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: Alycia O’Connell
Disciplines/credentials: Licensed Clinical Social Worker (LCSW), Licensed Clinical Independent Social Worker (LICSW), Certified Alcohol Drug Counselor (CADC-III)
Modalities: Safe and Sound Protocol (SSP), Eye Movement Desensitization and Reprocessing (EMDR), Internal Family Systems (IFS), Compassionate Inquiry, Cognitive Behavioral Therapy (CBT), Motivational Interviewing (MI)
Client Background
Name: Candace (pseudonym)
Age and Gender: 27-year-old woman
Program Delivered: Safe and Sound Protocol (SSP) Core (Hours 1-5); Balance (Hours 1-5)
Candace sought therapy for a diverse range of challenges and symptoms that significantly impacted her daily life. These included anger issues that had led to multiple job losses, persistent anxiety, changes in appetite, overwhelming feelings of boredom, fluctuations in weight, difficulties with concentration, frequent crying spells, persistent depression, an inability to make decisions, profound disappointment, and a problematic relationship with alcohol.
Candace also experienced chronic fatigue, feelings of abandonment and misunderstanding, pervasive guilt, a sense of hopelessness, irritability, and irrational thoughts connected to her anxiety.
In addition to these symptoms, Candace reported feelings of profound loneliness, a marked loss of interest in previously enjoyed activities, low energy levels, unpredictable mood swings, occasional panic attacks (occurring once or twice a week), withdrawal from social interactions, disturbances in her sleep patterns, chronic stress, troubling thoughts of suicide, work-related issues, and constant worry.
Clinically, Candace was diagnosed with both post-traumatic stress disorder (PTSD) and major depressive disorder (MDD).
At the start of treatment, Candace and her mother were grappling with the significant challenge of homelessness, which had persisted for several years. At the time, they resided in subsidized housing, with Candace’s mother receiving disability support. Candace, on the other hand, had been attempting to sustain employment through seasonal jobs. However, her ability to maintain employment had been consistently undermined by difficulties in managing anger and emotional regulation.
Candace had historically engaged with mental health professionals, dating back to her childhood, particularly during her time in foster care. As a result, she arrived at therapy with a complex clinical picture, marked by a series of prior diagnoses and an extensive history of trauma.
Candace’s primary goals with the SSP were to address her significant symptoms of depression and anxiety, which had been profoundly affecting her daily life. In addition to these symptoms, she expressed a strong desire to achieve specific goals. Her treatment objectives included completing her associate degree and establishing stable, long-term employment.*
Implementation of the Safe and Sound Protocol (SSP)
The SSP listening sessions were delivered remotely and independently. Candace’s engagement with the program was closely monitored, and she communicated her progress to provider Alycia daily, enabling them to titrate the listening as needed.
Candace started with 10-minute SSP listening sessions, and occasionally had to shorten to five minutes due to an increase in anxiety symptoms. After completing SSP Core, she also participated in SSP Balance, which she tolerated well.
Prior to beginning the SSP, Alycia had Candace engage in a Polyvagal autonomic nervous system mapping activity. This activity allowed them to gain insight into Candace’s autonomic nervous system functioning, providing valuable information for tailoring her therapeutic journey.
To ensure a smooth transition into the SSP, the very first 10-minute listening session was done in-session. This approach served multiple purposes: it helped Candace become familiar with the app and the listening process, and provided an opportunity to monitor for any adverse reactions. During her listening sessions, Alycia remained on camera, offering occasional visual cues, such as a thumbs-up signal, to gauge Candace’s comfort and progress. Candace reciprocated with a thumbs-up, facilitating real-time co-regulation.
Candace’s creative talents were a valuable aspect of her engagement with the program. She skillfully integrated her artistic pursuits, such as painting, diamond painting, crafting and puzzles, during her listening sessions.
“The trust and rapport established during our several years of working together played a pivotal role in Candace’s willingness to explore this novel therapeutic approach,” Alycia said. “As a result, we witnessed substantial gains that were previously unattainable through conventional therapeutic methods. The Safe and Sound Protocol (SSP) contributed significantly to her overall progress, allowing us to address areas of concern more effectively and deepen her healing journey.”
Over time, Candace demonstrated remarkable progress. She subsequently completed two additional rounds of the SSP, with five-month intervals between each round. Notably, she was able to extend her listening sessions to 30 minutes without any issues and no longer required support to modify the dosage. Her growing self-reliance in the listening process became evident, as she consistently tuned into her body and her unique needs.
Candace reports that the two challenges she had during the program were finding time to listen to the SSP every day and not over-listening. She shared that having a daily check-in helped to keep her daily routine and prevented her desire to just push through without listening to her body.
Response
Since completing SSP Core and SSP Balance, Candace has completed her associate degree and her first year of her bachelor’s degree. She has completed two separate practicum jobs and has maintained a job at a local school.
Recently, Alycia and Candace celebrated her progress by reviewing score graphs at various time points, highlighting the remarkable improvements she has made since beginning the SSP. Candace took pride in these achievements, serving as a testament to her dedication and the remarkable progress she has achieved in her therapeutic journey.
“Candace has always been one of my most dedicated clients. Throughout her therapy journey, Candace has consistently demonstrated unwavering commitment. When we were in person, she would take two buses to get to our sessions. She has never missed a session and never been late,” Alycia said. “Candace quickly grasped concepts from cognitive behavioral therapy (CBT) and Nonviolent Communication (NVC), [and] she was dedicated to completing homework assignments, but she had reached a plateau before the SSP.”
“The introduction of the SSP significantly impacted her journey, enhancing her overall well-being and allowing her to thrive in various facets of her life. It truly feels like the missing piece for this client” Alycia shared.
Candace’s scores were captured through three Unyte Assessments. The scores on her Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder (GAD-7) and PTSD Checklist for DSM-5 (PCL-5) dropped following the SSP. See below for Candace’s PCL-5 scores, as well as an analysis from Susanna Coss, Unyte Health’s Research and Training Associate.
Analysis: The overall severity of PTSD symptoms is summed, with scores ranging from 0-80. Higher scores indicate a greater severity of PTSD symptoms. Candace’s initial score of 74 signifies the presence of severe PTSD symptoms. A reliable change is considered to be between 5 and 10 points, while a change of 10 to 20 points suggests clinically significant progress. This progress is evident in Candace’s score, which decreased from 74 to 29 (45 points).
Discussion
Alycia shared that she’s noticed a profound transformation in Candace’s ability to connect with her body and emotions. Before the SSP intervention, she often responded with “I don’t know” or shut down when asked about her feelings or bodily sensations. Post-SSP, Candace not only identifies and labels her emotions but describes her bodily sensations in intricate detail. Additionally, her capacity to express metaphors and wisdom arising from her body attests to her heightened self-awareness and emotional intelligence. Alycia also shared that they were unable to successfully engage in Internal Family Systems prior to the completion of SSP due to her dissociation and lack of ability to tune into her body. Post-SSP, it is now one of her favorite modalities.
When Alycia inquired about Candace’s observations, she articulated several notable benefits she has experienced as a result of the intervention. She emphasized that the Safe and Sound Protocol (SSP) has notably improved her capacity to self-regulate her emotions. In situations where she typically felt overwhelmed and compelled to either avoid or swiftly exit, she now finds herself better equipped to navigate her emotions effectively. The SSP has been especially valuable in helping her manage overstimulating environments, allowing her to approach social scenarios with newfound confidence and comfort, even amidst high levels of noise.
Additionally, she shared how the intervention has enabled her to prioritize self-care, regain control of her breath during moments of panic, and gracefully step away from challenging situations for self-regulation. She’s now able to do this without abruptly exiting, feeling guilt for potentially causing a scene, or experiencing a panic attack. Candace’s final note highlighted a practical benefit: she no longer feels the need to cover her ears in response to the loud sirens of fire trucks or alarms.
She also explained that another crucial insight gained from working with Candace was the recognition that client shutdown during sessions often signifies an underlying need for nervous system regulation. She now understands that when personal frustration arises in these moments, it serves as a signal for her to regulate her own nervous system as a clinician.
“This self-awareness has been instrumental in fostering a more empathetic and effective therapeutic alliance,” Alycia shared.
Candace’s journey through the SSP illuminated the critical role of co-regulation at the outset of the listening process. Daily check-ins proved to be essential not only for maintaining consistency but also for providing much-needed support and ensuring the appropriate dosage of the intervention.
In Candace’s case, the SSP has provided invaluable insights into the significance of nervous system regulation within the therapeutic context. It became evident that establishing a sense of safety within the nervous system is fundamental to achieving meaningful progress in therapy, regardless of a client’s dedication and reliability. Alycia shares that this understanding has prompted a shift in her approach, emphasizing the importance of nervous system regulation as a foundational element of effective therapeutic work.
*As a recent update, Candace graduated with her associate degree and by June of 2024 she will have completed her bachelor’s degree. She has also applied to an advanced standing master’s program in the mental health field!
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