What is the Safe and Sound Protocol, and how is it meant to work?
Protracted withdrawal from benzodiazepines and other psych drugs is very difficult to tolerate. A person going through protracted symptoms will have disturbed sleep, restlessness, anxiety, and altered social behavior.
Polyvagal theory relates to the anatomy and functioning of the nucleus ambiguus in the brain and the vagus nerve. Protracted withdrawal alters the autonomic state of the person who suffers from this iatrogenic trauma.
The idea behind the Safe and Sound Protocol is that a therapy can work through the auditory system, since a great deal of stress is related to background noise and environmental sounds.
Safe & Sound Protocol is the brain child of Dr. Stephen W. Porges.
Research scientist, Dr. Stephen W. Porges, became aware of what he referred to as the “vagal paradox” in the 1990s, while studying respiratory sinus arrhythmia. He based his polyvagal theory on this paradox, and developed this sound therapy for healing trauma, Safe & Sound, based on his research of the vagal mechanisms and their evolutionary functioning.
Therapists can seek training in polyvagal theory and the therapies built on it through organizations that promote the theory and certify practitioners.
The Safe and Sound Protocol is based on polyvagal theory, which describes the functioning of the vagus nerve and vagal tone.
Safe and sound therapy is often offered in conjunction with eye movement desensitization and reprocessing therapy, also known as EMDR therapy, and also yoga therapy. These therapies are offered for complex PTSD, with the aim of helping people who have been through past trauma to work on prosocial behavior.
The Safe & Sound Method is meant to work on the vagus nerve to promote a safe state.
There are various vagal pathways, such as the dorsal vagal complex, and the ventral vagal complex. Safe and sound is designed to reach the autonomic nervous system, including the sympathetic nervous system and parasympathetic nervous system, using specialized music tracks.
In polyvagal theory, increased ventral vagus tone is associated with improved social interaction and social engagement. The goal is to calm sympathetic activation, which drives the fight or flight response, and the dorsal vagal shutdown response, which polyvagal theory describes as the oldest and most primitive.
Safe & sound is designed to optimize vagal tone, avoiding mobilized and immobilized states. The safe state, which supports social engagement, is the preferred vagal state.
Protracted withdrawal from benzodiazepines is a form of trauma. It is trauma to the central nervous system, caused by prescribed drugs.
While this microtrauma to the central nervous system can cause many symptoms, one of the most feared is akathisia. Akathisia is an intense inner restlessness: the person feels unable to sit down and stay still. A crawling feeling on the skin is a different withdrawal symptom, called formication. If akathisia or any withdrawal symptom ever brings thoughts of suicide, call or text 988, the Suicide and Crisis Lifeline, and call 911 in an emergency.
How well does Safe And Sound protocol work for trauma?
Dr. Porges and the therapists who use SSP report that some people with trauma and sound sensitivity feel calmer after it. Controlled studies are few, and the reports come mostly from the people who provide it.
The safe and sound protocol, developed by Dr. Stephen Porges, is meant to improve emotional regulation by calming the heightened alert state of the autonomic nervous system, according to its developer. Its providers describe success as improved comfort in social situations.
Benzodiazepine use, and subsequent post acute withdrawal symptoms, can lead to significant issues. These include mood swings, mental health issues, and cognitive impairment due to the ongoing physical symptoms and psychological symptoms.
Safe Sound Protocol is meant to exercise the middle ear muscles with specially filtered music.
Safe sound protocol is aimed at auditory sensitivity, using an integrated listening system. It involves a five-hour listening program with filtered music. The theory is that, during therapy, the brain builds new connections.
Safe sound therapy requires a period of daily listening to music filtered to be in the frequency range of the human voice. The developer’s theory is that working on the middle ear muscles reaches the vagus nerve.
Providers describe successful SSP therapy as improved social interaction and a steadier nervous system around sudden loud noises.
It is an auditory intervention intended to work on what polyvagal theory calls the social engagement system.
Dr. Porges has created this non-invasive intervention to help with sensory sensitivities by addressing auditory processing issues and related challenges, such as dysregulation.
Providers report that after SSP some people socialize more easily, sleep better, and have less gastrointestinal distress. Whether it helps protracted withdrawal is unknown.
Who offers the Safe and Sound Protocol?
While you may have a local SSP clinic in your area, the therapy may be offered as a telemedicine service. Treatment can be provided remotely, in conjunction with online therapy.
SSP is offered by licensed therapists and psychiatrists for trauma recovery, for social connection, and for psychiatric disorders.
While you can certainly use Google to find a local center that provides SSP, it is important to try to find a clinic that uses licensed doctors of psychology or psychiatry to implement treatment plans. Safe and Sound Protocol coaches may not have the same level of medical expertise and training.
Are there other therapies based on polyvagal theory?
If you look around, you will find a variety of feedback devices and electrical stimulators. The marketing campaigns invariably mention polyvagal theory. There are ads for gammaCore, Apollo Neuro, Fisher Wallace stimulator, and courses on how to train the vagus nerve for better vagal toning to heal trauma.
Some of these ads are specifically about depression, migraine headaches, relaxation, focus, or better sleep. There are even vagal nerve stimulator magnets.
In addition to these consumer products, there are implanted electrical stimulators that act directly on the vagus nerve. One such device has been FDA approved since 2005 as an add-on treatment for long-lasting depression that has not responded to other treatments.
These devices must be calibrated and set carefully to avoid causing difficulty breathing or swallowing.
Is it possible to improve mood using stimulation of the vagal pathways without going in for expensive therapy or buying a device?
The vagus nerve passes through the neck and can be affected by breathing and vocalization. There are breathing techniques that involve vocalizing to produce vibrations with the vocal cords.
The idea is that these vibrations stimulate the vagus nerve and have a calming effect, though that has not been well tested. Imagine, if you are in public, and feeling stress from the crowds of people around you, and you start to breath deeply and hum quietly.
Could focused breathing and vocalization make a difference? Is it possible to change your state of mind with singing or humming?
It can’t hurt to try various vocal sounds, along with deep breathing, to see how it makes you feel. You may discover that simple practices that did not occur to you previously can make a difference.
What about screaming into a pillow, guided screaming, or silent screaming?
Does screaming help to stimulate the vagus nerve? The benefits of screaming therapeutically likely work through other mechanisms.
There are a variety of therapies based on screaming. There is primal scream therapy, silent screaming, where you scream in your mind without screaming out loud, and controlled aggression therapy, where you scream into a pillow.
You may wonder why you would want to visit a therapist who specializes in scream therapy. Why not just scream?
The therapist may help to guide the screaming activity and help with specifically discussing past traumas. On the other hand, people do have the right to make noise without the approval of a therapist.
It is, however, a good idea to let people around you know that you are engaging in personal scream therapy, so they do not think you are in trouble. Screaming into a pillow may help to reduce the noise level, while allowing you to scream as loud as you like.
Is there any controversy surrounding the Safe and Sound Protocol?
Is it possible that SSP is a scam? Is polyvagal theory a scam? Could the safe and sound protocol be snake oil?
Dr. Stephen Porges is a doctor of psychology with an impressive list of publications. His academic credentials are impeccable.
Does the polyvagal evolutionary model of social mammals make sense?
Some experts claim that the evolutionary model described by Dr. Porges is not consistent with what we know about evolution. Others state that there is not enough evidence of this sound protocol being effective.
Still, because of Dr. Porges’s credentials, it is worth taking his ideas seriously. Some treatments that help people have never been properly studied, and SSP may be one of them. Yet, the reports of benefit come mostly from the people who provide it, so they are a reason for curiosity, not proof.
I have not personally tried the safe and sound protocol, so I cannot give a personal testimonial about its effectiveness.
Should I try SSP?
I would recommend starting with a doctor or therapist whom you trust and ask their opinion. They may have recommendations or referrals they can make to help you get to a trusted provider.
For example, you might want to ask your family doctor if they have an opinion on SSP. Even if they have not heard of it, they can research the science and give you their opinion.
As stated earlier, if you do decide to visit a safe and sound clinic, be sure to check their credentials first. Be careful not to go to a treatment center that is only staffed with coaches, and no licensed healthcare professionals.
Safe and Sound Protocol therapy is intriguing, and its providers say it helps some people. The evidence that it works is thin, and it is not a substitute for medical care during a taper.
This article is educational. It is not medical advice, and reading it does not create a doctor-patient relationship. Decisions about starting, continuing, or tapering any medication should be made with your own physician.
