This case study on the Safe and Sound Protocol (SSP) was published in the Harvard Review of Psychiatry, September/October 2022.
Clinical case studies play an important role in building a strong foundation of evidence for therapeutic interventions. They tell a holistic story about a client’s experience and allow space to observe change across a wide range of possibilities in the context of an individual’s real-life experience. As evidence for the Safe and Sound Protocol (SSP) grows, case studies shed light on who, how and under what circumstances the SSP can be most effective. This helps to inform both program planning and future areas of study.
A recent publication from the Harvard Review of Psychiatry does just that, telling the story of MT, a 10-year-old girl with Functional Neurological Disorder (FND) (Rajabalee, et al., 2022). Along with an expert medical and research team, co-author Dr. Stephen Porges provides insight into the mechanism and impact of the SSP.
FND is a neurological-somatic condition with an unknown cause. There is disconnection between the brain and body due to disruption in the sending and receiving of signals related to memory, concentration, emotions, cognition and motor functions. FND is often triggered by bio-psycho-social factors, including childhood trauma, interpersonal stress or illness (NINDS, 2022).
When MT was diagnosed, she presented with a cluster of somatic symptoms that included unsteady gait, blurry vision, periods of confusion, a persisting headache, back pain, nausea and difficulty swallowing, which appeared to be triggered by a viral illness. Following a formal diagnosis of FND, she was admitted to the intensive Mind-Body Program at the hospital, which included physical, psychological, pharmacological and family therapy.
Due to the severity of MT’s condition, however, she struggled to participate in the program, and MT’s rumination on her pain grew to catastrophizing and suicidal ideation. MT particularly struggled with cognitive, or “top-down” therapies, which directed the team to prioritize physiological, “bottom-up” and passive regulatory therapies — including the SSP.
The SSP was delivered in nine listening sessions over six weeks, starting with 15-minute sessions and building up to 30 minutes. As she participated in the SSP, her capacity for communication, social behaviors and physical movement improved significantly, returning to walking, climbing and play. Her breathing slowed and catastrophic thoughts settled. Her assessment scores on anxiety, depression, stress and the Body Perception Questionnaire (BPQ) returned to “normal” levels. In follow-ups two months, then a year and a half later, MT had retained these benefits and her sense of well-being.
While the program plan and outcomes of this important case study may not apply to every client with FND, it paints a clear picture of how the SSP can help support the health and well-being of clients with similar presentations. Due to its influence on the autonomic nervous system, the SSP helps clients better access their social engagement system. Improved nervous system regulation has important secondary effects on breathing, heart rate, cognition and other essential neurophysiological functions, which supports overall healing and recovery.
National Institute of Neurological Disorders and Stroke (NINDS), (2022). Functional Neurologic Disorder. Retrieved from https://www.ninds.nih.gov/functional-neurologic-disorder
Rajabalee, N., Kozlowska, K., Lee, S. Y., Savage, B., Hawkes, C., Siciliano, D., Porges, S. W., Pick, S., & Torbey, S. (2022). Neuromodulation Using Computer-Altered Music to Treat a Ten-Year-Old Child Unresponsive to Standard Interventions for Functional Neurological Disorder. Harvard review of psychiatry, 30(5), 303–316. https://doi.org/10.1097/HRP.0000000000000341