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Case StudySSPPhysical Challenges

Safe and Sound Protocol (SSP) reduces frequency of cyclical medically unexplained symptom flare-ups

🕑 8 minutes read
Posted October 10, 2023

About the Provider

Name: Terri Rowland
Disciplines/credentials: Compassionate Inquiry Practitioner
Modalities: Safe and Sound Protocol (SSP), TheraPhi therapist, chartered herbalist, certified reflexologist, birth doula

Client Background

Name: Fred (pseudonym)
Age and Gender: 72-year-old man
Program Delivered: Safe and Sound Protocol (SSP) Core (Hours 1-5); Balance (Hours 1-5)

Fred has an array of medically unexplained symptoms (MUS) that medical professionals have generally diagnosed as an autoimmune disorder and auto inflammatory disorder. The symptoms associated with his MUS began about 20 years ago. 

Fred’s set of symptoms, referred to as a “flare-up,” appear in a very specific order in constant 30-day cycles that begin on Fridays. The set of symptoms appear in the following order:

  1. Itchy and swollen hands, and a red, blotchy rash on the front of the body opposite of his trunk that moves to the arms, hands, face and then to the trunk at the back of the body. 
  2. A complete cessation of appetite, followed by a fever, severe chills and massive internal inflammation of every organ and body system. 
  3. By day two of a flare-up, Fred is unable to drink any fluids and has violent retching every hour, lasting two to three days. By this point, the kidneys go into complete shutdown (renal failure) and remain non-functioning for four days. This forces Fred to stay in bed for seven to 10 days with no food and very little fluid. He spends most of this time asleep, and “when he [is] awake, the weakness he experiences renders him almost immobile. His misery [is] unspeakable,” according to Terri. 
  4. The last symptoms are nosebleeds and a heavy headache, accompanied by slow mental processing lasting for five to seven days. 

Typically, the inflammation would then begin to subside. He would be able to get out of bed and ease back into eating and drinking, his kidney function would resume, and his energy levels would gradually begin to increase (although the first four to five days after a flare-up remitted were physically and energetically agonizing). 

Just as he would start feeling “normal” again, the next flare-up would begin. Fred’s quality of life was being severely impacted and he experienced despair, not being able to do anything to prevent his mysterious set of symptoms. 

His symptoms have stumped many specialists across his country. There was no treatment available because they did not know what his body was doing. Blood work, scans and biopsies revealed that things were seriously out of order internally, but shed no light on the cause or mechanism. 

Fred lives alone and has recently lost a spouse to cancer. He had little for a support system and was self-employed, as he was unable to hold down a regular employee position due to his health challenges. 

The markers in his blood for kidney function and inflammation were extremely high. Certain white blood cell counts were unusual, either very low or very high. Red blood cell counts were odd and unexplainable. Nearly every value that was examined in his blood was outside of normal range, most of them significantly high. 

Terri brought on Fred as a client once she had an understanding of the vagus nerve and the SSP. At the start of his first SSP session, he was skeptical because the barrage of symptoms had always been unrelenting and at the time had been worsening. Treatment goals were to help the vagus nerve find some regulation and to see the potential impact on his set of symptoms.

Implementation of the Safe and Sound Protocol (SSP)

Fred was Terri’s first SSP client. They first began with the SSP in August 2021. The treatment plan was to meet in person daily from Monday to Friday and see how much listening, if any, he could tolerate. They began with SSP Core, completing 30 minutes of listening each session with pauses for regulation exercises as needed.

During Hours 3, 4 and 5 Fred took a couple days’ break between the sessions. Some of the songs on the SSP Original playlist brought up sadness from painful memories for Fred. When this happened, the music was paused and he would talk a bit about the memory, allowing himself to feel what had come up. During these pauses, they did touch exercises, which worked well for Fred. 

Most sessions caused some physical discomfort. By the end of the sessions, he was feeling a new sensation that took him some time to name — he eventually realized he was experiencing peace, which was something completely new for him. He experienced some headaches post-listening, but they were resolved within the same day and did not disrupt the listening plan or pace.

Fred completed his first round of the SSP over 12 days. By the end of this round, he was feeling significantly more relaxed and the feeling of peace was welcomed. When peace was present, it was very easy to see that his social engagement system was engaged. Fred listened to SSP Balance three or four times a week following the completion of SSP Core. There was no difference in his flare-ups, but the feeling of peace continued. 

Eight weeks after Fred completed his first round of SSP Core, his second round began. This round took 13 days with breaks throughout. Again, Terri stayed with Fred for each session, co-regulating and doing breathing and self-touch exercises. Fred felt much more emotion this time and took breaks during the listening sessions to process. He felt some agitation through Hour 3 that resolved in Hour 4. 

The peaceful feeling at the end of each session was even more pronounced than during the first round of the SSP. Fred would sit in the recliner after the session was over with his hands over his heart and savor this feeling of peace for up to half an hour each session. His social engagement system was fully engaging before the end of each listening session. 

After the second round of SSP Core was complete, Fred listened to SSP Balance five times per week for three months. He tracked his flare-ups and noticed they were lasting for only four days instead of seven to 10 days. The cyclical intensity was still high, but he started to recover more quickly. After several months, he noticed the time between flare-ups was lengthening to six weeks between flare-ups instead of the previous three weeks. 

Six months later, Fred was ready for his third round of SSP Core. For this round of listening, Terri and Fred started the listening session together with co-regulation exercises. Terri would then leave the room and let him listen to the music independently in his own space and peace. He listened to the SSP Core Classical playlist. Since this playlist does not have words, there was no association to the lyrics this time, and he noticed a huge difference in his body. The peace he felt this time was once again even more pronounced than before, and he was able to sense and name that he was now feeling safe. The third round of SSP Core took nine days and Fred continues to use SSP Balance almost daily, often describing his state as blissful.  

Since the beginning of 2023, Fred has only had two minor flare-ups that lasted two days each. He has had two “mini” flare-ups that came and went very quickly with only a few of the symptoms presenting rather than the entire set. His kidneys are no longer shutting down and his overall health is improving as his body is able to heal from the damage created by his flare-ups. 

Fred also recently received shocking results from his blood work. All the values in his blood work were within normal range, with only one or two tests slightly elevated. (One value is notably elevated, but there is an explanation for it.) He was pleasantly surprised and grateful about this change. 

He is now finding homeostasis as the dread of repeated flare-ups is leaving him, and he is beginning to gain some trust in his body again. He is able to enjoy life differently now and can access a ventral state with some regularity. He is playful, happier and feeling safer than he has for a long time. Fred now uses Polyvagal Theory language in his daily living and recognizes when he is in different autonomic states and what they mean. 


“The changes in his cyclical flare-ups have dramatically abated. The blood work earlier this year proves on the biological level the improved immune response through the SSP, the reduction in inflammation system wide, and the reduction in trauma through the SSP,” Terri said. 

Terri shared that all previous attempts at modality work for Fred’s MUS resulted in one of two results. The attempts either changed absolutely nothing or triggered an immediate flare-up. Before the SSP, his vagus nerve had been dysregulated, putting him in a chronic state of defense. Fred has tried psychotherapy a few times and even before the session concluded he was already heading into a flare-up. 

Fred is well aware of his childhood trauma, which began at a very early age. The reactivity in his body demonstrates the vagus nerve’s survival response through the MUS set and how protective its function has been through the trigger of immediate flare-ups when trying other modalities outside of the SSP. 

Today, Fred has an improved quality of life, more enjoyment and reduced stress overall. He is so relieved that these episodes are moving into remission. The peace and bliss he is finding is tremendous. His ability to regulate and notice when he is either dysregulated or regulated is improving constantly. He is living in a new world of vagus awareness and function. 


Co-regulation was very important for Fred. The presence of a regulated vagus nerve during the first two rounds of the SSP contributed to the peace and safety he found. In the third round of the SSP, the vagus nerve was finding its own regulation within the sessions, which is why he was able to listen by himself. Terri shared that, in hindsight, Fred may have benefited from starting with SSP Connect rather than jumping straight into SSP Core

Fred refused to fill out any forms as it has always caused him a high level of stress. Terri and Fred met in the middle, collaborating on questions and answers. 

Terri shared that it was noteworthy that she took the SSP training because of Fred: “I had heard [Dr. Stephen Porges] present on Polyvagal Theory in the summer of 2021. At the end of his presentation, he said two lines about MUS and a five-hour musical intervention. Within two weeks, I was in the SSP training.” 

“I am so pleased and so amazed at the depth of function that can be restored to a badly dysregulated nervous system. I am profoundly grateful for Stephen and Unyte for bringing this healing to the world,” Terri said. “The client is so happy the cycle of flare-ups has changed. The terror and dread he would feel when his hands started to itch was awful. He would cry when he felt a flare-up start. He has found liberation through regulation.”

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