UNEDITED TRANSCRIPT: The following transcript may contain typographical errors or other mistakes due to inconsistencies in audio quality, background noise, or other factors. We cannot guarantee its precision or completeness. We encourage you to use this as a supplement to your own notes and recollection of the session.
Tami Simon: In this episode of Insights at the Edge, my guests are Dr. Stephen Porges and Karen Onderko. We are celebrating the release of their new book with Sounds True. It’s called Safe and Sound: A Polyvagal Approach for Connection, Change, and Healing. Stephen Porges is a world-renowned and distinguished neuroscientist, the developer of Polyvagal Theory and the creator of the Safe and Sound Protocol. He’s published more than 500 peer-reviewed papers and six books on Polyvagal Theory. Karen Onderko has been instrumental in bringing the Safe and Sound Protocol from the laboratory to the clinical worlds, conducting the initial testing, developing the early training, creating delivery guidelines, and supporting the Safe and Sound Protocol provider community. And here they are. Together we’re celebrating the release of Safe and Sound. Steve, Karen, welcome.
Stephen Porges: Thank you, Tami.
Karen Onderko: Thanks, Tami.
TS: Here at the very beginning. I mean, Steve, it’s a really big deal to be the developer of a new theory of how we understand the human nervous system. So right here at the beginning, and as a way of introducing you and the theory to our listeners, tell us a little bit about that. How did this happen? How did you develop a new theory?
SP: Well, the developing it, you know, many people have kind of like insights, intuitions or visions. I’m not saying there’s pathology lock with all those, but, um, basically I’ve spent decades trying to create a language for what I saw or what I. Saw the world as, or how the nervous system worked.
And I, to me it was very intuitive, very natural. I didn’t think it was novel. I thought it in, in many ways I thought it was derivative because the ideas to me were sitting right in front of me. And when all one needed to do was to read literally the foundational material. And this, of course would be the obvious conclusion.
Uh, what is the obvious conclusion? Because the listeners might wanna know what that is. It’s extraordinarily simple. It’s really states that our physiological state, that we’re in our biobehavioral state, whether we’re highly aroused, calm, we’re sleepy, impacts on how we react and interact in the world. It biases how we relate.
And if we take that as an understanding of what it is to be a human, we realize that aberrations in our behavior can be mediated by the state we’re in. So if we’re anxious, we’re over aroused. If we’re in a state of the. Let’s say defensiveness. We’re not processing the information in the same way as if we were in a calm state, engaged, curious, and on a journey of exploration.
So our physiological state is really a mediator of our experience. And in knowing that, acknowledging that, we then start asking big questions. Can we use that knowledge as a portal of intervention to enable people to feel calmer in their bodies and safer with others?
TS: Okay. One follow up question about this, Steve, for people who are still like, wait a second. How did this new framework change our appreciation of the human nervous system? How do we think about it differently now?
SP: Okay, so the point is we, I would say that most people basically made that assumption that the assumption that our bodily state impacts on our behavior, uh, for themselves, but they projected on others that everyone else’s behavior is intentional and controlled by reinforcements.
So why a child acts out, people would say, well, they want attention. They’re not saying they’re acting out because their physiological state is dysregulated. So we lived in a world that had two vectors. One was reinforcements and the other one was intentionality. And they were basically aligned that your intentionality of what you did, your behavior was determined by being rewarded or punished.
And that was the world we, we dropped into. Polyvagal Theory says, look, you just need to think about yourself in this world. And the way you feel. Your own feelings are a major mediator of how you react in the world. And Tami, one of the major questions here was in science were bodily feelings and acknowledge, uh, uh, observation.
Whether they’re acknowledged, phenomenon, or where they is, it’s minimized. And in general, when I entered science, bodily feelings and emotions were minimized.
TS: Once again, I’m gonna keep going here because when other people talk about polyvagal theory and they explain it, and I’ve heard several other people Yeah.
And I’ve said to them, help me understand polyvagal theory. They explain it very differently than the way you’re talking about it. They talk about the vagus nerve. Yeah. Yeah. They talk about two branches of the vagus nerve, how this was a new revelation and our standing. You’re not saying any of that?
SP: No, because it’s much more foundational. So the foundational point is that our state influences how we react to the world. Now if you ask me, how do we understand that state does this, does our bodily state follow any rules? Then we get into the hierarchy of autonomic states. We get into our evolutionary history, and we get into essence laws, basically laws of science that explain that when we get challenged, we start using more and more primitive neural circuits.
And that’s Polyvagal Theory. But the first point is why is it important? The second part, if that physiological state is important, what rules does that follow? And if it follows certain rules, how can we use that information to enhance or optimize human experience? And that’s how Polyvagal Theory utilizes the simple intuition that our own physiological state mediates affects biases, our life experiences.
TS: Okay. And what are the most important rules from your perspective that people need to understand that you identified, like if you get nothing else, this is it. These are the rules you need to know.
SP: Okay. There the rules are that there are. Three basic physiological, uh, circuits that follow an evolutionary hierarchy.
And what that means is newer circuits inhibit older ones. And when we get challenged for survival, those that inhibition is removed and the older circuits come into play and we use terms like, uh, losing your head and we become reactive. What we’re saying is our cortex lost its ability to inhibit our foundational brainstem mechanisms for survival.
So that’s very polyvagal. But what it also tells us, and this is why. Became so important in the trauma world. It teaches us if we are a therapist, if we are parents, if we’re spouses, and we’re friends, to be what I call more polyvagal informed. And what that means is that when we interact with others and including our, our social pets, dogs and cats and horses, we’ve become aware of their physiological state through the signals that they are broadcasting.
Because through this evolutionary journey, voice and facial expressivity became tied to the vagal regulation of the heart. So what we’re able to do is literally broadcast our physiological state to others so you can understand Polyvagal Theory and never put an electrode on a person. Never measure their heart rate, never measure their vagal regulation.
All you need to be is attuned to the intonation of their voice and their facial expressivity, because the intonation of the voice is being regulated by the vagus as well. And this becomes extremely important in all social interactions because we are conveying signals of trust and accessibility in our voice.
If our voices are more melodic, like a mother’s voice calming her baby, or how many people might talk to their pets, we know that we are broadcasting signals of accessibility. But the the culture we live in says, it’s not how I say things, it’s what I say. And the point is, our bodies say that, say respond in a different way.
Our bodies respond in saying, I hear what you’re saying. I may agree with what you’re saying, but I really don’t like you. You know, it’s like the features just don’t map into, I don’t trust you. So the issue is life and sociality. This is where Polyvagal Theory comes in with the concept of co-regulation.
It’s really about the neurobiology of trust and how do you broadcast the physiology of a nervous system that is accessible enough to be trusted and not a nervous system that is going to jump out at you and hurt you.
TS: This notion of how we respond to the sounds we receive and also other people’s facial expressions. This brings us into now yes, neuroception the Safe and sound protocol as well. Yeah. And that, you know, you referred originally to the Safe and Sound Protocol, the SSB as a listening. Yeah. Therapy. Yeah. And Karen, I’d love to know how you and Steve and your stories intersect in the development of the SSP.
KO: Well, they don’t really, uh, intersect in the development of SSP, which is really all Steve and his colleagues. Um, but where I come in and my, my colleague Randall Redfield come in is that we found Steve and, uh, understood that the, that this therapy had been hiding in plain sight in his laboratory. Um, we had reached out to him to see if Polyvagal Theory might inform why, while, why a different therapy that we had work been working on, uh, was so effective.
And after spending about a day with him at his home in North Carolina, in Ro in, uh, chapel Hill, uh, we sort of came to sort of an understanding that maybe working on his therapy and, um, delivering it through the company, integrated listening systems would be a good idea.
TS: So for people who are hearing about Safe and Sound Protocol for the first time, I’ve never heard about it. What is it? How does it work?
KO: Okay. Do you you wanna take—
SP: I do want, I do wanna start because, yeah. Rather, rather than talking about how the therapy works, I’d rather talk about observations that people see every everyday life. What, what does a mother do when the baby is crying? She uses a prosodic, a voice that has intonation changes.
What do you do with your cat, dog and horse? What type of voice do you use and what type of voice do do mothers and fathers usually use with their children? Uh, if they want good results, they use a melodic voice. Now what that is really telling an observer is that the intonation qualities of vocalization are more powerful than the words.
’cause you can communicate with both nonverbal children and nonverbal pets through intonation. And what we hadn’t really acknowledged, I would say, we as a culture, is that intonation was really triggers a, uh, a, a, uh, genetically formed template of safety. And what Safe and Sound protocol was all about was how do you deliver that, uh, to individuals who are in physiological states of great defense.
TS: Help me understand, because intuitively I get it. I’m imagining listening to, uh, my wife, talking to our dogs. I know also how I talk to them. I, I, I know there are certain people’s voices. I just hear their voice and I immediately feel better and calm. But what I don’t understand is what’s actually happening in my nervous system while that sense of safe and sound is occurring.
SP: Okay. The first thing is the detection. And this is, I see where I thought you were going to go was with Neuroception. And Neuroception is this construct that Polyvagal Theory introduced that basically says our nervous system detects signals of threat. And signals of safety. Now the issue of signals of threat is really kind of universal with virtually every living organism, including plants, they detect threat.
But signals of safety are kind of special to social mammals. These, the signals that we’re talking about, and they have a lot to do with facial expressivity, gesture and intonation of voice. So the point being made here is that we are wired to communicate signals of safety through intonation of voice.
This is, and to listen to that. So when you ask the question, it’s a listening therapy. It’s not a hearing therapy, it’s a listening. It’s a detection of signals of safety. ’cause when you detect signals of safety, your body reflexively, and this is the point, reflexively changes physiological state, because if you’re in a state of defense, you can’t process those frequencies of human voice.
TS: Okay, so receiving these sounds, these loving, sweet, reassuring sounds that shifts my nervous system state out of a defensive sense of feeling of threat into this other state. What’s going on inside?
SP: Okay, it, it’s actually quite specific because it’s shifting your body into a physiological state of calm, calmness, not in defense.
What that means is that it’s downregulating sympathetic arousal, and it’s triggering the neuroregulation of the vagus calming our body down. But even more than that, it’s triggering the neural regulation of facial muscles and middle ear muscles to help us pull in more information. I. So when we hear the modulated voice, our physiology comes down and our auditory apparatus starts to retune itself to human voice.
And this becomes critical. ’cause you can’t, as you retune to human voice, there is a price and that prices, you’re giving up the detection of predator sounds. So it is like when your body’s in a state of threat, you detect low frequency sounds, and human voice becomes very difficult to process. But when you start processing human voice, then predator, low frequency sounds are greatly attenuated.
And now the intersect occurs because when you start studying neurodivergent individuals or people with certain attributes of mental health issues, they have auditory hypersensitivities, but it’s not across all sounds. It’s about low frequency. Sounds are overwhelming to them. They can’t go to shopping malls, they can’t go to restaurants.
They can’t hear what people are saying. So they become hypersensitive to low sounds, low frequency sounds, but they can’t extract human voice. So it’s hyposensitive, but hyposensitive to speech.
TS: Now, the Safe and Sound Protocol is the delivery of music. It’s not the delivery of the spoken voice. Tell me how we move from the spoken voice to music.
SP: Well, it started off with using vocals. So there was this overlap and the idea was the can you use music that is like, uh, an easy portal where people would just kind of like listen to it and not overthink it? Uh, and because if you think about ballots or vocals, they have stories embedded in them. They have modulation, and the music we like has a lot of modulation, but the ballots and the vocalizations tend to be female voices, or let’s say tenors with men.
So I used to say that. Our nervous systems were waiting for Johnny Mathis. So you might recall Johnny Mathis, uh, uh, when you were young. Young. And the issue was that it made teenagers feel safe enough to be comfortable in each other’s arms. So we really think about it. Uh, the music was used to enhance intimacy in people who were, in a sense, uh, young and very defensive and unsure themselves.
So the music was literally signaling that your bodies could become accessible. And we think about it as a very interesting issue of the selection of music. If we put on a march or rap music or something like punk music, bodies would not be accessible because they’d be more mobilized. So music with its tempo and with the frequencies, and especially about where the major voice is.
Basically duplicates. Lot of these features. Now, there is a segue here, because if we move to classical music, we find out that the voice of the, of the mother, the voice of the female, the voice of the tenor becomes the violins, the violas, and they, this is carry the voice. They carry the theme that pulls the audience, the listener, into it in the same way.
TS: Now you mentioned the middle ear, and I’m curious to understand more the function of the middle ear in this whole process.
SP: This is an interesting journey because in audiology, it’s kind of downplayed. It’s viewed as a structure that’s involved in a reflex to protect the inner ear from damage. So when you have real loud sound, there’s a contraction, but it actually has a dynamic function.
And this has really been under understudied, underutilized that, uh, but you can see it in real life. There are people who have Bell’s palsy and bell’s palsy, which is paralysis of the facial nerve on one side of the face. But the facial nerve itself is the major regulator of the middle ear muscles. And so what happens with people with Bell’s Palsy, why it’s an important natural experiment is that they get auditory hypersensitivities, so you don’t have to go any further.
You have a natural experiment. The hypersensitivities occur when this nerve is paralyzed and what is also linked to it, this is where Polyvagal Theory comes in, that nerve, the EDUs mus nerve, that, excuse me, the EDUs muscle regulated by the cranial, the facial nerve actually goes, is related in the brainstem to the area that regulates the vagus, calms our heart down so that when we process melodic sounds, it’s basically functions like a vagal nerve stimulator.
Our bodies calm down, so there’s a tightly wired aspect and the take home thought here is that we have middle ear muscles and they’re striated fast twitch muscles, but they function as if they were part of our autonomic nervous system. They’re intertwined in the neuroregulation with nerves that regulate our viscera, our gut, our heart.
TS: Now you also just mentioned the brainstem, which is something I’m curious to learn more about because you describe in how the Safe and Sound Protocol works in the book, that this is a type of control center or dial that can impact our nervous system. I thought, okay, this is really important. I wanna understand this more.
SP: Okay. Again, I like to juxtapose some of your questions to the world that we are all dropped into.
TS: Please, please.
SP: The world we’re dropped to.
TS: It makes it easier for me to understand it, Steve, so I appreciate it.
SP: Okay. Well, the world we’re dropped into is what I would call cortico centric or cognitive centric, meaning that, uh, intentional behavior, the cortex and anything below the cortex is not very important because it’s shared with all other vertebrae or many other vertebrae, other mammals.
Our cortex is what we kind of pray to. The issue is we forget that underneath the cortex is a small area and it’s a narrow, basically the brain looks like a triangle upside down, and the bottom is the brainstem. The brainstem is a conserved, uh, evolutionarily conserved. Uh, an anatomical set of structures with certain goals, and that is to regulate your foundational survival mechanisms.
And through evolution, those areas of the brain, the lower part, have become repurposed to link them with sociality, with work, with attention, but primarily with sociality in a sense that we can now be safe enough to do other things that we know the cues. So what this whole plan of Polyvagal Theory, it’s kind of like saying if your foundational survival mechanisms are not in a sense supporting your health growth and restoration through supporting defense, everything above it is disrupted.
And that’s the world that many of us see. We see anxiety disorders, we see gut problems, we see, and everything is kind of like linked to a neuro dysfunction, not necessarily damage, a neuro dysfunction of our bodily organs. And these have become known as medically unexplained symptoms or functional neurological or functional gut problems, in a sense, their nervous system, uh, dysfunctions without pathophysiology.
TS: Karen, I wanna, uh, bring you in here to talk about the SSP itself and two of the early mantras or slogans that were introduced in how to deliver this listening therapy effectively. One is less is more, and then also safe before sound. And I wonder if you can explain both of those.
KO: Sure thing. Uh, first I wanna just make it clear to listeners that when we’re talking about this music, um, the client is actually wearing headphones that where the music is, you know, being transmitted to them and they are with a provider, that’s a really key thing.
So they’re together with a provider who’s attuning to their bodily reactions and their responses to the music. So less and more, less is more relates to the idea that. Don’t go too fast, don’t do too much at a time. And your provider should be, uh, really closely attuning to your response to the music to make sure that you’re not over listening.
Um, a little at a time is, uh, people are calling it micro titration. You listen to a little bit at a time, and those small cues of safety can accumulate into, uh, rather large changes. Um, so less is more relates to short listening sessions of SSP in order to get short bursts of short cues of safety that can accumulate.
That was, uh, uh, something that we really understood once we shifted from using the SSP primarily with children to u to adults. Listening to the SSP, we can get more to that later. But I wanna answer your question about safe before sound. So, when we named the, uh, therapy Safe and Sound Protocol, it was, it made sense, ’cause that’s a phrase, safe and sound.
Um, but it also really, uh, pointed to the idea that the client needs to be in a safe space to be, for the, uh, therapy to be effective. That can, that can come from therapist who they’re with, the provider who they’re with, giving them cues of safety and co-regulation. Um, and it can come from the music itself.
So, but we, we know that we want the client to be feeling safe and ready and accepting of the music.
TS: Now the Safe and Sound Protocol has been administered to this point to more than 200,000 people with their stories collected. Mm-hmm. And in the Safe and Sound Book, you take examples of many different case studies and we’re gonna talk some about all of the different applications.
One of the things that really struck me is how in many of the cases an event had occurred in the person’s life, maybe it was a sudden death in the family or a virus or illness or some other sudden trauma. And their nervous system became stuck in some type of state of threat, chronic defense, and then the safe and Sound protocol was administered.
And these really remarkable results came. What I wanted to understand, as someone who’s had my. Nervous system becomes stuck in a state of defense. It’s happened to me and I’ve been like, what? How did that happen? How did it get stuck like that? What? What events create that stuckness, and why do some people go through events like that and it doesn’t get stuck, but it does become, help me understand this.
SP: The issue is the fact that it got stuck is telling you the potency of what that signal was to your body. And if your body processed it as life threat, and this can happen by public humiliation or being bullied just as well as being in a car wreck or waking up in the middle of a surgery or being raped.
Uh, the body interpret the, interpreted the experience as life threat, then it’s not easy to just kind of like, oh, this will resolve itself. That now is a trauma that needs therapeutic work. And so the Safe and Sound Protocol then became an adjunctive therapy to aid therapists to move their clients into these states.
Now, the part that you’re really asking, Tami. Is that when it gets re restructured like your nervous system was, it’s a good example to say you got stuck. The answer is it doesn’t mean that you’re not responsive to signals of safety. It’s just that signals of safety are now interpreted by your body as signals of vulnerability.
And this to me was the most remarkable thing about Safe and Sound Protocol, is that if people start to use it, who had severe trauma histories, they had a sense, an abreaction, and now I had to figure this out. It was literally very disruptive to me because for me, you know, I could listen all day and it didn’t have any negative effect.
But in this situation, what I start to understand is that through this process of neuroception, the nervous system detected signals of safety, shifted the body into accessibility. And that has its own internal bodily features. And those bodily features of that physiological shift is interpreted through another process called interoception, meaning I feel it in my gut, or I feel it in my heart.
And that information we’re aware of, and that information is from body back to cortex, back to brain. And now the body reacts and now the cortex is, uh, been there before I’ve been accessible. And what happened? And that is where the therapist, so this is where I learned so much about from the trauma therapist, that they were able to titrate the, the Safe and Sound Protocol to allow people to touch that moment, touch that moment of accessibility, then to resolve it, then to expand it o over time, but respecting that the client was reinterpreting a neuroception of safety as vulnerability.
TS: So this is a, a very important point of why the Safe and Sound Protocol is an adjunct to other forms of working with real humans, human to human. I’m not just off on my own listening to the sounds because I could start feeling quite vulnerable and actually in a certain sense, if I’m understanding correctly, drop back into a traumatized state instead of entering the healing process through being able to connect with my SSP provider. Is that correct?
SP: Yeah, it’s actually connect with other. I will give you the example that I had with a 42-year-old autistic adult who, uh, his parents basically thought with the, whenever he talked to them, he was very, it was all about him. He was not relating. And when he came into my laboratory, he turned 90 degrees when he talked to me.
So there was no face to face. But after five hours, and that’s the total protocol I walked, we were delivering at one hour a day for five days. I walked into the room, he looked me, looked directly at me, put his hand out, and said to me, good morning, Dr. Porges. Now the point is he wasn’t taught to make eye contact.
He wasn’t taught to reach out. His body had shifted state, and now the social interaction was spontaneous. And this is very different than how autistic. Individuals were being treated, they were being treated to make eye contact with, uh, basically reinforcers. And of course, the eye contact when being forced to make it is not engaging, is not connectedness and not comfortable for either the autistic individual or the person they’re looking at.
KO: Steve, what you just said was really important, actually saying that this man was so focused on himself. Um, and that becomes the case when you are stuck in a state of threat. You know, you could be stuck in a sympathetic state or in a dorsal state, but you really become very self-focused and inward, and it becomes difficult then to.
Have connect to, to have connections with other people give you that sense of safety because you’re so focused on yourself. So something needs to, you were saying, Tami, that how do I get, why is it that I get stuck in these states? We talked about that, but how you can get unstuck from these states is to receive abundant cues of safety.
And the SSP really facilitates that by delivering these cues of safety through sound, that really the nervous system has to just accept without any real intention or um, or effort on the part of the listener. And so that begins the, at the beginning of starting to feel a little safe, letting some safety come into the system so you can unwind some of those habits or, uh, patterns of defensiveness.
SP: So, Karen, we can basically talk about the world we live in now, which has lots of signals of threat, and we start seeing even political levels. People are not talking about connection, they’re not talking about benevolence, and they’re not talking about compassion. They’re talking about self survival. And it’s the natural in a sense, when one moves out of this ventral vagal social engagement, trusting physiological state, it becomes very proximal about self.
And so we can see it on the individual level, but we also can see it on a cultural level. And pandemic for us set that stage moving.
TS: And just once again, I wanna make it real for people how the listening therapy, the Safe and Sound Protocol works. You mentioned Karen, people are wearing headphones, they’re working with a provider. Am I doing this? How often? For how long? What’s the, what’s the delivery of the protocol like?
KO: Um, it, it depends. It depends on the client. It depends on the client’s situation and the where you are, e everything is, is a variable that will make a difference. Children seem to be able to move faster through the SSP.
They’re often together with their parents or they have their parents co co-regulating them with them after the, their sessions and they just seem to be maybe a little bit more, um, flexible, um, some adult. So, so the shortest amount of time that it would take to complete the five hours of listening that Steve was mentioning is probably, um, two weeks or something like that.
So let’s say the delivery, uh, length takes somewhere from two weeks to maybe several months up to say even nine months for some people, even in the book, the cases that we talked about. And that’s be goes back to that concept of less is more. So if clients are listening to very short sips of the music, very short exposures to the music, and then letting that sort of.
Uh, integrate into their body before they do another short, you know, listening session or listening, uh, segment. Uh, then it, it can just take that, that long, longer amount of time. So that’s people with, um, uh, complex trauma, chronic illness, more, you know, more complicated situations.
SP: Yeah. Well, I’d like to kind of like elaborate a little bit more if we’re talking about like, children who have auditory hypersensitivities and they don’t have an identifiable severe trauma, uh, experience.
You know, it could be delivered in five sequential days even and get, that’s what I did in my laboratory and I had. Literally no adverse effects. But when you start dealing with, let’s say, adults with trauma history, where being in a physiological state of accessibility is really vulnerability, then it’s gonna take time.
Then the SSP is not the primary therapy. It’s a therapy that is used to accelerate the basic, uh, therapeutic strategy that the therapist is administering. So we have to separate, is this in a sense a tool for auditory hypersensitivities being used in OT or pediatric population, or is this a adjunctive tool to deal with trauma?
And they’re totally different situations, different protocols have to be developed, and the issue is how it it, how does it intertwine with other therapeutic strategies? And Karen, you can talk about, um, the best practices of SSP with other therapies.
KO: Um, so SSP pairs really well with almost any other therapy because, uh, what it’s doing is allowing that client to have a sense of safety in their body.
And all healing begins with safety. So we’ve found that EMDR, somatic experiencing, uh, cognitive behavioral therapy, all, uh, um, proceed faster. It seems like SSP is something of an accelerant for those other therapies because the client’s body is now ready for that. Um, uh, if a client comes in as in really stuck in a state of threat, it’s possible that they’re not ready.
They, maybe they’re. They don’t have as much access to their cognition or their executive functioning. So to talk through their story, through say, a top-down therapy like cognitive behavioral therapy, which is very successful, but some people aren’t, just, just aren’t ready for it. So with SSP, you don’t have to talk about the story.
The focus can be on your state, the state of your nervous system, and how you’re feeling and what it’s like in your body so that you can develop enough safety to be able to have access again to your cognition, to be able to talk through and process the, the story
TS: In the section of Safe and Sound, where you share these case studies and you present them beautifully. And Steve, I loved the section where you reflect on each case study and give your polyvagal insights into what’s occurred. I think the, the section that surprised me the most was that Parkinson’s disease was included, that the SSP could be effective with something that I think people might think, well, yeah, that’s related to the nervous system, but this is, music’s not gonna help this. Come on.
SP: That’s really, um, okay. The, the person who is described in that actually contacted me and I, uh, as assign assigned him to, uh, a friend who dealt with, uh, really uh. Really severe cases. And I, I was just curious like you would be if you’re doing that, but I had a model, and this is what you wanna know, is why would I think that someone who had a well-defined disease with apparent pathophysiology, why would this be helpful?
I had been working with Aler Danlos individuals and I’ve come up and those are people who have joint hypermobility. And the issue with them is they also have high levels of anxiety. And I got pulled into their community and I was asked to basically write a forward for a whole book on this. And the book was really written by primarily physicians who themselves had Aler Danlos.
And this was the interesting story. They were asymptomatic until they had a traumatic event following the traumatic event. They had a dis, a dysregulation of the autonomic nervous system and then this array of symptoms came down. So the issue is. When we have disorders, are we having a response to the disorder or is the response part of the disorder?
- So let’s take a real optimistic perc. It’s like long covid. Long covid. You have a response to the disorder, but your body reacts to covid, kills the pathogen, but now you have a cluster of symptoms without any true cause. What about chronic pain? The body has now resolved the damage that created the pain, but the pain is still there.
That’s the reorganization of the nervous system and those types of disorders. Chronic disorders. I was curious with, and I view them as. Literally being piggybacked symptom profiles being piggybacked on another disorder. And I had in my mind the idea is that you could disrupt that piggybacking with Safe and Sound Protocol.
And what’s interesting, what I learned from the Parkinson’s is that the social engagement system was still available, meaning the smile and the engagement. Yet I thought Parkinson’s, by definition was the mask, the face. But what we learned was that the face rapidly reacted to the safe and sound. Those part.
But what also happened is that it went in a, uh, opposition to a sympathetic hypertenicity of what the body trying to curl back in, to tie down. So it became a intervention that would instance open up part of that nervous system that was being pulled down by the disease, but it couldn’t push the other part of the disease too hard to, in a sense, let this part of me go so I can engage.
So this was a real titration experiment in which I. Gentle bit could slowly move facial expressivity and movement even though the person still had a disease. So the issue is can we, okay. In, in modern medicine, we end up seeing disease clusters, uh, symptom clusters as if they are the disease. What if the symptom cluster has both a disease in it and something that’s piggybacked on it?
And what’s piggybacked on it is a body whose nervous system detects that it has a disease and says, I’m in the state of threat, but the state of threat is not part of the disease. So it’s in a way that I had this insight that might be potential possible to treat some of these diseases. There’s been a book written on Long Covid, which is really focused on using, uh, Safe and Sound Protocol.
Uh, as a way of titrating and moving out of long covid. There are people who many, many pain psychologists are using the Safe and Sound Protocol to deal with chronic pain. So we start seeing that it’s starting to get some traction in time to break these piggyback disorders. I, I don’t have a better word for it right now, but it’s the notion that we get diseases and our body responds to that disease, uh, with the features of the disease, but also with a cluster of defensive reactions like inflammation.
Inflammation is a very generalized defense reaction, but when you get rid of the pathogen, what happens to the inflammation?
TS: So, just to see if I understand this correctly, and we can use long covid as an example. So there are these piggybacked responses of, I feel. Uh, in danger threat. I’m gonna tighten up, close down.
SP: Well, don’t make it intentional. Don’t make it intentional. My memory is—
TS: No, it’s all happening. It’s all happening at this, uh, subconscious level. Yeah, but this is the nervous system response to the feeling of threat. So, and by using the Safe and Sound Protocol, I’m able to calm, relax, soothe these defensive reactions, connect with the provider. My face changes. What happens to the disease process though, itself underneath?
SP: Well, it doesn’t, it hypothetically, it shouldn’t touch the disease process unless it’s been inappropriately diagnosed. So it doesn’t take away Parkinson’s. It doesn’t take away alos. Dan Lois, what it does is gives a, uh, resource of engagement, of optimize a burden.
It takes a burden off that population of being more flexible within society. It is, by the way, it’s also my perspective on, on neurodivergent. You, you can still be neurodivergent, but it would be nice if your body were calmer and you weren’t hypersensitive to sounds Life would be, uh, easier or more enjoyable.
So we don’t have to give up what we may think is special to us, whether it’s a disease identity, and there are people who have disease identities and what we’re saying is really, there’s certain features that we can do something about. It’s a very optimistic perspective that we can reduce the burden of some of the symptoms that we are experiencing.
TS: Our nervous system is on our side. That’s a quote that I pulled from Safe and Sound and I thought, gosh, you know, I wonder. People I think, who find themselves in chronic states of dysregulation, whether they’re anxious or depressed, or have suicidal ideation, and they know that their nervous system is coming up with all of this material all the time, and they hear our nervous system is on our side might have trouble appreciating that. And I wonder if you could help us all appreciate it.
SP: The word is we start by honoring what our nervous system is doing, and sometimes we honor what it is goes when it goes into a state of defense by saying, look, I understand what you are doing for me. You’re keeping me alive, but now it’s time for me to inform you that I no longer need you to keep me alive. I’m, I’m safe where I am. That’s where the cue of safety come in. So the first part is self-compassion and honoring what our body does and when the body experiences life that this goes back to your example, Tami: being stuck. It, it is a projection that your nervous system. Detect it that it was under life threat.
Now, whether it really was under life threat is irrelevant. It was that your nervous system experienced it. That’s why people being publicly humiliated can go into literally all these features of severe complex trauma from that. So the issue is, it’s not that the trauma event itself is life-threatening, it’s that my nervous system interpreted it as life-threatening.
Karen?
KO: Yeah. I do wanna just say that understanding Polyvagal Theory itself was very. Very, um, healing in almost every one of the, um, case studies. And I think that’s an important point because it goes back to the nervous system is on our side. When you understand more about your, the autonomic nervous system and Polyvagal Theory and how moment to moment our body is shifting from state to state based on what’s happening in the world and are, um, the cues of safety and the cues of danger that we’re experiencing in the world.
So understanding that that is happening in your own body is so, um, forgiving. You know, it goes from, you can, uh, take away any judgment of yourself to an understanding of yourself and other people’s behaviors. Um, but it’s also quite hopeful, and I think this is a really po important point about the nervous system of being on our side, is that Polyvagal Theory tells us that you are not broken, you are adaptive, and these states that your body has moved into are protective of you.
It also says that the nervous system can change. And this is hopeful too because these small cues of safety can lead, you know, can accumulate and lead to change. Um, so the nervous system is on our side even though it may not always feel like it.
TS: Alright. One thing I’d like to understand better, and I think you’ve already sort of explained it, but the truth is I don’t really understand it, which is as I’m receiving these cues of safety and intuitively I know I’m feeling calmer, and then maybe I might feel vulnerable, I’ll connect with my SSP provider.
They’ll be warm and loving and I’ll feel connected and I’ll be like, wow, I’m feeling better. And my nervous system is experiencing some level of getting reset into a place of. Of safe connection by doing this repeatedly, intuitively, I get that that’s happening. What I don’t understand is what’s actually going on in this nervous system, flexible transformation such that a reset of my system occurs. What’s actually happening?
SP: Well, what’s actually happening is that you’re experiencing a moment of safety. The, the part is that it in a sense, you, in the description you gave, you place a lot of the burden on the provider and a little what the, what the SSP does, it says the provider just needs to hold the space, needs to be comfortable, welcoming. The music will do the rest, and—
TS: But how are these moments of safety? Shifting so inside that this dial that felt stuck or whatever you wanna call it, this, you know, I imagine it, uh, being like a, that it actually changes. How do those moments of safety accumulate?
SP: Well, there are parts to it. You, you’re asking about a reset versus just the experience.
TS: Mm-hmm.
SP: So the idea is the reset occurs through multiple experiences with the nervous system now has the experience of moving from like this to like this. So it’s going through it. So now when it gets like this, it has a visual, you have a visualization. If I can use that term of that, it will pass and I’ll be comfortable again, but when you’re stuck, you have no visualization. You don’t have that image, you don’t have the auditory vis, uh, visualization or the, you don’t feel the, the part that I like to always ask, I find this really kind of one of the most interesting things in, in the trauma world, is the fact that many people who have experienced severe trauma do have a visualization of what it would be like to be in a loving, safe relationship, even though they have no history of that.
And I have found that to be one of the most remarkable features I. Of humanity. And that is, we all know what it is, even though we might not have experienced it. So when you’re asking me these questions, what’s going on? I’m saying there are circuits that evolved that get triggered through a sequence, uh, this case acoustic patterning that our nervous system cannot refuse, but has to react.
And if you have a trauma history, that reaction in itself creates a sense of vulnerability. So now you have to process why is it, or how, how do I experience safety without experiencing vulnerability? And I think that becomes the big question for a good portion of our society. How can we be accessible and not vulnerable?
TS: I’m wondering specifically if you would help me understand at a physiological I. Level things like heart rate variability, vagal tone. How is the SSP impacting those functions in, in the nervous system?
SP: To understand that you have to take another construct, and the construct is an area of the brainstem called the ventral vagal complex, and that’s where the mammalian ventral vagus, which gives us heart rate variability, emerges.
That’s where it comes from. But in that area, it’s not just the vagal control of the heart, it’s also controls the middle ear muscles. It controls the facial muscles. It controls the integration of all that information so that it means that there are what that really provides for the human. And for other social mammals, our portals.
So anything that touches that social engagement system will impact on our visceral state. So listening, facial expressivity, smiling, laughing, even ingestion. And so the Ingestive Act is utilizing the same nerves that our social behavior is. And of course, our culture integrates ingestive behaviors with sociality.
TS: Anything to add, Karen, about the physiological process that the SSP is facilitating?
KO: Well, I think he covered the physiological process, but if I could give some examples maybe that. It can give you a better sense of how it could get kickstarted. So Steve was talking about reasons why people’s middle ear muscles might not be working.
They could have low muscle tone, they could have Bell’s Palsy, they could have had a history of ear infections. And so when someone so easy in children because they’re so expressive, but uh, a child feels that sense of safety maybe for the first time because of sound and kids are giving their parents their first hug, they feel that like their body has shifted.
They have a, like a felt sense of what it is to be safe in their bodies because the music gave them that. Um, one 4-year-old child said her first word when she experienced the first listening session of SSP, and it was, hi. It was like a bid for connection with other people. I. So if that’s the case that you’re, you’re feeling safe for the first time or the first time in a long time, this, that felt sense gives you something of an anchor to also know that you can get back there.
And that has — that has a lot to do with it too. So then when these other nerve cranial nerves are lighting up your facial nerve, the nerves that you know, the control, your speaking and your hearing, and even your head turning, uh, start to impact you more, and they, you start to notice that more in others and you feel it more in yourself.
I, for instance, have this tell of, uh, when I’m in a connected ventral vagal state, which is that I can sense the nerves, my facial nerves, they, I just start to sense them kind of there and lighting up.
TS: Well, let me ask you a curve ball question. Here’s a curve ball question In, uh, Qigong practice, they’ll recommend that you take on a slight smile because it changes your physiology. And I’ve always had a mixed reaction to that. Like, do I really wanna actively do something like that outside of myself to, you know, by forcing myself to slightly smile even when I’m not in the mood. I wonder what you think. And part of the question is I’m wanting to understand more about facial expressivity in the nervous system.
SP: Let me step in for a moment about neural exercises. And SSP is a neural exercise, and what you’re describing about the smile is a neural exercise. And basically it is, uh, inviting greater fluidity of those neural circuits. That’s what it’s doing. Yeah. And that’s what breathing does, and that’s what listening does.
And so we, I’d like to categorize what I call neural exercises that facilitate what I call the social engagement system. And when we even talk about like early developmental problems or disruptions, we ask questions like, suck, swallow, breathe, uh, vocalized circuits, are they doing well? Because that’s the same system and many children who have difficulty in that coordination of those basically are on developmental trajectory of behavioral problems
TS: In the book—
KO: Do you sense that, Tami?
TS: I’m sorry, go ahead.
KO: Do you sense it when you smiled? Can you, can you sense other aspects of yourself feeling a little better?
TS: Oh, yeah. Totally better. I feel, I feel totally different. Yeah, yeah, yeah, for sure.
SP: Well, do you ever rub your forehead, Tami?
TS: Of course. Yeah.
SP: What about your neck?
TS: I, I rub all over my head.
SP: Okay. And neck and shoulders?
TS: Yeah.
SP: Okay. So the trigeminal, which goes into the ventral vagal complex is near the surface here. And actually electrodes on its stimulating act like a vagal nerve stimulator.
TS: You’re on your forehead as you’re—yeah.
SP: The third eye, have a good time with it. And, and likewise, the neck, there’s an area called where the carotid sinuses, where, uh, bowel receptors, blood pressure receptors are. That goes directly to your vagus brainstem area. So we do things. And with your dog, do you ever do this to your dog pet?
TS: Under their chin, for sure. Yeah.
SP: Yeah. So we know this and they tend to like it. It’s comforting and calming, but we would not let a stranger do that to us. Would we? So the issue is we, uh, there’s also other ones. Some people press on their, on their eyeballs. Have you seen people do that? There is another reflex, it’s called an opto vagal reflex. So when you press on the eyeballs, you get a surge in your vagal regulation of the heart.
So listening is actually another portal of getting into the same circuit, except it’s so non-invasive and almost stealth. And that’s what I kind of view these, the you need a portal that does not take intentionality or conscious effort to work because conscious effort interferes with the processes.
TS: Which brings me to my final question, which is, I’d love to know what you both hold as the vision. You’re, you obviously have tremendous excitement and passion for SSP. What’s the vision for how this will unfold and influence, impact, and help people heal in the world?
KO: Well, for me, I’m just so happy that, uh, we could publish a book with you, Tami, um, because it’s a nice way to get this information out into the world.
Just the early readers, even your editors, um, said things like, oh, I see myself in this book and, um, and my family and I’m really interested in this therapy. Um, as it, as it expands and people know more about it and they can experience it more, it, um, it just gives me hope that, that people can be helped by something like this.
And, um. It, it can be used in schools, it can be used in so many different, um, settings. And we’re starting to see people be creative with that. And so that just makes me so happy. And if the, if the book is read by people and it helps them come to this work, it’ll just, um, that will make me really happy.
SP: Okay. From my perspective, I don’t think people should have auditory hypersensitivities. I’m getting very pragmatic. I think the auditory world is an interesting world to experience, and I think so many people are compromised. I think we treat it listening as if it was a hearing deficit, when it’s more like a state regulation problem.
And many people who have difficulty listening or processing auditory, uh, basically speech have been marginalized. Uh, they’ve been forced to take hearing tests and they do fine in those, and now they’re treated as if they’re not intent on listening. So I think we’ve misunderstanding. I have a great misunderstanding of how we process, uh, intonation of vocalizations and how we can optimize our ability to understand each other.
So want to get down to the root. SSP can optimize how people communicate with each other. Now, whether they use the SSP or the principles of SSP at this stage of my life, I, either one is, is great, and the idea is that understanding that our physio, let’s go back to the first statements of your question.
Understanding that if my physiological state is locked into a state of threatened defense, I’m not gonna do well processing auditory instructions or verbal instructions. I’m just not gonna do well.
TS: Steve, you and I spoke in a different time and you mentioned to me that one way you like to refer to Polyvagal Theory is as the science of safety and that you believed everyone, every human being has the right to feel safe. And I was really moved by that. I’ve thought about it. I probably thought about it a hundred times. Oh. And I’ve thought to myself, I want everyone to feel safe. I want everyone to have that experience. And I’m mentioning that here at the end of our conversation, because I think the SSP and the underlying framework is a huge contribution to that, and it’s such a big and important idea. And I wonder as we close our conversation, if you can say more about that.
SP: Well, it’s kind of, yes. I would make one statement and say, it’s our evolutionary heritage is to feel safe. And what we’ve done with this, uh, what I’m trying to bring to the consciousness of, of our community is that we have the tools, the neural circuits on board to feel safe.
And our culture has compromised that. So by placing people in chronic threat, because it kept them moving or mobilized or more productive, it was a contradiction in how their nervous system evolved. It evolved to co-regulate, to connect and to, in a sense, feel safe. And this has been disrupted by our culture.
Now, it doesn’t mean that we can’t disrupt it for periods of time, like work hard, Tami, and then have periods of time where we don’t work hard. The idea is we need those periods of time where we connect, we co-regulate, and we respect that our bodies need that type of feelings of feeling safe. Not that we shouldn’t work hard, we shouldn’t attend, we shouldn’t create, we shouldn’t daydream. I mean, the issue is that we need to respect the capacity of whom we are.
TS: I’ve been speaking with Dr. Stephen Porges and Karen Onderko about their new book with Sounds True: Safe and Sound: A Polyvagal Approach for Connection, Change, and Healing. Thank you both. What brilliance, creativity, passion, and helpful work to put in the world. Thank you so much.
SP: Thank you, Tami.
KO: Thank you.
TS: Sounds True: waking up the world. Thanks for listening.
