WHAT IS THE SAFE AND SOUND PROTOCOL (SSP)?
The Safe and Sound Protocol (SSP) is an evidence-based, auditory-based therapeutic intervention developed by Dr. Stephen Porges. It is rooted in the Polyvagal Theory and designed to support nervous system regulation, social engagement, and emotional resilience, while also reducing noise sensitivity.
SSP uses specially filtered music to stimulate the vagus nerve, improving the function of the middle ear muscles. This helps the brain better process sound, allowing individuals to focus on human speech while reducing sensitivity to background noise. By promoting a sense of safety, SSP can support emotional and physiological regulation.
HOW DOES THE SSP WORK?
Sound enters the ear and travels to the inner ear, where it is processed by the auditory system. The middle ear muscles (the tensor tympani and stapedius) help filter sound by tightening the eardrum. This process—known as the middle ear transfer function—is crucial for auditory processing. It serves two primary functions:
- Reducing loud sounds to prevent discomfort or damage.
- Filtering out low-frequency noise to help the brain focus on human speech.
When these muscles do not function properly, the brain may struggle to distinguish important auditory cues, leading to increased noise sensitivity and difficulty processing sound. The SSP trains the auditory system to improve these functions, helping the brain feel safer in its environment and reducing discomfort.
HOW CAN THE SSP HELP PEOPLE AFTER A CONCUSSION?
After a concussion, many individuals experience symptoms such as noise sensitivity, autonomic dysregulation, emotional distress, and trauma-related symptoms (e.g., hypervigilance, difficulty relaxing). The SSP may help by promoting nervous system regulation and improving auditory processing.
While research on SSP for post-concussion syndrome (PCS) is still emerging, evidence suggests its benefits in related conditions. Preliminary studies and case reports indicate SSP may help with:
- Reducing Noise Sensitivity
- Many individuals with PCS struggle with hyperacusis (increased sensitivity to sound) and difficulty filtering out background noise.
- SSP helps train the auditory system to better distinguish between meaningful and irrelevant sounds, reducing sensory overload.
- Research suggests SSP improves auditory processing and sensory integration in populations with sensory hypersensitivity (Schoen et al., 2019).
- Enhancing Mood and Emotional Regulation
- The vagus nerve plays a key role in mood regulation and emotional resilience.
- SSP supports the parasympathetic nervous system, helping to reduce anxiety, depression, and irritability in PCS patients.
- Some studies also show improvements in social communication and emotional flexibility.
- Addressing PTSD and Trauma-Related Symptoms
- Many concussion patients experience hypervigilance, an exaggerated startle response, and difficulty feeling safe.
- SSP may help shift the nervous system out of a chronic fight-or-flight response into a more relaxed state, improving emotional regulation.
- SSP has been studied in populations with PTSD and anxiety, showing reductions in hyperarousal and improved nervous system balance (Porges et al., 2014).
- Supporting Autonomic Nervous System (ANS) Regulation
- PCS is often associated with autonomic dysfunction, leading to symptoms like dizziness, fatigue, low heart rate variability (HRV), and blood pressure instability.
- SSP’s impact on the vagus nerve may help restore autonomic balance, improving physiological regulation.
AM I A GOOD CANDIDATE FOR THE SSP?
You may benefit from SSP if you experience any of the following symptoms:
✅ Noise Sensitivity (difficulty filtering sounds, discomfort in loud environments, auditory overwhelm)
✅ Emotional Dysregulation (intense mood swings, anxiety, depression, irritability)
✅ Hypervigilance (always on high alert, easily startled, difficulty relaxing)
✅ Autonomic Dysfunction (dizziness, fatigue, irregular heart rate, poor stress tolerance).
SSP may not be appropriate for individuals experiencing:
❌ Severe or constant tinnitus (ringing in the ears)
❌ Active psychosis (i.e., hallucinations, mania)
❌ Uncontrolled seizures
❌ Severe, active suicidal thoughts.
WHAT TO EXPECT DURING SSP?
- The SSP is delivered through a listening program that requires over-the-ear headphones.
- Sessions involve listening to specially filtered music for a prescribed amount of time.
- The program is accessed via an app that must be downloaded onto a phone or tablet.
- Pacing is individualized to each patient’s needs to ensure comfort and optimal results.
THE SSP & TORONTO CONCUSSION CLINIC
At this time, we are only offering this service to patients with MVA funding. Our ambition is to be able to provide it to others in the near future. For existing MVA patients at TCC, if you’re interested in starting the SSP, please reach out to us at team@torontoconcussion.ca and request participation in the SSP.
Last update: May 2025