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Case StudySSPAnxiety

SSP and OT intervention help eliminate teen’s panic attacks at school

🕑 3 minutes read
Posted November 14, 2022

About the Provider

Name: Shamala Manilall
Occupational therapist
Safe and Sound Protocol (SSP), Sensory Processing/Integration, neurodevelopmental treatment (NDT)

Client Background

Name: Alyssa (pseudonym)
Age and Gender: 13-year-old girl
Program Delivered: Safe and Sound Protocol (SSP)
(SSP Core, Hours 1 through 5)

Alyssa lives with her parents and sibling in a middle-class home and attends her local community junior high school. She was diagnosed with anxiety disorder and had been experiencing several panic attacks daily that resulted in a loss of consciousness at least twice a day, putting her at high risk for physical injury. The only noticeable sign leading up to a panic attack was the vigorous shaking of her legs, but by that time it would be too late to intervene.

These episodes started when she was 12 years old and had been occurring for about a year. There was no significant event other than some social challenges with her girlfriends that seemed to coincide with the first episode. She had been receiving cognitive behavioral therapy (CBT) through a psychologist and was followed by a psychiatrist.

Since she was losing consciousness so often, she was assigned an educational assistant to support her safety at school. After several months, the school and her family felt that she needed targeted intervention and requested occupational therapy (OT) support. The process began in January 2022, and Alyssa was assigned an OT assistant (OTA) in March to support her on a daily basis with developing strategies to manage anxiety, emotional and self-regulation, self-advocacy, executive skills and social skills, with the goal of reducing the frequency and intensity of the panic attacks.

Alyssa had been on 125 mg of Sertraline, which was increased to 150 mg after an appointment with the psychiatrist just before starting the Safe and Sound Protocol (SSP) with provider Shamala Manilall. To allow Alyssa’s body to adjust to the medication, Shamala withheld the start of the SSP following this change.

Implementation of the SSP

The SSP was delivered to Alyssa remotely with the OTA as the supporting adult. Alyssa listened to the SSP music for 30 minutes every day in a quiet room while engaging in puzzles and sucking on a lollipop as needed.

Other modalities were also used. Shamala implemented the FOCUS on Self-Regulation program, which includes motor activity, breathing and mindfulness, after each session. Alyssa chose to use the breathing exercises from the sequence as her main strategy to support her regulation.


Alyssa responded immediately to the SSP Core. On the third day of the half-hour sessions, her panic attacks dropped to once per day. By the sixth session, the duration of her panic attacks had reduced in intensity and would last about one to two minutes — from 15 minutes previously.

Within one month of completing the SSP, Alyssa was completely free of panic attacks at school.

Alyssa is very insightful and aware of her challenges. She is now advocating for herself by asking for specific supporting strategies and occasionally will ask to listen to the SSP music for about 15 minutes to help manage and maintain this progress, as she understands that the SSP was beneficial to her progress.

Alyssa’s parents are highly appreciative of the change in her level of anxiety and have indicated that the support has been “instrumental” in their lives. The school team has recognized the value of the SSP Core, as well as the supplemental OT intervention, and advocated for OT support for the next school year.


“The treatment has been highly successful,” Shamala said. “The effectiveness was more apparent due to Alyssa’s insight, feedback and requests for the music.”

Shamala notes that at this time, Alyssa’s providers did not work as a multidisciplinary team to understand each other’s roles in support of Alyssa’s challenges, and that it is hard to compare the effect of the medication versus SSP Core as there was no other comparison to use.

“We understand from mom that the psychiatrist’s goal is complete remission from any panic attacks,” adding that her Sertraline dosage was increased to 175 mg, despite her being free of panic attacks at school, five weeks following the completion of the SSP Core.

Discover the Safe and Sound Protocol

Developed by Dr. Stephen Porges, the SSP is a non-invasive acoustic vagus nerve stimulator that helps clients connect with themselves, others, and the world from a foundation of physiological safety.

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