The information presented in this case study was submitted by the identified provider and reviewed by the Unyte Clinical Team. Modifications to the text have been made solely for the purpose of enhancing comprehension and clarity for the reader’s benefit, and were carefully applied while ensuring the accuracy and integrity of the original submission. Unyte Health makes every effort to use updated terms and inclusive language, this case study retains the author’s original descriptions to be most sensitive to the client’s identity and preferences.
About the Provider
Name: Rachel McFedries
Disciplines/credentials: Whakaora Ngangahau; New Zealand Registered Occupational Therapist
Modalities: Safe and Sound Protocol (SSP), sensory processing, cognitive behavioral therapy, play-based learning
Client Background
Name: Hazel (pseudonym)
Gender and Age: Woman, 32 years old
Program Delivered: Safe and Sound Protocol (SSP)
- SSP Core: Hours 1-5
Hazel is a 32-year-old woman who was diagnosed with long COVID after contracting the virus in November 2022. Prior to her illness, she was a fit, active and high-achieving school teacher. She lives with her husband and their preschool-aged daughter. In early 2023, following an eight-week summer holiday in New Zealand, Hazel attempted to return to her teaching position but found herself unable to cope with the occupational demands of the role. This included the high-level executive functioning required, as well as the physical demands of standing and walking throughout the day. Consequently, she was unable to continue working.
At the time of her initial contact with Connect Occupational Therapy in May 2023, Hazel was at the beginning of her recovery journey, establishing a rehabilitation plan and organizing insurance coverage. She was establishing access to in-person therapy from a clinical psychologist, an exercise physiologist and a vocational rehabilitation occupational therapist through separate providers.
The onset of long COVID profoundly disrupted Hazel’s daily functioning and social support systems. Unable to attend work or her church community, she experienced significant feelings of isolation, frustration, fatigue and brain fog. She sought treatment specifically to address a sensitivity to noise, which she had never experienced prior to her illness. Hazel struggled to process auditory information, particularly in environments with competing background noise, such as a cafe with music or multiple simultaneous conversations.
At the start of treatment, Hazel identified that processing excessive noise directly contributed to:
- Loss of concentration
- Anticipatory anxiety around possibility of noise when entering new and familiar environments
- Anxiety surrounding the demands of weekend parenting (while her daughter was home from daycare)
- Avoidance of busy family routines, including the morning routine with her husband and daughter
- Irritability during periods of heightened noise
- An increase in physical pain and profound fatigue, specifically an aching sensation in her head and shoulders that caused her to “feel like an 80-year-old woman”.
Hazel’s primary treatment goals were to engage in social situations more frequently without experiencing noise-related physical pain, to reduce irritability with her husband and daughter, and to establish a progressive trajectory toward a long-term return-to-work plan.
Implementation of the Safe and Sound Protocol (SSP)
The Safe and Sound Protocol (SSP) was delivered through independent listening sessions guided and monitored by provider Rachel McFedries – an approach aligned well with Hazel’s strong motivation, self-awareness, communication, and ability to adhere to its guidelines. Hazel completed the five hours of SSP Core using the Classical Flow playlist over three weeks. To support autonomic regulation and prevent overstimulation, listening was carefully titrated, starting at five minutes per day and gradually increasing to a maximum of 20 minutes per day.
Hazel integrated the listening sessions into her afternoon schedule, which she typically used for a daily rest as part of her long COVID pacing strategy. This time of day provided a quiet domestic environment conducive to safe therapeutic engagement. To optimize her sensory environment and promote cues of safety, Hazel completed her listening sessions while lying on her bed, using an eye mask and a weighted blanket, and often transitioned into a nap immediately afterward.
Her provider, Rachel, conducted three Zoom consultations with Hazel throughout the program delivery: an initial setup consultation prior to listening, a midpoint review at Hour 4, and a follow-up consultation eight weeks post-completion. Rachel and Hazel also maintained regular communication via WhatsApp throughout the process to monitor titration and autonomic responses.
During these consultations, Rachel provided targeted psychoeducation, which covered:
- The role of the vagus nerve and the autonomic nervous system in regulating stress states
- The concept of the window of tolerance
- Strategies for pacing and prioritizing daily occupational demands
- Nervous system regulating activities from Unyte
- The importance of co-regulation, specifically focused on intentional, supportive interactions with her husband and whānau (Māori word for family)
- Sensory processing patterns, informed by a sensory profile questionnaire that indicated Hazel scored “more than most” in both sensory sensitivity and sensory avoiding quadrants
Alongside the SSP, Hazel continued her existing recovery routines, including regular stretching, yoga and deep-breathing exercises. Additionally, Rachel provided parent coaching to help Hazel navigate the sensory and emotional demands of parenting her three-year-old daughter.
Response
Following the completion of the SSP and her collaborative work with her provider, Hazel reported meaningful physical, emotional and functional improvements, with additional positive changes observed by Rachel:
- Reduction in Pain and Irritability: Physical pain flares related to noise sensitivity had decreased. Hazel noted that noise no longer induced irritability, stating that this symptom has “pretty much gone now.”
- Improved Parenting Capacity: Managing the family morning routine has become significantly easier. Hazel can now tolerate ambient noise, such as the radio, without feeling irritable. Her anticipatory anxiety regarding weekend parenting demands, which previously began building as early as Monday, reduced to little or no anxious feelings.
- Increased Community Participation: Hazel has successfully visited cafes with her family. While she still uses earplugs as a preventative measure, she feels comfortable and unbothered by the environment. She can now enter and shop in visually and auditorily demanding department stores without earplugs — environments she previously avoided entirely. Furthermore, she is attending church more frequently and coping well with those auditory demands.
- Enhanced Auditory Processing: She can comfortably remain present in a room where multiple conversations are occurring simultaneously without experiencing distress or cognitive overload.
- Reduced Avoidance and Increased Stamina: Hazel is less likely to avoid busy situations, allowing her to plan and participate in meaningful weekly routines. Her overall functional stamina has improved; she can fit more activities into her day with less fatigue, at times eliminating the need for an afternoon nap. Her walking distance has also increased, positively impacting weekend family outings.
While Hazel continues to work toward her long-term goal of returning to her teaching career, she reports feeling that the SSP accelerated her recovery trajectory faster than would have occurred otherwise.
Hazel shared:
“It’s been awesome; noise sensitivity has improved significantly. It was previously so limiting. I would recommend it to anyone with noise sensitivity or who even just wants to work on their vagus nerve.”
Her provider noted that the impact of the SSP was evident both psychologically and physically. During the final Zoom consultation, Hazel’s eyes appeared brighter, and her posture was notably more upright. Although she recognizes that her recovery journey is ongoing, she maintains a positive and open outlook.
Discussion
Hazel was desperately looking for an intervention to reduce her noise sensitivity, expressing frustration that her other providers were focusing on everything except this specific symptom. Since this sensitivity significantly impacted her pain and fatigue, she felt that her recovery would be hindered without addressing it directly.
Hazel was a highly motivated and resourced client who was able to follow the listening plan, access coregulatory support and engage with and communicate with her provider without difficulty, making independent at-home delivery safe and suitable for her. Her provider noted that the self-determination and self-efficacy Hazel gained by taking charge contributed greatly to her overall success.
From a clinical standpoint, an important adaptation was made regarding outcome measurement. During the initial consultation, Hazel stated she was sick of objectively charting her progress, such as being asked to rate her pain out of 10 for other providers. Taking the client’s lead, Rachel made an informed clinical decision to forgo objective, numbered outcome measures. This adaptation developed deep therapeutic trust, helped the client feel fully “in charge” of her own therapeutic journey, and contributed to creating calm in her nervous system.
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