During discovery calls, I am often asked about adverse Safe and Sound Protocol side effects. I sometimes hear from clients who have been through the process before with another provider, and who “suffered”, or about people who have scared themselves by reports of side effects from online forums and blog posts.
I would like to explain a little bit about what it all means, and why understanding the impact of the Safe and Sound Protocol is extremely important.
Safe and Sound Protocol side effects
Safe and Sound Protocol Side Effects
When we work with the SSP, we need to work with an individual’s nervous system. This means watching very carefully for signs that the autonomic nervous system is processing. NOT for “signs of dysregulation”, which is a term that people tend to over-use in an SSP context, in my opinion. If we notice “dysregulation”, we’ve gone way too quickly for the nervous system to keep up with.
Look at the Safe and Sound Protocol as marathon training: could you run a marathon in 2 hours in 3 months time? Most people couldn’t. Most people would need to train for months (or years), and would complete in at least 5-6 hours. If most people tried to rush into running a marathon in a couple of weeks and with minimal training, they’d more than likely need to receive medical attention.
Safe and Sound Protocol “Side Effects”
Safe and Sound Protocol Side Effects vs ANS Processing
Early on in my experience as an SSP provider, probably about a year in, I decided to do a self-experiment and deliberately over-listen to SSP to see what would happen. I listened to the whole five hours in a weekend! The result was incredibly interesting and has given me a profound understanding of how the Safe and Sound Protocol works. The result of 2.5 hours of listening per day – in which I deliberately ignored cues of panic, mobilisation and collapse – was that I experienced severe vertigo, severe jet lag-like fatigue, an inability to organise my thoughts or move forward (like wading through glue), and heavily disrupted sleep interspersed with nightmares.
My discomfort continued for about 2 days, and then settled and gradually disappeared. However, I did not benefit at all from that particular round of SSP, whereas I’d always experienced beautiful shifts in the past from working at the speed of my nervous system. By this, I mean I always responded to my autonomic cues, and titrated the SSP accordingly. This doesn’t mean “x minutes per day” – it means yesterday I listened to 10 minutes but then found I couldn’t get to sleep… so today, I’m going to take a break and let my system settle. Tomorrow, I may listem, or I may not, depending on whether my system tells me it’s safe to continue listening or not.
Whenever I’ve done another round of the Safe and Sound Protocol since, I’ve noticed signs that my nervous system needs to settle more easily. I’ve experienced misophonia and tinnitus temporarily too on occasion, but both settle within a few days – although I do have the knowledge to be able to help my body process using somatic techniques, so this is something I am able to help my clients with if any processing becomes uncomfortable after listening.
Another “side effect” I’ve experienced more recently is a sore neck and shoulder, which suddenly appeared half way through a Zoom session with a client.
My neck and shoulder pain started after I snowboarded down a sand dune in North East Brazil back in 2003, and fell off at high speed! However, whenever I’ve been stressed or overloaded, my shoulder pain has always re-emerged. Normally, it takes ibuprofen and a couple of visits to an osteopath to sort it out. However, this time, I suddenly had the reaslisation that I was half way through hour 2 of the SSP and that while I am completely un-stressed at the moment, my body was trying to tell me to keep myself safe.
As soon as I’d realised this was the case and acknowledged it, the pain started to dissipate, and the following day, I woke up and it was no longer there. I found this enlightening, and similar effects have been reported by several clients in the past.
I ask my clients to watch out for a number of very obvious signs of autonomic shifts. The rule of thumb is to put anything out of the ordinary down to the Safe and Sound Protocol rather than assuming SSP has nothing to do with it.
Open communication with a provider is of paramount importance. Agreeing how you’ll work together and how you’ll communicate is key, as well as keeping in close contact throughout the process. Do NOT go AWOL and seethe silently about side effects – you have engaged your provider to keep you safe and they have a duty of care toward you!
The bottom line is not to fear this processing. It needs to happen, but it needs to happen safely and with understanding and connection.
The Safe and Sound Protocol (in its standard format) is a five-hour listening therapy, which works directly with the autonomic nervous system to make the a person feel safe in the world by tuning up their autonomic function, which in turn improves social engagement. It does this by passively stimulating the vagus nerve by means of specially filtered music. It is the only auditory programme to work directly with the autonomic nervous system, and is now used widely by all sorts of healthcare and mental health professionals with a variety of conditions caused by mis-firing autonomic nervous systems.
The Safe and Sound Protocol was first launched as a way to help autistic children improve social engagement. It has been acknowledged since that the reason this is so effective is because it’s working with the trauma inherent in autism – in other words, the stress caused by being forced to function in an environment that is not accepting of autism.
For context, I have been working with the SSP pretty much since it was first available in the UK, and have probably worked with more clients than anyone else here – with a myriad of presentations and a beautiful rainbow of different nervous systems.
The Safe and Sound Protocol for neurodivergent families
The Safe and Sound Protocol used to be provided by means of an MP3 player, which I would use in-clinic. I would also sometimes rent these MP3 players out to clients once they had been through a rigorous screening session in clinic. There were huge challenges in using physical equipment, in that either clients had to attend scheduled sessions, OR schedule a rental period. Most of the time, this worked well, but occasionally, more sensitive clients needed more time or needed to miss scheduled sessions. This made providing the SSP – and using the SSP as a client – costly and a logistical nightmare.
However, from March 2020, SSP providers had to adopt a different way of working due to lockdowns and our lack of understanding of COVID19 at the time.
The licensing organisation, Unyte, released a digital version of the SSP via an app. This enabled discussion on the safest way to work with clients remotely with the SSP.
It is important to recognise that the Safe and Sound Protocol in itself is not a therapy – it is a TOOL used by therapists, and we all do it slightly differently. Some hand-hold, some budget providers only give access to the tool and let their clients get on with it – not really advisable, but it happens – caveat emptor.
My opinion, having run a clinic for neurodivergent children and adults for the last 8 years, is that it is important to engage with the Safe and Sound Protocol (and my other work) in an environment that feels safe. For most people, home is a safe space – so this makes engaging with the SSP in the comfort of your own home appealing, convenient and most effective.
Even more effective is ensuring that a child’s needs during the SSP are fully met – and the best way to do this is for a parent to go through the process themselves first.
My approach is to train parents first. They then go through the Safe and Sound Protocol themselves, and learn to understand their bodies’ cues and their own nervous systems. After that, they take their own children through the SSP, as those who understand their children better than anyone else, as well as through the eyes of someone who has completed the Safe and Sound Protocol in their own way.
When I first started working with primitive reflexes with my own child, over a decade ago, I remember our therapist telling me that parents of children with retained reflexes always benefit from going through the process themselves too. At first, I thought this was a potential money-spinner and ignored the advice. However, the more I read about primitive reflexes and the more fascinated I became, the more I realised that it was something I needed to experience – if only to understand the changes we were seeing on a daily basis in my child.
I decided to take that time out for myself – I went along, was fully assessed and did exercises daily in order to experience what my child experienced. And I changed – enormously – for the better. The experience dramatically improved my social anxiety, as well as my ability to connect so much better with my child, which is completely key to seeing positive results. A prescriptive “working on” approach when working with neuroplasticity therapies is not as effective as a “working with” approach.
The same happened when I trained in the SSP. Of course, I used it on myself before using with my children. And of course, I had the same excitement and impatience as my clients often have when they first approach me! At first, all I noticed was calm and spontaneous joy – and later came the realisation that my connection with my children, patience and ability to co-regulate effectively had all improved so dramatically that my children had CHANGED – without my children even going through the SSP themselves.
By the time it was their turn, the outcome was so noticeable that I remember being stopped at school pick-up time by the teacher, who wanted to know what we had done as there was such a marked change in my child’s focus and attention.
For example, if a parent’s motive for using the SSP is to “fix” their child, it’s unlikely they’ll notice as much of a benefit as if they work with themselves first and then with their child. When children have undesirable “reactions” to the Safe and Sound Protocol, it is because a child’s primitive brain is feeling under attack – the SSP can make this more sensitive.
Working with the Safe and Sound Protocol is like buying a beautiful piece of well-loved antique furniture – a table, for example, complete with blobs of paint and scratches, applying paint stripper and giving it a good rub down:
If you then nurture and look after that piece of furniture, perhaps applying a coat of varnish or wax and protecting it with coasters when you put a mug of tea down on it, it will gleam in it’s new setting (equating to co-regulation and providing cues of safety). If you, however, don’t look after it and stick hot mugs of tea down, or allow the children to draw on it with sharp, scratchy pencils, it’s going to quickly return to the way it was before you did all that work.
I specialise in working with the Safe and Sound Protocol with neurodivergent families. For this reason, my pricing includes a parent and child and full coaching in polyvagal theory and how to use the Safe and Sound Protocol for YOUR FAMILY. This looks completely different for each family. For example, the SSP for PDA involves ensuring that a child understands that this is going to work for them on THEIR terms – not mine. Another good reason for parents to go first!
If you would like to understand how the SSP could work for your family, please book a discovery call.
I often tell my clients of how I feel my post-natal PTSD is healed, and yet I had an experience late in 2022 that made me realise that I’m not all the way there quite yet – but I DID feel empowered to explain this to medical professionals, who now listen to me as a result of my explanation of what’s going on in my physiology.
If you’d told me even five years ago that I was a trauma survivor, I would not have believed it.
Post-natal PTSD
However, I realised that I had trauma from the birth of both my children during somatic training a while back, in which that out-of-control situation and body position were re-enacted, and my reaction was identical to my reaction to the hideousness of my very medicalised birth, as a result of an induction that I wish I’d not consented to (I wish I’d insisted on a C-section, even though that’s not a politically correct thing to say – and even though our NCT facilitator made us feel that water births by candlelight were the only way to go).
I remember a health visitor coming to visit when we first moved to our current home. She decided that I must have post-natal depression because I wasn’t working and my child (aged 13 months) wasn’t going to nursery yet. I decided that health visitors were nosey parkers who could not distinguish between someone who wanted to spend time with their baby and their narrow-minded narrative of post-natal depression. After all, I didn’t WANT to work – I was happy just hanging out with other mums and babies at that stage. However, the more I thought about it, the more I wondered whether she was partially correct – except it was PTSD. But I kept rationalising and telling myself that I was “fine” – because that’s what a traumatised person does. After all, we’ve survived the experience and even “moved on”.
Through further work with Polyvagal Theory and story telling, I realised that my medical trauma goes back even further: back to a time that I was admitted to hospital with suspected appendicitis as a teen and was treated like a body rather than a person. However, this potential root cause is a relatively recent discovery.
As a result of my birth trauma and subsequent post-natal PTSD, which has included flashbacks and nightmares, whenever I drove past the Royal Surrey County Hospital, where I had my first child, I used to get a rising sick feeling and feel angry and upset. I couldn’t work out why. I used to take both children for various hospital appointments there, and from the moment an appointment letter arrived, I’d feel powerless and shouty. When I visited the hospital, I used to walk past the maternity department and would feel triggered. I would arrive around 3 hours early for appointments – using the terrible hospital parking situation as an excuse to be so early -and be spontaneously rude to people without realising why. I wondered at the time if there was something wrong with me, as I thought it was strange that I used to be suddenly so spiteful and unpleasant – that is not the usual me. My trauma was so obvious (and yet not obvious to me at the time).
Following my first ever round of SSP back in 2018, I remember taking my youngest child to a hospital appointment at that hospital, and not only did I arrive at an appropriate time – around 20 minutes early, which allowed for traffic and parking, but I was socially engaged for the appointment, wasn’t rude or defensive with anyone and then walked back past the maternity department and thought “oh yes, that happened…” but I didn’t feel triggered! I still felt angry about what happened, and the fact that things SHOULD have been different, but my body had not reacted in the same way – I hadn’t gone into fight or flight. I had acknowledged a time when I didn’t feel safe, but wasn’t dominated by it.
We are all offered talking therapies by the hospital we give birth in. We can even sit and go through birth notes (albeit selectively) with a midwife. However, this does not even touch trauma, because as I’m sure you know, trauma is non-verbal.
During a recent traumatising incident involving breast screening and negative framing of my very small chance of having a malignant growth, I pretty much lost my powers of speech.
This step towards healing my post-natal PTSD is just one of many wonderful effects that the Safe and Sound Protocol has had for me.
In the past year, I’ve had to take my child for two general anaesthetics, which is not an easy thing to do – remaining calm and cheerful when they’re artificially put to sleep and potentially wake up in pain. I have dealt with both incidents easily without being ragey from the point of receiving an appointment letter, or bursting into tears.
All of this was achievable without having to attend counselling (which wouldn’t have worked, as I would not have admitted to or even accessed the feelings associated with the event).
As you probably already know, the Safe and Sound Protocol SSP is a five-hour listening programme, based on Dr Stephen Porges’ Polyvagal Theory.
Brief overview of the polyvagal theory
When we work with the nervous system, less is always more. “More” is like stretching a perished rubber band to breaking point – you’re bound to see side effects as a person grows into their “more”, whereas with less, a person can still grow into a more settled system, but gradually.
The analogy I tend to give my clients is that doing the Safe and Sound Protocol SSP is marathon training for your nervous system, and the speed we work at all depends on your nervous system’s starting point: a couch potato who lives off deep fried mars bars and coca cola will need to spend a lot longer preparing to get fit before they even start marathon training, and marathon training itself will need to be slow and steady, as otherwise they could suffer injuries.
The Safe and Sound Protocol is designed to help a person process trauma as well as improve social engagement, language and cognition. The protocol was originally intended for children with developmental trauma as well as to improve social communication for children with autism, but it is in widespread use by psychotherapists and other trauma therapists globally for complex trauma in adults, as a powerful non-talking intervention that helps people to process trauma effectively.
Your practitioner NEEDS to be trauma-informed and it is essential that they also that they understand how to work with the nervous system. This means they need to be trained in trauma and understand both trauma and the polyvagal theory in depth. This doesn’t mean simply banding the word “trauma” around or citing a couple of books they’ve read. A practitioner MUST have a thorough knowledge of how the SSP works and they must work with you to ensure that they understand exactly how much listening you need every day as well as the volume you should use, whether to complete in clinic or digitally and so-on.
Please watch before you start your SSP journey
Safe and Sound Protocol SSP
A thorough administration of SSP involves a lot of preparation and support on the part of both you and your practitioner, and success is equally dependent on you fully engaging with what you are doing as it is on your practitioner working ethically and knowledgeably with you.
Carol Ann Rowland of Halton Therapy & Neurofeedback in Georgetown, Ontario is an esteemed colleague and valuable member of the SSP practitioner community. I asked her to encapsulate why it is so important to find the right practitioner with the right level of experience and sensitivity – rather than focussing on price:
Safe and Sound Protocol SSP
People looking for an SSP practitioner are often tempted to go with whoever has the lowest rate. Unfortunately, practitioners who strive to offer the lowest price are often cutting corners in how much time they are investing in their clients’ processes. At best this may lead to the process being much more difficult than it needs to be. At worst, there is the potential that, if dysregulation gets big enough, that improvements may either be reduced or sabotaged completely. In some cases the process will end up costing even more when intially taking a budget approach as it may become necessary to then find another practitioner who is able to help repair where things went wrong. Worst of all, someone who has a difficult experience with SSP may never be willing to repeat it again, which is heartbreaking given that SSP can be life changing for many. With SSP I often see shifts that usually would have taken decades of hard work before showing up. It is well worth investing in a quality practitioner who will ensure that you have the best and gentlest possible experience, while maximizing the potential for signficant improvements.
Carol-Ann Rowland
Let me give you a couple of case studies – one positive, one negative, in order to illustrate my point further about the importance of being trauma-informed.
Adverse reaction to SSP in a 6 year old
William, aged 6 did SSP last year at home with his parents. He had a history of lengthy hospital stays and trauma. It is worth mentioning that our health and social care system in the UK had not identified the link between invasive early childhood hospital stays and behaviour, and hence William had been placed on a diagnostic pathway for autism and ADHD.
His practitioner advised starting with 15 minutes of listening, but unfortunately his mother decided that because he was looking relaxed and happy while listening, she would leave him to listen and play with Lego while she went to do the dinner. She forgot he was listening, and he did a full hour. She admitted this to the practitioner, who took a deep breath re ignoring instructions, and said it would be wise to give it a break the following day. Unfortunately, this advice was not heeded, and so William did a second hour-long session the following day… after which he threw a cat down the stairs, kicked a hole in a shed door and threw his mother’s mobile phone in a fish pond. When his mother asked the practitioner whether this was a normal reaction, the answer had to be very measured considering the fact that all instructions had been completely ignored.
It took William FOUR months for anyone to see any benefits. By this time, he was on a final warning at school for violent outbursts. However, once he had settled, his progress was fantastic: he was able to verbalise the reasons for his anger so much better, and in the meantime, sleep settled right down too.
Since the initial round of SSP, William’s mother has also done SSP for herself and he has had a repeat of days 3-5.
In fact, the above is still a positive result, despite appearing to be an adverse reaction. In fact, William was merely responding to his environment after being overwhelmed by too much challenge to his nervous system in one hit. It is also worth mentioning that the reason why an experienced practitioner may suggest that a parent also completes SSP themselves is that it is essential for parents to connect deeply with their children during this process. Leaving them to play Lego while they listen is not going to provide the magic bullet they think they are paying for, and neither is completely disregarding carefully given instructions.
A client rescued from a bad experience with a cut-price SSP experience with a practitioner, who did not offer any support during the programme
A mum contacted Emma, desperate for help with her teenage son, who had got to day 4 of a third round of SSP and was suffering from extreme sensory overwhelm.
When asked when the previous rounds had been, Emma was alarmed to find that this parent was sharing physical SSP equipment with another 5 families – and using SSP once every 6 weeks! Given that SSP continues to take effect for up to 8 weeks post SSP, repeating quite so often is ill-advised.
Emma decided to complete day 5 of SSP, but VERY slowly (5 minutes every day or two, depending on reactions), and incorporating external (bodywork) support for the vagus and facial nerves.
The mother then followed up with a course of cranial osteopathy.
The teen went from being totally shut down (eyes tightly closed, hands clasped over ears, non-verbal, distressed, sleeping all the time), to smiling, relaxed facial muscles, laughter and expressing desires in language. A fantastic transformation!
Please beware of cut-price SSP practitioners, lack of supervision and lack of nevous system and titration knowledge.
A wonderful experience for an adult with PTSD
Annabelle, a 40 year-old with PTSD following survival of a terrorism incident, first did SSP in December in clinic, following many years of talking therapies, EMDR and somatic experencing.
She completed the SSP in half hour slots on a Monday and Friday over 5 weeks. Even after her first half hour, she noticed incredible gains in terms of ability to connect with strangers. After completion of day 3, she had a job interview and got the job, where she remains happy to date. She completed the five-day protocol and reported a fantastic shift in terms of anxiety. However, she decided to undertake a booster of days 3-5 remotely using the Digital SSP in April 2020 due to stress over the Covid-19 situation, which she reports to have made her feel noticeably calmer and better able to sleep through the night without 3am wake-up-and-worry sessions.
What has happened, and why was this so successful? Annabelle fully engaged in the process. She researched SSP and the Polyvagal theory thoroughly in advance and engaged with her practitioner every single day to give the required feedback so the programme could be tweaked if necessary.
So, how do we avoid having a William situation, and ensure a peaceful Annabelle situation?
Research your provider.
How long have they been qualified to deliver SSP?
What is their background? Is it relevant to your reason for seeking out SSP?
Don’t be scared to ask how many clients they have worked with.
What kind of client they specialise in?
Do they specialise in SSP or are they a jack of all trades?
Are they trauma-certified?
Do they work with nervous systems as part of their discipline? (This is EXTREMELY important)
Ask them to explain how SSP works – can they do this clearly?
Ask what sort of side-effects they have seen and how they deal with them.
Do they ever refuse clients? (you want them to say yes, and explain why – you would also want them to explain that they cannot deal with those stuck in a “freeze” state, and will ideally need to see them face-to-face in clinic).
How do they work out how to work with clients?
Do they use all 3 pathways? If they do NOT use the Connect programme, steer clear.
How long will your provider allow you to access the SSP for?
How will communication take place during the protocol? (you want them to say that they are on call for you all the time by email and/or telephone).
What will happen post-SSP? Do they have modalities compatible with SSP for continuation, or alliances with other therapists to refer to?
What is their go-to follow up? (hint: no one modality works for everyone)
Do they insist on you following their programme or do they have a network of other therapists they refer to?
How will they prepare you for SSP?
How do they use the SSP Connect Programme?
In addition, are they strikingly cheap or strikingly expensive? (Some of my UK clients recently have told me about OTs charging in excess of £2000, which is, in my opinion as a far more experienced practitioner than nearly every OT in the country, absolutely extortionate, and totally contrary to Dr Porges’ vision of this being accessible to those who need it).
Do they have a website? Have a good look – see if all the materials are theirs or lifted from other sources. You can quickly get an idea of experience levels by the way SSP is described and whether materials are original or copied. (I say this as someone who has spotted my work embedded on so many websites – some SSP practitioners think they shouldn’t need to “reinvent the wheel”, but the fact is that the wheel NEEDS to be reinvented for each individual…)
Emma has been providing SSP for almost five years years, and have worked with in excess of 500 clients, with a variety of presentations and different nervous systems.
Emma conducts 1:1 workshops and case supervision for anyone recently trained in SSP who is wishing to incorporate SSP into practice, and regularly advises and collaborates with Unyte-iLs on training/clinical practice.
For any questions about the Safe and Sound Protocol, either as a client or a practitioner, please contact me.
