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: Dara Paprock
Disciplines/credentials: Associate Marriage and Family Therapist (AMFT), Licensed Chemical Dependency Counselor (LCDC), trauma-informed yoga teacher
Modalities: Safe and Sound Protocol (SSP), cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), sensory integration processing, integrative therapies, yoga therapies, play therapy, drama and sensory therapies, art therapy, Internal Family Systems (IFS)
Client Background
Name: Joy (pseudonym)
Age and Gender: 60-year-old woman
Program Delivered: Safe and Sound Protocol (SSP)Core (Hours 1-5); Connect (Hours 1-5); Balance (Hours 1-3)
Joy was referred to SSP provider Dara Paprock by her husband of 10 years. She presented with prescription benzodiazepine withdrawal syndrome, PTSD symptoms, panic, isolation, anxiety and depression. Joy, a survivor of the Sept. 11, 2001, attacks, had been receiving psychiatric and psychological treatment from the World Trade Center (WTC) Health Program for 22 years. Unfortunately, the treatment was ineffective. Joy was experiencing uncontrollable bouts of crying and weeping, and constant nausea that increased in intensity and frequency over the last eight months. The nausea led to visits to the emergency room, and medications were not helping. Her annual physical checkup with the WTC clinicians did not explain the reason for the nausea. Furthermore, over the 22-year period of care from the WTC Health Program, she had been hospitalized multiple times with increased symptoms of isolation and anxiety.
Joy was prescribed benzodiazepines immediately following 9/11. She was educated on the long-term, negative effects of benzodiazepines and over the years tried to seek alternatives so she could get off them completely but had terrible results. She had been prescribed the maximum dose for at least 12 years and also took an SSRI for her depression. She stated that she felt like “no one understands” and had limited contact with friends and family. She was afraid to be alone and missed her life.
“Benzodiazepine withdrawal syndrome can occur while maintaining prescribed dosage. This is because of the tolerance and highly addictive factors of the drugs in that class, which can happen quickly,” explained Dara. “Further research in PTSD shows that introducing benzodiazepines as initial treatment for trauma may prevent physical processing of the trauma within the first 30 days, prolonging and compounding the symptoms.”
Joy was seeking support for:
- Medically induced benzodiazepine dependence
- PTSD
- Panic, depression and agoraphobia
- Chronic state of nausea at a seven or higher (with zero being no nausea and 10 being the need to call an ambulance)
Since benzodiazepine was no longer effective in treating her anxiety, she was hoping to get off the medication. She believed that her chronic state of nausea could have been a result of long-term use at maximum dosage.
When Dara first met Joy over Zoom, she began crying. In order to proceed, Dara used empathetic and active listening, reflecting, reframing, somatic prompts, and a Brain Gym program. The initial consultation lasted one and a half hours, during which Dara observed that Joy had irregular breathing and at times wasn’t breathing at all.
Dara noted that nausea and repressing the breath can be symptoms of long-term anxiety and side effects of benzodiazepine. Because of Dara’s experience as a chemical dependency counselor and somatic practitioner, she experimented with short breathing exercises to determine if Joy was a candidate for the Safe and Sound Protocol (SSP). Within 20 minutes, they were able to bring her nausea from an eight and a half to a three.
Due to this indicator, Dara chose to introduce the SSP to Joy. Joy committed to engaging with SSP Core and following up with her progress throughout. Dara hoped that the SSP would support an induced relaxation response to address and modify perceptual distortions of constant fear so that Joy could better relate to her care team and get her needs met.
Implementation of the Safe and Sound Protocol (SSP)
The SSP was delivered remotely. Joy and Dara’s first two sessions lasted two hours, with 30 minutes of SSP Connect listening. In the third session, Dara listened alongside Joy to get started with SSP Core.
Prior to each SSP Core listening session, Dara encouraged Joy to find a comfortable place where she could move around and have water. She recommended that Joy bring something to squeeze, such as a pillow, to acknowledge and meet the intensity of feelings that were arising, including nausea and shaking.
During the first SSP Core session, they paused often to address the feelings that were surfacing. Dara also invited Joy to periodically blow on her own finger like a candle, sustaining the exhalation and using her eyes to focus on her finger to bring her back to the “here and now.”
On the second day of SSP Core, Joy brought food, water, blankets and pillows. They began the session by rating Joy’s anxiety and nausea levels. They engaged in breathing and grounding exercises, tense and release prompts, and ensured that Joy’s breathing was regulated and comfortable. She was able to spend about 30 minutes engaged with listening while coloring in an adult coloring book.
Additional supportive activities included psychoeducation, co-regulation, Brain Hack series, silence, acceptance, encouragement, affirmations and reflection. They printed the Brain Hack PDF so that Joy could engage with it when she felt overwhelmed. Dara used these tools to encourage Joy to experience her feelings.
Response
Three weeks after completing SSP Core, Joy was able to maintain decreased symptoms of nausea and anxiety. Her tolerance for time outside of the home increased by 20% and her ability to locate the source of her anxieties and ask for what she needs improved by 40%. She continues to meet with Dara on a biweekly schedule or as needed.
After the fourth day of the SSP Core, Joy’s husband shared with Dara, “She has improved more with you in less than a week than 22 years of psychiatry and psychotherapy.” He maintained this sentiment 21 days after Joy completed the SSP.
Dara noticed remarkable changes in Joy within the first five days of listening. For example, on day three, Joy’s nausea level was less than one, rather than her typical rating of an eight. Her psychiatrists met with her one week after she began the program and wrote her a prescription to continue with the SSP.
Discussion
Dara shared that providing enough time for initial intake, meeting at the same time each day, and adding somatic interventions was vital to Joy’s success with the SSP. Dara also reported that acknowledging Joy’s physical responses indicative of parasympathetic nervous system activation as positive – such as sighs, yawns and deep breathing – had been helpful.
© 2024 Unyte Health US Inc.