and some over-ear headphones. Your headphones must not have active noise cancelling turned on when you use them.

The music is downloaded via an app and you listen to the music in a silent environment according to the schedule prescribed by your practitioner. There is a total of 5 hours of music which must be done in the correct sequence.

The digital version has the benefit of additional programs that are designed to help maintain the progress you have made after the main program.

For those with very sensitive systems, there are also lighter programs designed to get the body ready for the core program.

Renting The Physical SSP

The physical SSP system simply consists of an MP3 player and headphones supplied to you.

Generally the physical system is more expensive to hire due to postage costs for the unit, but otherwise, the programs are the same. You can usually rent the physical system from the same practitioners that offer the digital SSP, though more practitioners are going digital-only.

The Safe and Sound Protocol is not a DIY therapy!

It is crucial that you work with a practitioner to undertake the SSP.

Hiring the unit without practitioner input risks the program not working. Worse, though, if the program is used inappropriately it can make you feel quite unwell.

This is a powerful program, and anything with such large therapeutic potential also has the potential to cause side effects if not done correctly. It often shocks clients just how much change they can experience from what seems to be “just music.” The impacts on the nervous system are far reaching and, particularly for those with complex illness, this can result in temporary adjustment effects.

A good practitioner will prescribe exercises, dietary adjustments, lifestyle changes and possibly even supplements to help ensure that your body can keep up with the changes in your brain, without too much difficulty.

What works for one client doing the SSP is not necessarily the best method for another, so your practitioner will need to spend some time talking with you to get to know your needs.

Research studies done on the Safe and Sound Protocol (when it was originally called the Listening Protocol) had the clients listen for 1 hour per day, 5 days in a row.

It is now widely understood by experienced practitioners that this schedule is unsuitable for all but the most robust children and is almost always totally unsuitable for adults. A good practitioner will get to know the needs of their client and help to ensure that the music is paced correctly for the client. I have had some clients listen for 1 hour daily, and some who listened for only 15 minutes, with breaks for exercises in the middle.

For many clients, an initial intake interview is all the practitioner input that is needed until the program is finished, but practitioner support must always be available during the listening period if need be. For some clients, several appointments are required over the course of a few months in order to ensure the client is well prepared and benefits fully from the potential of this powerful music.

Is the Safe and Sound Protocol all I need to do?

The Safe and Sound Protocol is not a stand-alone therapy.

When I use it with my nutrition clients, we scaffold diet and lifestyle adjustments around the listening so that the body is being supported on all levels before we add the nervous system input.

In addition, while the music program works on the body’s response to trauma, it is also important that the mind, soul and spirit are supported as well. If our thoughts, feelings and interactions are unhealthy, no amount of body support will heal us.

Many of the clients who come to my practice for the Safe and Sound Protocol have already done a huge amount of work on their thought patterns and emotions with counsellors, psychologists and other therapists of all kinds. For these clients, the Safe and Sound Protocol is often one of the last steps in their healing – getting the body to come into alignment with their now healthy mind. For others, the mind has yet to be restored and supporting the body through the SSP is a gateway to give the client more capacity to work on their thoughts and emotions.

In either case, it is important that each client is working either with myself or with other therapist/s to continue to support both body and mind until the client feels that their healing is complete.

In most cases, the Safe and Sound Protocol is part of the complete therapeutic package chosen for each client. Generally speaking, most clients benefit from repeating the core program more than once.

The frequency of repeats depends on the client and what other activities they are engaging in. The minimum time frame between core repeats is three months, to avoid overstimulating the nervous system. For some clients, 18 or more months can go by between repeats before the initial benefits start to wear off. With enough support, most clients are able to discontinue repeating the Safe and Sound Protocol after a certain number of repeats, but there is no harm in repeating indefinitely if the client feels it helps!

Safe and Sound Protocol Evidence and Research

For more information on the research and impacts of the SSP, please investigate the research links below:

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4117928/   (In this article, the SSP is referred to as the Listening Project Protocol – its original name.)
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3610863/

How do I know if the Safe and Sound protocol is right for me?

If you are interested in exploring the idea of doing the Safe and Sound Protocol then your best bet is to make an appointment for an intake interview.

From there, your practitioner, be it myself or another trained SSP provider, can tell you if they think you will benefit and if you are ready to complete the program. In my practice, an intake interview does not obligate you to go ahead and there is definitely no pressure if you don’t feel ready.

If you are unsure about proceeding, I really recommend that you watch some of the many excellent YouTube clips on the Safe and Sound Protocol to give you a bit more of an idea about what changes people are seeing from the program. I hope that if the information I’ve presented in this article resonates with you, that you’ll give it a try!

I want to Try the Safe and Sound Protocol – What Should I Do Next?

If you are interested in using the SSP you will need to have an appointment with Nicole to discuss your suitability and work out how we can best tailor the program to give you optimal outcomes. (Note that existing nutrition patients can simply discuss during a regular appointment if desired.) You may require more than one appointment as you progress through the program if you have complex needs or a very sensitive nervous system. Most children only require the initial interview.

All SSP fees include email support while you are using the program, and for a reasonable time period afterwards.

Costs (GST included where applicable):

• Intake interview/appointments: approx 45 minutes: $105.
•  Digital SSP (1 full round of 5 hours of core program): $280.
•  7 day hire (physical system): $280
• 10 day hire (physical system): $390
• Refundable deposit (Physical system only): $200
• One month use of prep. or maintenance program, if required: $45

Delivery fees are approximately $56 express for the physical system, for those who are unable to collect from clinic (Sunshine Coast or Brisbane).