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Safe and Sound Protocol (SSP)

Summary: The Safe and Sound Protocol (SSP) is an auditory intervention (distinct from auditory integration therapy) that helps to calm individuals who have troubles with sound sensitivity and/or who have troubles tolerating social communication including talking. Initial clinical trials showed success with youth with autism spectrum disorder (ASD) though it seems that it may be helpful in more situations as well. SSP is developed by Dr. Stephen Porges, and is based on polyvagal theory.
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Do you (or your loved one) have the following:

  • Troubles with social communication, such as problems keeping back and forth conversations with others?
  • Troubles with sympathetic activation, such as always being ‘hyper’, easily angered or anxious, with problems staying calm and relaxed in situations?
  • Sound sensitivity, such as problems with loud noises; problems when there is a lot of background noise, e.g. classrooms, public places, crowds?

If so, the Safe and Sound Protocol (SSP) might possibly be helpful.

What is the Safe and Sound Protocol (SSP)?

In order to learn, work and play, our nervous system needs to be in a calm state emotionally and physically.

The problem however, is that some nervous systems become easily distressed from the sound of social interaction, e.g. being in a classroom with peers; having to interact with siblings or parents at home.

When your nervous system is under stress (or distress), your nervous system is not calm, which makes it difficult to learn, work and play. The body’s alarm becomes activated in order to defend itself from the danger, and can lead to ‘fight’ (angry, irritability, aggression), or ‘flight’ (anxiety).

Diagram: In certain individuals, sound trigger’s their brain’s alarm system, leading them to go into a state of fight/flight.

Many times, talking therapies may have been tried to deal with the stress -- however, when one’s nervous system becomes triggered from social engagement and sound, talking therapies are not able to work well.

One way to help such nervous systems is the Safe and Sound Protocol (SSP).

Developed by Dr. Stephen Porges, the Safe and Sound Protocol (SSP) is a 5-day auditory intervention (i.e. sound) designed to reduce auditory sensitivity, which leads to increased social engagement, resiliency, and a calmer nervous system.

How does it work?

  • The individual listens to 1 hour of music while engaging in fine motor activities or a relaxing activity over a period of 5 consecutive days. (If the person is unable to tolerate 1 hour at a time, a shorter period may be used, however it should be done on consecutive days and continued from the point that they stopped listening.)
  • The music has been processed specifically to ‘retune’ the nervous system by:
    • Stimulating the muscles of the middle ear, which allows for improved filtering of the high and low frequency sounds a child has to process.

The end result?

  • This allows the client to feel safer and socially engage. The client can better interpret human speech, as well as the emotional meaning of language. Once interpersonal interactions improve, spontaneous social behaviors and an enhanced ability to learn, self-regulate and engage are often seen.

Who Might Benefit From SSP?

There is the most evidence for the following: 

  • Autism spectrum disorders (ASD).

In addition, anecdotal experience (i.e. unpublished data) suggests the following may also benefit

  • Sensory processing disorders (SPD),
  • Attention/deficit hyperactivity disorder (ADHD/ADD)
  • Survivors of trauma (including developmental trauma)
  • Social engagement problems, i.e. problems connecting with other people socially
  • Reading comprehension problems.
  • Sound sensitivity following concussion
  • Gastrointestinal (GI) disruption due to nervous system overstimulation (e.g. reduction in binge eating behaviours, reduction in stress/anxiety related diarrhea).”

Any Reasons to Avoid Using SSP?

Caution should be used with individuals who have had:

  • Seizure in the past year,
  • Bipolar disorder or psychiatric disorder with psychotic features.

For the above individuals, it is important to see a neurologist or psychiatrist for approval prior to starting a program.

Frequently Asked Questions (FAQs)

Q. What if my child has sensory issues and cannot tolerate headphones? Can the sounds be played on speakers?

A. Unfortunately, the intervention requires the child to wear headphones for the SSP protocol -- and the child is not to talk or engage with the therapist during this time.

Q. How can we desensitize my child to headphones?

A. According to Heather Hodgins-Chan (Pediatric Physio and OT), there are various strategies such as:

  • Practice putting the headphones on several times before.
  • Have your child put the headphones on you so that they can see how you react.
  • OT approaches for tactile sensitivity,
    • Sensory brushing with reflex integration exercises for Fear Paralysis and Moro reflexes;
    • Therapeutic tapping (aka emotional freedom technique);
    • Proprioceptive tasks such as using an exercise ball over the body to provide deep pressure should be done at home regularly;
    • Deep pressure via small hand held massager to use on the child's back, arms, and legs;

Q. My child (who is very inflexible!) states that s/he doesn’t doesn’t like some of the songs on the adult or child playlist.

A. Advice for parent is that if its just one or two songs, just take the headphones off your child. During that time, listen yourself until the song is over; or skip ahead the appropriate amount of time.

How can I find an SSP practitioner?

For More Information

Scientific References

Porges S, Bazhenova O, Bal E, Carlson N, Sorokin Y, Heilman K, Cook E, Lewis G: Reducing Auditory Hypersensitivities in Autistic Spectrum Disorder: Preliminary Findings: Evaluating the Listening Project Protocol. Front Pediatr. 2014; 2: 80.

About this Article

Written by the health professionals at the Children’s Hospital of Eastern Ontario (CHEO), Ottawa, Canada. Special thanks to Heather Hodgins-Chan, OT in private practice.

Competing interests: Some of the professionals consulted for this article (such as occupational therapists) may use the Safe and Sound Protocol (SSP) in their clinical work.


Information in this pamphlet is offered ‘as is' and is meant only to provide general information that supplements, but does not replace the information from your health provider. Always contact a qualified health professional for further information in your specific situation or circumstance.

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Date Posted: Apr 27, 2021
Date of Last Revision: Jun 18, 2021

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