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Case StudySSPAutonomic Nervous SystemLong COVIDPhysical ChallengesPolyvagal Theory

The Safe and Sound Protocol (SSP) as a gateway to healing for people with long COVID

🕑 6 minutes read
Posted September 28, 2023

About the Provider

Name: Sally Riggs
Disciplines/credentials: Psychologist, coach
Modalities: Safe and Sound Protocol (SSP), Cognitive Behavioral Therapy (CBT), Coaching

Client Background

Name: Maggie (pseudonym)
Age and Gender: 46-year-old woman
Program Delivered: Safe and Sound Protocol Core (Hours 1-5); Connect; Balance

Maggie presented in January 2022 with long COVID. Symptoms listed were, but not limited to, brain fog, headaches, memory loss, post-exertional malaise, fatigue, chest tightness and pain, shortness of breath, urinary incontinence, insomnia and weight gain: “My whole body is inflamed and puffy.” She met the criteria for diagnosis with postural orthostatic tachycardia syndrome (POTS), dysautonomia and chronic fatigue syndrome (ME/CFS).

Maggie lives at home with her husband and two teenage sons. Her third son is away at boarding school. She lives in Scottsdale, Arizona, which is a very hot and dry climate, especially in the summer.

In Maggie’s own words, she said, “My husband is great at advocating for me and helping me to make medical decisions regarding my care. He is less capable of showing emotional support.  Our three sons are very worried about me and help whenever I ask.”  

When provider Sally first met Maggie in January 2022, Maggie said, “I have tried everything: red light therapy, trigger points, acupuncture, supplements.” 

As a medical professional, she had also sought help from every medical specialist, including cardiology, pulmonology, and functional medicine specialists. Reportedly, all were telling her there wasn’t much more they could do. 

Prior to infection with SARS-CoV-2, Maggie was an active, high-achieving professional, mother to three teenage boys, and wife to a busy, professional husband. She was a clinical research administrator, traveling frequently for work, juggling her children’s needs, and her husband’s busy work travel schedule. On top of it all, she would regularly run half-marathons.

She had a pre-existing diagnosis of Celiac disease that was well managed with diet, and was otherwise fit and healthy. She also reported a diagnosis of major depressive disorder (MDD), for which she had been prescribed antidepressants since college.

Maggie was seeking support in her recovery journey with long COVID. Her suspected initial infection was December 2019 at 43 years old. Maggie said that she felt stuck, and that she was in an immobilized state. She had heard Sally Riggs, her SSP provider, referring to this in a YouTube video for “long haulers” discussing Polyvagal Theory

She reported that for a year, she did not know what was wrong with her, and went from doctor to doctor until finally in September 2020, her cardiologist said, “I think you have long COVID.”

At the time, she reported brain fog, headaches, memory loss, post-exertional malaise (PEM), fatigue, chest tightness and pain, shortness of breath, urinary incontinence, insomnia, and weight gain. She reported having reluctantly quit work at the end of October 2021. She tried to rest, but experienced no change with her symptoms. She also reported that people told her that she wouldn’t ever get better, and she needed to accept her disability. 

The treatment goal was for Maggie “to be who she used to be”: physically strong; mentally strong; able to take care of her family, be on top of her game professionally, and exercise.

Implementation of the Safe and Sound Protocol (SSP)

The SSP was delivered over Zoom remotely. Maggie began by listening to the SSP Connect pathway from January through February 2022 for 30 minutes most days. Maggie began listening to SSP Core between February and June of 2022. She also continued listening to SSP Connect throughout the delivery of SSP Core. 

SSP Core was delivered five minutes at a time, initially in remote sessions, with a maximum of 10 minutes of listening per session. Listening sessions occurred twice per week. Once Maggie reached hour two, she engaged in some listening at home between sessions, up to a maximum of five minutes per day two or three times a week, with no listening happening on days she was symptomatic. 

All of hour three took place in sessions over Zoom, continuing with five minutes of listening twice per week. Again, hours four and five included some listening at home between sessions. 

Once SSP Core was finished, Maggie took a one-week break before moving onto SSP Balance. She listened to SSP Balance two or three times per week for five minutes at a time, and still continues this now. She also listens to SSP Balance on symptomatic days, rather than skipping.

During the remote delivery sessions, the client was encouraged to learn more about her own nervous system, and was supported in being able to name the state she was in. She was also provided with exercises to help support her nervous system and facilitate gentle movement between Polyvagal states. For example, when noticing dorsal activation, she was supported with gentle rocking, holding her face in her hands, and deep breathing.


Sally is well on her way to living the life of her dreams again. Her activities of daily living (ADLs) have much improved, as has her brain fog and energy.

Initially upon completion of the Safe and Sound Protocol (SSP), the client still reported fatigue and some frustration that she wasn’t better. She also reported ongoing insomnia.

A week later, she reported improved brain function and being able to tolerate a little more activity. Over the summer, things slowly started to improve more. Family members reported significant change in affect and connectedness.

“I also noticed a significant change in affect,” Sally said. As of the end of October 2022, she reported that Maggie was “much better,” with significantly less fatigue, PEM and brain fog. Maggie has also been able to travel to visit family, accompany her husband on work trips, and attend her son’s sporting events. 

“At the time of writing this case study in November 2022, she is reporting improved mental cognition (able to make decisions; no longer getting lost in her neighborhood while driving; word recall improved; not as easily overwhelmed),” Sally said. 

Maggie also reported attending her sons’ activities, such as football games, soccer games and horse competitions. She is now able to drive an hour each way to pick up her son from school once a week. With the support of a CAWS coach, she is now walking up to 30 minutes twice a week, and has increased her strength and conditioning work to one to two times a week. She also continues to travel more, using a wheelchair in the airport.


Sally shares that she knows that this intervention helps people with long COVID because it worked for herself and has worked for many of her subsequent clients since. 

“Over time, I have learned more about befriending my nervous system, more techniques for leaning into nervous system states, and gently supporting movement towards sympathetic and ventral. I have also integrated these concepts into my sessions.” 

She also learned that it is incredibly important to go very slowly with clients with long COVID: “I cannot stress this enough.” This client was able to tolerate five minutes at a time; however, others have needed to go even slower, perhaps two or three minutes or even less. 

“If you are delivering the SSP to clients with long COVID, I do not recommend 15 minutes of listening upfront, as it can lead to a crash and other symptoms. Also, it is crucial to provide co-regulation, at least for hours one and three. I would not recommend giving the client access to the app without support,” Sally said. 

Sally also shared what she would do differently next time. 

“[I’d] use pre- and post- measures to demonstrate the impact the SSP can have. With this client, I was fairly new to the SSP, so we just used the Unyte SSP Intake Form and the ANS Screener. I realize now this doesn’t allow me any pre- and post- analysis. I am now using the [Body Perception Questionnaire], [Neuroception of Psychological Safety Scale], and a functioning and quality of life assessment.” 

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