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A Therapeutic Model: Passive and Active Pathways

The Safe and Sound Protocol is intended to accelerate the effectiveness of other modalities by preparing the client’s emotional and physiological state.

Dr. Porges discusses two pathways to achieving progress with clients: the Passive Pathway and the Active Pathway.  Both lead to improvements in state regulation, social behavior, communication skills, and quality of life.

The Passive Pathway utilizes the vagus nerve and neuroception to assess and achieve safety.  Over-activation of the sympathetic nervous system interferes with learning, attention, behavior and health.  We conceive of the SSP as the Passive Pathway helping the client to restore balance to an out-of-balance autonomic nervous system and to achieve a calm autonomic/physiological state. This is the foundation of an effective therapy and opens the system to further neural change from therapies that follow.

The Active Pathway engages and exercises the Social Engagement System and challenges it to become more resilient. The combination of consistent attention to the music and movement engages the client and can create and secure neuroplastic change. As an example, iLs’ Focus programs and the VoicePro utilize the Active Pathway. If you use another therapy modality, we believe that it too will be accelerated by starting first with the SSP as a Passive Pathway.

Features Addressed by the SSP

Separate from the clinical studies and published research papers of Dr. Porges, et. al., iLs conducted a Feasibility Trial and a Beta Phase where clinicians (OTs, PTs and Speech Therapists) used the SSP with their clients. The following tables include direct responses from clients about the changes they or their child experienced following the five-day SSP intervention.

Social Communication

The SSP is a portal to the Social Engagement System and it can have powerful effects on how a client interacts with the world.  Examples are: better eye contact and facial expressivity; improved understanding of speech; better emotional control; more reciprocal interactions; and increased emotional expressivity among others.

Pre-SSP

Post-SSP

Often avoids eye contact Has been more relaxed and keeping better eye contact
Poor communication with peers More social interaction; generally happy and not as frustrated
Unresponsive or argumentative We’re noticing fewer “I don’t know”s and “I can’t”s
Responded only to specific questions She’s been commenting more now.  She sometimes talks about something even if we don’t ask.  Conversation is more spontaneous now.
Not very aware of others’ feelings or even her own She’s more interested in what others are feeling.  For instance, if a child is crying, she gets concerned.  She also tells us if she’s upset with something.  Sometimes when she’s happy, she tells us about it. She seems to have developed more compassion. She actually moves toward upset/hurt kids to help.
Poor social behavior; usually runs around in her own world She’s observing peers at the playground now.  She was even socially engaged enough that another girl came over, introduced herself and asked her to play!
Social interaction is often affected by sound sensitivity, so I am not always eager to connect with people I have been enjoying social engagements!  Even when there was eating, I have enjoyed many social interactions.  Feeling pleased instead of drained.  This program produced a deep sense of relaxation.  As the days passed, it seemed like doors that had been jammed open got to close and my brain was processing sound in a different way.
Nonverbal.  Difficulty in communicating with other people She has shown the most improvement in her desire to communicate nonverbally.  She has facial expressions, laughs, plays and points to what she needs.  She has more of a desire to communicate and play with other children.  She even started to pretend play after the program! Her social interaction is definitely improving even as a nonverbal child.  She seems to be making little strides every day and is even trying to speak more.
She very rarely would initiate conversation unless she was asking for something She is initiating conversation more freely now.  We’re seeing spontaneous verbal language we hadn’t seen before.
Facial expressions are flat. (23-year old who sustained 2 head traumas/concussions related to car accidents) A real change in facial expression.  When happy, she looks happy and when angry, she has the dirty look face mastered.
Discomfort with physical expressions of affection My 24-year old daughter told her cousin today that the SSP “made her a better hugger!”
Communication problems related to Fetal Alcohol Syndrome New behaviors his parents are noticing:
Eye contact with each person around the dinner table;
Accelerated emergence of correct verb tense;
Increase in intentional pauses before speaking and careful articulation of sentences;
General improvement in fluency;
More affectionate;
Improved use of known vocabulary.

Physiological state

Just like the brain, the Autonomic Nervous System is plastic and can “learn” to stay more activated than necessary.  Being in a state of chronic defensiveness, as in some psychiatric and behavioral disorders, compromises the social engagement system and the related neural networks “learn” to engage less.

By improving the ability to assess safety in social situations, the SSP helps clients to activate a parasympathetic state.  Improving state promotes behavioral regulation.

Pre-SSP

Post-SSP

Low confidence; unwillingness to try new things Improved willingness to try new things; noticeable pride in accomplishments
Fearful OK with taking risks – step by step
Unresponsive or argumentative We’re noticing fewer “I don’t know”s and “I can’t”s
Morning and evening routines have been trouble spots for some time Now she seems more willing to get ready by herself.  She’s been more cooperative and less irritable – even when hungry/tired.
Fearful at playground She’s not afraid to use the playground equipment at the park anymore.  Hesitant at first, but after the first try, she was doing it like she’s been doing it for a long time.
Poor emotional control Much less trouble controlling emotions and excitement.  Better control of emotions and fewer tantrums now.
Lingering struggles with sleep, attention and motivation following the death of a spouse “There seems to be a better sense of control about my emotions and a sense of balance and calm. It has been extremely rewarding to be more deliberate and aware of my reactions. This change has improved the communication and conflict resolution in some of my most important relationships.”
Problems with state regulation Calm behavior, happier, more facial expression (a lot of smiles). His speech therapist’s comments were: “He has made a huge leap with word finding, attention to task, and endurance. Major changes on my end.”

Sound Sensitivity

Sensitivity to sounds is a prevalent symptom in a number of disorders.  People who experience sound sensitivity may: respond negatively to unexpected or loud noises; become distracted or disturbed when there is a lot of or continuous background noise; and/or find it difficult to extract the frequencies of human speech from background noise.  With the SSP, we have seen significant improvements on the SCAN-3 (a measure of auditory processing) specifically on the Filtered Words and Competing Words subtests.  These respectively assess the ability to decipher human speech from background sounds and to hear equally from both ears.

Pre-SSP

Post-SSP

Overwhelmed easily by sounds in the environment Can more easily accept sounds that previously bothered them.  For instance, mall music that had previously been too overwhelming is now not even noticed.
Struggles to modulate voice level Better control over voice volume; less need for yelling or talking loudly.
Bathroom hand dryers have ALWAYS made her cover her ears This week, she had NO reaction to a public hand dryer.  I asked her if the noise bothered her and she said NO.
Cannot tolerate trigger sounds: sneezes; coughs; sniffs; eating and drinking sounds.  Reacts by covering head and ears and cries and screams (11-year old girl with Misophonia) Has been much more relaxed and is not noticing all occurrences of these sounds.
Responded only to specific questions She’s been commenting more now.  She sometimes talks about something even if we don’t ask.  Conversation is more spontaneous now.
I have experienced sound sensitivity since age 8.  Started wearing earplugs in college and then more and more until almost continuously for the last 7-8 years. I can now be around people eating and drinking without earplugs.  This is astounding to me!  These sounds are more in the background now.  This is incredibly hopeful.
Social interaction is often affected by sound sensitivity, so I am not always eager to connect with people I have been enjoying social engagements!  Even when there was eating, I have enjoyed many social interactions.  Feeling pleased instead of drained.  This program produced a deep sense of relaxation.  As the days passed, it seemed like doors that had been jammed open got to close and my brain was processing sound in a different way.
Discomfort with sound in classroom “I was talking with her teacher and we both realized that she has stopped saying that the classroom is so loud! That is one of the major reasons we decided to try it! I think the additional things we have seen are all a result of the reduced hypersensitivity to those noises… For instance, she set a goal and achieved it for swim team, and is more focused in choir. She is making gains in math. I really do think it has helped more than I know or can explain…”
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