Safe and Sound Protocol (SSP) Podcast- A Polyvagal Theory Informed Therapy

Episode 4: Safe and Sound Protocol Podcast - Dr Stephen Porges Dec 2019 (Part 1) SSP Development; Early Autism Trials; Autonomic Responses and Trauma.

January 20, 2020 Dr Stephen Porges Season 1 Episode 4
Safe and Sound Protocol (SSP) Podcast- A Polyvagal Theory Informed Therapy
Episode 4: Safe and Sound Protocol Podcast - Dr Stephen Porges Dec 2019 (Part 1) SSP Development; Early Autism Trials; Autonomic Responses and Trauma.
Chapters
Safe and Sound Protocol (SSP) Podcast- A Polyvagal Theory Informed Therapy
Episode 4: Safe and Sound Protocol Podcast - Dr Stephen Porges Dec 2019 (Part 1) SSP Development; Early Autism Trials; Autonomic Responses and Trauma.
Jan 20, 2020 Season 1 Episode 4
Dr Stephen Porges

In part one, Joanne interviews the originator of the Polyvagal Theory and inventor of the Safe and Sound Protocol - Dr Stephen Porges. Link to Dr Porges website to learn about Polyvagal Theory and related research.
He discusses how he came to develop the Polyvagal Theory based upon his scientific inquisitiveness from being a 12-year-old clarinet student to his university studies and research in the psychophysiology of human interaction. He reviews the essential link between the heart and brain via the Vagus nerve and the resultant expression of physiological state through facial expression. He discusses how the Safe and Sound Protocol is able to operate by "stealth" in changing the function of the Middle Ear Muscles to improve auditory hypersensitivity and social engagement. He discusses the progression and changes that were made in implementation from working originally with autistic children to adults with trauma.

If you wish to learn more about the Safe and Sound Protocol please visit for Australia and New Zealand - https://integratedlistening.com.au/ssp-safe-sound-protocol/ and for North America and the rest of the world - https://integratedlistening.com/ssp-safe-sound-protocol/

We welcome your feedback and questions at ssppodcast1@gmail.com

Show Notes Transcript

In part one, Joanne interviews the originator of the Polyvagal Theory and inventor of the Safe and Sound Protocol - Dr Stephen Porges. Link to Dr Porges website to learn about Polyvagal Theory and related research.
He discusses how he came to develop the Polyvagal Theory based upon his scientific inquisitiveness from being a 12-year-old clarinet student to his university studies and research in the psychophysiology of human interaction. He reviews the essential link between the heart and brain via the Vagus nerve and the resultant expression of physiological state through facial expression. He discusses how the Safe and Sound Protocol is able to operate by "stealth" in changing the function of the Middle Ear Muscles to improve auditory hypersensitivity and social engagement. He discusses the progression and changes that were made in implementation from working originally with autistic children to adults with trauma.

If you wish to learn more about the Safe and Sound Protocol please visit for Australia and New Zealand - https://integratedlistening.com.au/ssp-safe-sound-protocol/ and for North America and the rest of the world - https://integratedlistening.com/ssp-safe-sound-protocol/

We welcome your feedback and questions at ssppodcast1@gmail.com

Joanne McIntyre:   0:00
Welcome to the Safe and Sound Protocol Podcast, A Polyvagal theory. Informed therapy. I'm your host, Joanne McIntyre. Here we talk everything Polyvagal and SSP related. Dr Porges has provided us with a revolutionary framework for understanding the connection between our autonomic nervous system and behavior. The SSP Acoustic intervention is an exciting new therapy helping people all around the world. Welcome to the fourth episode of the Safe and Sound Protocol podcast. Today I'm so honored to have the one and only Dr Stephen Porges as my guest.

Joanne McIntyre:   0:40
Because the information was rich we have broken it up into two parts. In part one, Doctor Porges discusses the theoretical basis behind developing the Safe and Sound Protocol and then in part two dig deep  into therapeutic application. So without further ado, I will formally introduce Dr Stephen Porges. He's a distinguished university scientist at Indiana University, where he is the founding director of the Traumatic Stress Research consortium. He's professor of psychiatry at the University of North Carolina and professor emeritus at both the University of Illinois, Chicago and the University of Maryland. He served as president of the Society for Psychophysiological Research and the Federation for Associations in the Behavioral and Brain Sciences and a former recipient of the National Institute of Mental Health Research Scientist Development Awards. He has published more than 300 peer-reviewed scientific papers across several disciplines, that have been cited in more than 30,000 peer reviewed papers. He holds several patents involved in monitoring and regulating Autonomic state. He is the originator of the Polyvagal theory, a theory that emphasizes the importance of physiological state as the expression of behavioral, mental and health problems related to traumatic experiences. He is the author of the Polyvagal Theory: Neuro physiological Foundations of emotion, attachment, communication and self regulation published by Norton; The Pocket Guide to the Polyvagal Theory: the Transformative Power of Feeling Safe, published by Emotion, and the co-editor of Clinical Applications of the Polyvagal theory.The emergence of Polyvagal informed therapy, published by Water in 2018. Dr Porges is the creator of the Safe and Sound Protocol Acoustic Intervention, which currently is used by more than 1500 therapists to provide spontaneous social engagement, to reduce hearing sensitivity, and to improve language processing in communication and state regulation and social engagement.  

Joanne McIntyre:   3:07
Welcome, Dr Porges, I really appreciate you coming and spending your time with us today. And I'm really hoping this is an opportunity for us to really delve a little deeper into the Safe and Sound Protocol and to understand more about how it came to be.

Dr S Porges:   3:24
Well, thank you for inviting me in. For me this is a wonderful opportunity for me to tell my journey in terms of developing the SSP. And more than that for me to describe what feelings of gratitude I start experiencing when I hear from people about how effective it is in changing the lives of others and that to me is really part of one's life's goal is to do something, do something that is helpful to others. So let's let's move on. Let's get some good questions.

Joanne McIntyre:   3:57
Well, I guess I'm not personally. What I'm really curious, curious about is, as you're developing the Polyvagal theory At what point made you kind of divert to explore the ear at the extent that you did and then think about and an acoustic intervention.

Dr S Porges:   4:18
This is an interesting intellectual journey that actually started off when I was in graduate school. So let me take you back. You say, invite me to give my life history. Actually, I can bring it back to when I was 12 and that was a clarinet player, a musician. I was a actually quite a good clarinetist. I ended up being. Ah, second seat in the all-state band in the state of New Jersey and my clarinet teacher was the former solo clarinetist for Toscanini, the NBC symphony. So I would go weekly to New York City for a clarinet lesson. But the is issue isn't really the quality of my abilities to play the clarinet. It was really what happens when you play the clarinet. When you play the clarinet, you basically take a breath and you exhale very slowly. And so when you exhale slowly, you're playing your music. Singers do something similar, and if you are public speaker and you speak in longer phrases within any modulated voice Ah, you also are exhaling slower. And I didn't understand all this, except I understood the bodily feeling so as an adolescent  going through puberty, as males do and women do as well behavioral state. {I have one right now]. No. Well, just the only I thought 15 more years to be concerned about. That's all. What you start realizing is that the underlying issue in life for humans as a new mammalian species is our ability to regulate our body state. It  is really about regulation of our feelings and our physiology. And what I started to learn serendipitously was playing the clarinet by exhaling slowly was calming me down. I was calm, and there were other instances of emergent properties. Of that, I was able to: think dream, create ideas because I was going to different places. So it's where you know, you're not in a sense of, of that you have to move or do something. You're in a sense you're more present. And that becomes a common word in the land, the world of therapists being present and isn't being embodied so slow exhalation enabled this rapidly maturing adolescent male to be in his body and to be present in the world while at times also going on journeys of thoughts of discovery and creativity. So that was me as his young teenager, and as I grew up, I went to graduate school is always interested in what does, what do physiological measures of an individual tell you about the individual? What did they tell you about what you're thinking or their intensions?  It wasn't really the issue of lie detection, it was really trying to know more about how to navigate in this complex world. So when we're navigating the world, we have to be reading cues about others and noone tells us how to read cues. They tell us we're supposed to do certain behaviors. They don't tell us what are the cues? How important is intonation of voice, How important this facial expression, how important is orienting your head to the person that you're speaking to, So these are things that our body reacts to. So I was interested in this. I went off the graduate school. I was trying to find what discipline studied physiological activity while people were going through different psychological experiences and there was a new discipline that was emerging at that time called psycho physiology. It was a discipline that really was interested in what physiological futures change when psychological states changed. And I started in this area and I was one of the first people could be a developmental psychophysiologist, meaning studying Children and babies to kind of understand what's going on in their world through the use of physiological measures. So over time. So that brought brings you up now to the late 19 sixties. And I got my PhD in 1970. And I'm off now running, doing research, measuring physiological activity in newborn nurseries and I'm getting a little side interest in clinical issues. Measuring that side issues being: What happens during surgery and medical procedures and I'm watching autonomic, meaning heart rate, measures changing and I'II start defining and developing. Actually, in the late sixties, while still a grad student, metrics, ways of measuring heart rate variability. At that point, no one had really quantified it. So my research is really the first published studies quantifying heart rate variability as both an individual difference based on a measure and also trying to define how heart rate  variability changed when people were attending or psychologically engaged. And that's kind of goes back to my early questions when I was even in high school. But they really, as a scientist, I wasn't satisfied with the use of physiological measurements. As indices or correlates of other processes. I want to know why. I wanted to know what were the pathways, what were the pathways, neural pathways that regulate the heart and that led me to understanding the Vagus and vagal control of the heart. And what you find is very interesting is that in the whole area of psychophysiology and stress physiology, people never mentioned the Parasympathetic system or the Vagus,  before, I would say, probably before 1990 they talked about sympathetic reactions. They talked about hormonal reactions, cortisol, norepinephrine. But they didn't talk about vagal rate regulation of the heart, and that really was my work that brought that in. But I was hit with a problem in the early 19 nineties, and that was I was developing methods that I called methods of measuring vagal regulation of the heart from the heart rate variability. And I was using those measures as the measures of resilience and basically ah, measures of health, growth and restoration Positive indicies of health. And I published a paper in 1992 on babies in a Journal called Pediatrics, in which I talk about these measures of heart rate activity as being predictors of outcome, and I looked at high-risk babies, and full-term one's and show that there, uh, respiratory  sinus arrhythmia [RSA]  being the heart rate variability in the respiratory frequency was different in these two groups. And while I was proposing that a good clinical indicator of this resilience measure would be a measure of vagal tone to the heart quantified by respiratory sinus arrythmia. Now that then stimulated a letter, and I always like to make the statement it was before e mail. So I got a letter and the letter and the letter was from the neonatologist who said that when he was first, we said it was an interesting paper. However, what he was in medical school who blended the Vagus could kill you. And he said, " Perhaps too much of a good thing was bad." Now, first of all, I had to understand what he was saying. He was saying that as a neonatologist, one of their major concerns is a phenomenon called bradycardia when the heart rate drops too too low and can't support oxygenation of the blood sufficiently to keep the individual alive. So bradycardia marker indices that there's not enough oxygen going to the brain and the baby is then going to have severe complications and potentially lethal. And those that Bradycardia loop was vagal. Yet the vagal tone that I was talking about was perfected whenever you had the rhythms and the heart rate you never had the bradycardia. This I called the vagal paradox. So with the vagal paradox, I then have a problem. And the problem was, how could the Vagus both be protective and kill you? And that led me to a ah, a true academic search of information in which I went through the literature of everything. All things vagal and I basically landed in the area of the sub-basement of the National Institute of Health Library. And I start to look at an area that had never even taken a course in which was comparative neuroanatomy in comparative neuro anatomy looks at the nervous systems of different species to develop a hypothesis, or plausible hypothesis, of evolution. Because we can't really measure things that have become extinct, but we could see the more modern relatives of those extinct organisms. And when I started to find out, was that there was a major transition when, uh, between reptiles and the early primitive mammals. And those early primitive mammals had two branches of the vagus, and one branch was primarily regulating the gut, the other branch was regulating the heart. But the branch that was regulating the heart was going was coming from an area of the brain stem that regulate the muscles of the face and head, including the middle ear muscles. So what you start to see is that when the animals evolved, they regulated their physiological state through social interactions that required vocalizations,  facial expressivity and listening. And that's how they could determine whether one of their species, that con specifics, was saying to come close to. So the issue was, what were the nerves producing vocalization? Well, they were vagal nerves also but they weren't going into the heart, but they were parallel to those going to the heart. So just as heart rate variability in the respiratory band was predictive of a or coincident with a physiologic state of calmness prosodic voices which meant more variability and intonation, was where nervous systems were looking for inner interactions so we could feel safe and calm down. And just think for a moment, that is, a person talks in a monotone high voice, their own frequency. How do we feel? We get anxious with them. And if they talk with booming, low monotone voice, how do we feel? We feel that there's a predator in the room. So these are evolutionarily defined frequency bands that mammals inherited where I say humans inherited from our primitive mammals. So so by around up in 1994 I created the Polyvagal theory and in it I was describing these two different branches of the Vagus. But by 1998 I had incorporated what I called the social engagement system, which literally tied together the cranial nerves, regulating the muscles of the face and head with the vagal regulation of the heart and that leads us into really SSP, leads into the power of social interactions, as regulators of physiological state. because what this system tells us is that as we study the evolution, the regulation of our heart and our viscera being tied to the regulation of facial muscles and the muscles of the head and muscles of vocalization.

Joanne McIntyre:   16:25
And I think that and I remember doing some rating and just around this whole themes that even Darwin, remember that Darwin that he refers to the connection between the face and the heart via the pneumogastric nerve, so interesting to hear he discovered that. But yet no one did anything else with it until essentially your work.

Dr S Porges:   16:48
Yeah,  I used to in many of my papers. There is the quote from the expression of Darwin's book of the Expression Off Emotions in Man and Animals, where he talks about the pneumogastric nerve, which was later called the  Vagus. Yeah, so it was in a sense it became, and he calls it, he says the connection between two most important organs of the body and the important part about understanding and conceptualizing the Vagus and everything that evolves from this in terms of models of treatment, is that the Vagus is a conduit. It's a wire, but it's a bidirectional wire. It has signals going to the heart from the brain stem, but also from the heart and body through the brainstem. And most of the fibers are sensory, but most people don't think about the sensory components of it. We are this bi directional brain and body system, and that's why conditions where states of our body influence how we can access memories or access [cortical cognitive] cortical areas that enable us to be efficient and make good decisions. And in your background, Joanne, where you're interested in neurofeedback and EEG patterns. What has been lost in much of that research was what I would call a cortical-centric perspective. Which we acknowledge the important role that afferents, especially those coming up through the Vagus, the sensory patterns , what they do to, ah, cortical activity? And how they change the accessibility of decision making and calmness. So basically, it's important for us to really bring another person into this discussion. This is a person by name of Walter Hess. And Walter Hess in 1949 received a Nobel Prize in medicine and physiology or or, as they say, medicine or physiology. That's what the Nobel committee calls it. But what Hess's Nobel Prize was for was basically about the central nervous system regulating the viscera, regulating the autonomic. So that was known by 1949 and in his Nobel Prize speech, he talks about functionally one nervous system not a peripheral or autonomic and versus a central. So what we've had in our academic learning is a decapitation of the head from the body. We create a dualism - where the body became less important and the brain became everything. But what, uh, Walter Hess is saying is that their interactions, and this has been, is a wonderful quote in his  speech where, "This has been known from the earliest of times," and it's very new Agey, and I know, when I read that in my talks, is that if I use that  quotation I would never get a paper published or grants from it. But I think he really is right and it's a conceptualization. So in the world that we've been in, it is because people see the separation. They don't understand the importance of physical illness on mental process or physical injury. Or, let's say, medical emergencies on psychological state and that reaches now into the world of SSP providers because a lot of lot of the clients have had even medical trauma or psychological trauma, but no identifiable injury to their bodies that we would normally call trauma. But it had to do with all the contextual cues going on.

Joanne McIntyre:   20:30
Well, and I think hopefully that this spice is changing with that awareness between body and brain connection with, with the information like the ACES study, where they sort of  see the correlation of those early life stress and then how it plays out a mental health and in physical illness.

Dr S Porges:   20:51
I think it's extremely important. But let's let's actually talk a moment about ACES. And what ACES does and what ACES doesn't do. So ACES is "adverse childhood experiences". But it's, it's, really a spreadsheet of events, and our bodies are basically do not catalog experiences based on a number of events. We catalogue them based upon our bodily feelings. So there's a distinction between a Polyvagal perspective to trauma versus an ACES. One ACES is just saying, uh, give you an accumulation of categories. Polyvagal Theory says that the human documentary is not a narrative of events, it is a narrative of Feelings. When we take that as as being something real about being human, we then start opening portals of how we treat reactions to trauma.

Joanne McIntyre:   21:48
So would you sort of say that more that accumulated of biological stress that just kind of just snowballs over the years.

Dr S Porges:   21:57
Yeah, and the problem with ACES model is that psychological stress that snowballs or accumulates may not hit the threshold of being an adverse experience for one person. But it could be, in a sense, almost life-threatening to another. So we now live in the world. We say, "Ah, that didn't bother me. What do you all upset about", as opposed to world that says, Oh, that bothered you. How can I be helpful, how can I support you enable you to feel safe in the world that I feel safe in."  And that's part of our human responsibility.

Joanne McIntyre:   22:38
So we're going in. So you're now wanting to, you've developed  and realized the connection with the Vagus with Cranial nerves and ear and prosody. But then you so much deeper into.

Dr S Porges:   22:53
Well, yeah. So now we're into the up, I actually went through, after I tried to figure out what is the timeline of these things, it's is actually on my Web page. There's a little bit of a timeline where I identify what I think we're the statements that that occurred. So about 1998 I wrote a paper. It's called "Love." I can't remember the rest of the title, but it's in a ah, very uh, it's a very good journal called Psycho neuro endocrinology. And it was a paper that I wrote because my wife, who is Sue Carter, was editing a, was running a conference in Sweden for the Winter Grand Foundation, and it was on the biology of love. And the whole conference is a special issue of the journal. And given that my wife was running the conference, I felt I had to do an important article. And in that article is where I introduced a social engagement system, which is really kind of talking about the preamble of, of bonding that you have to send cues to another to be safe before you can be in physical proximity before you can have physical contact before you can feel comfortable in the arms of another. So we're all basically starts building on the model that we are negotiating psychological space through voice and through facial expressivity, and that enables us to come closer. So that brings us to 1998 by 1999 well actually by 1997. I was already experimenting because I can tell it's time tonight because some of the videos I still show have the year stamped on it, and I was trying to develop intervention for autistic kids, and ah, which I wanted to port into their nervous system - Hyper-prosodic vocalizations. So if prosody is part of this teacher that our nervous system is looking for, what happens if we take away low frequencies, high frequencies and we amplify the modulations of songs? So it's kind of like visualized an equalizer were we turn off the highs and lows, But then we jump around and move the frequencies dynamically in the middle. So we're actually creating more activity, more intonation than is normal. And that these changes of intonation follow all the rhythms of our biology- of breathing frequencies and vascular  frequencies, so our nervous system sees them as being biological. And that's that's what the initial SSP was all about, and to my surprise we ran it on four artistic kids. To my shock. Ah, they almost didn't appear to be autistic to me after we ran it. So I figured it was a, not a good thing for me to have experienced because is it okay, now let's do something else. I, uh but I needed now over the years to kind of understand what was going on, and so we try to develop measurements and actually had a patent published on a device that measures the middle ear muscle tone. And because we were able over the next decade to actually start showing in subjects that the tension of the middle ear muscles could be regulated through, SSP could be triggered. So I was really trying to develop measures and methods to validate a concept that didn't exist within speech and hearing sciences. So what I was saying was that the middle ear muscles were the critical filter. There were a few papers on that, but most people didn't talk about the rehabilitation of those neuroregulations muscles they treated as if this was a permanent one. So if you have a permanent deficit in the normal regulation and middle their muscles, the first symptom is very simple. You're hyper sensitive to sounds. Fortunately, and I said it's fortunately ,not in a because I should say, for unfortunately, there's a medical disorder that has that feature, but I don't mean that it's fortunate those people have that feature

Joanne McIntyre:   27:25
I understand yet, but it helps provide the discovery of the connection. 

Dr S Porges:   27:29
Yes, that's right. But we have to be sensitive. So the, the Medical disorder is called Bell's palsy. Bell's palsy is a partial. It's a Hemi paralysis off the Facial nerve [CNVII]. But the facial nerve also regulates the more primary, the more powerful middle ear muscle - the Stapedius.  So when people have a paralysis their face kind of droops. But they also have auditory hyper sensitivities. And it's really quite remarkable and the real tell tales to look at the obicularis oculi, which is the orbital muscle around the eye and that loses its muscle tone. And the face now looks flat, emotionally flat and cold, and the person now is hypersensitive. And now you start seeing the facial features of people who are very stressed people who may have PTSD or people or individuals on the autistic spectrum. So you see a lot of these features, even someone who gets a cold or gets a illness. The face goes flat, and they often are auditorially  hypersensitive and their voice. Ah, it reflects that change in state. So we started

Joanne McIntyre:   28:49
And more irritable as well. Next, this is immediate emotional response when you can't have clear acoustic information,

Dr S Porges:   28:58
Right? And then how do we respond to people who are irritable. We'll look and we'll tell them that. Why are you being irritable? As if it's an intention to be irritable. And what their body is telling you is that they're being overwhelmed by the sensory stimulation in their world? And so it's somewhere along the line, probably, in the early 19 twenties and thirties, when we became such a behavioristic oriented culture, with Watson and behaviorism, we kept on really saying, "Whoever we are, it's because of our intention". And if we're not nice, we don't intend to be nice. We started giving people all kinds of responsibilities for behaviors that were much more emergent or were spontaneous. And when we learn about that, we start teaching people how to manage their bodies in these complex situations. And so, in the late 19 nineties, I was using these acoustic stimulation to trigger physiological behavioral states of safety. And what happened was a lot of kids start to basically no longer have autistic symptoms, and the reaction by their clinicians were- that the clinicians have done this. Ah, that wasn't SSP, and it was a whole, whole interesting issue of what was going  on. And so I decided that I wouldn't, I would not, although I continued it, probably already into 2010 continued with the autism research. I would say that I'm not dealing with autism into the work, but auditory sensitive. And then I got into another kind of hole because the area of auditory processing assumed permanent auditory processing deficits or Central auditory processing deficits. And I actually was doing studies where we were showing that many of the autistic kids who came into the off scale on unloading by the time they had five days, they were in the normal range, eh? So how could this be a permanent central dysfunction? Should it, couldn't it be a, a, central regulation the peripheral middle ear muscles or a state change that will enable this to occur. The metaphor, so over time, I need to develop a language of what I was actually doing. So the language starts to take on a different narrative. The narrative is - what does a mother do to compensate? Yeah, the mother uses a prosodic voice. And what happens to babies- Anger, frustration, tears, discomfort it disappears. If the mother is gentle and as a good intonation. Fathers aren't as good. So what I would like to talk about is the  experiments or these observations, l have in airports, where the father has to take the boy toddler to the bathroom and the toddler comes back screaming. And the father is really irate. Yeah, yeah, and because it's out of control, he can't control the bit, the child . The child goes to the mother and the mother just kind like smiles and says a word. Tears disappear. And so you start seeing the cues being different and the different roles. I often say fathers are not particularly good with their kids or their spouses, but they're great with their dogs. And, that is, when they talk to their dogs, they use a false voice, a prosodic  voice. But when they talked to the spouses they never give up the male voice. When they talk to the kids they don't give it up, either. But when they talk to their  pets, they do so. The other metaphor always played with is his notion that our nervous system is waiting for Johnny Mathis. And Johnny Mathis was a a singer when I was growing up, but it was a singer that, uh, the adolescent males and females used to listen to when they want to become closer together, turn the lights off from each other on. And basically, what it did was it enabled both individuals to feel safe in the arms of each other. It took away the need to talk only made them feel safe with each other. It's a very interesting metaphor. So what did Johnny Mathis voice have to do with, how did overlap with the voice of ah ah, mother's lullaby or mother's words. They overlap in the same frequency modulation,

Joanne McIntyre:   33:40
So was your thinking  around the protocol in time to make a narrative around that you're thinking. I wanted to shift and make that connection with middle the muscles and, and the prosodic signs of safety.

Dr S Porges:   33:55
I think the critical thing is we evolved to feel safe with others. We evolved to regulate our biological physical physiological state through our interaction with others, and those interactions often have a lot of vocal input. And that  seems to be a portal that is very powerful. It's so powerful that we often tend to be unaware that it's happening. So SSP became what I would call a stealth intervention. It's a, no one felt they were doing it, it was passive. Their bodies could process it. It wasn't a challenge in which they fought back. Now, the issue is, what we start learning from the use of the SSP is as people's bodies feel safe, if they have a severe trauma history, feeling safe becomes a cue to react. So SSP makes the traumatized individual biologically and physiologically feel vulnerable. So we have this is continuum from vulnerability to accessibility, and we want to be accessible human beings. But if we have a trauma history, the memories of accessibility are over laid with memories of being injured. And that's where therapy Ah works where people use SSP with other therapeutic modalities. And they can use SSP to enable their clients to move into different physiological states. But we think and talk about it resolved.

Joanne McIntyre:   35:39
Yes, yeah, and I think practitioners really educating themselves about political theory and using that framework and even pulling some of the work from dead. Dina's application in therapeutic setting even supports, um, outcomes with the pay as well. Nothing.

Dr S Porges:   35:59
Yeah, yeah. So if we take so Debs work is really brilliant because it allows clients for people to experience their physiological state development narrative to understand it with with the labels of the political theory where they are moving into states of calmness and safety in states of war reactivity and mobilisation versus states of collapse. Eso. And when we started understanding how we move through those they become resource is compressed to move away from things that barbarous. And we know that we're scared about that. Uh uh, So there are other therapeutic modalities, like a grieving methods are also very useful in doing rapid physiological state chips that teach us about our internal bodily state. And in my workshops, I often do a little bit of breathing exercises. Uh, not for not for making people feel better, but for demonstrating that the physiological state that you go into Candace Troy your perception of another. So if you increase the ratio of inspiration to expiration, slow, inhale and we'll wrap it exhale. You turn off the Vegas and you start mobilizing your perspective

Joanne McIntyre:   37:19
telling this story you doing exercise at a presentation in the UK

Dr S Porges:   37:24
Yes, yes. People became destabilized, and actually one person said so in the U. S. Somebody actually, the only people who knew? Kay told me The person change from looking like a bubble, which is a robust Southern American old boy, kind of up to a Buddha. So just by breathing is perspective. The other person changed from a says, pulling back to a sense of worth loving and caring. What people would often say to me is that when they do, the long inhalations and their bodies get more tense. That person who's who's observing this happened peril. When is an observer? But when is a breather? They see the observer as being critical off them. They did. I do something wrong because they see the face is more colder, more withdrawn. But when they exhale slowly. So what a lovely person. I'd like to get to know that

Joanne McIntyre:   38:28
I need to use exercising one of my trainee like that guy.

Dr S Porges:   38:32
You'll be surprised how powerful it is, but it's what I also start. Limbs that the observers face starts to change almost like a mirror. So if you become cold in your face, you're sending a trigger together person's face, and I

Joanne McIntyre:   38:51
think nothing great learning exercise for some awareness and just understanding from Yuri

Dr S Porges:   38:56
is moving these automatic things into our sense of awareness of our own body.

Joanne McIntyre:   39:05
And I think I know we're talking about the application of some of the work that diner doesn't talked about in her book, uh, with individuals. But I think the applications for families where parents learned understand Aryan regulatory or bagel systems model triggers on then. Then they could help identify that in their Children, and particularly if they do have a child with trauma history or on the spectrum, they can learn to see what their states are and respond. I can't be rather than looking at it is behavior.

Dr S Porges:   39:41
Yeah, I told agree, and I think what I started to learn when I start developing the technique was that you couldn't treat the child alone. You could you could take these kids who carried diagnosis and you can make enable in the B spontaneously socially engaging. But if the family wasn't welcoming and supporting it back, the the child went back to me, avoiding withdrawing on dso I realized that you really you need a strong psychological case. Balkan go to any intervention

Joanne McIntyre:   40:17
entirely Great timing, right? Uh, what if we go back to you doing the research on the second protocol because it wasn't like something you did in a couple of years. You spent quite some time really gathering your daughter about behind it.

Dr S Porges:   40:36
Yeah, well, there's a lot of it that is theoretically driven. So I know you're you're curious about the duration of the sessions. How many sessions? The first thing you have to, uh, you need to understand is what it was. The quality of where the characteristics of your earlier must usually very small smalls muscles in the body. But they're fast twitch muscles, meaning that a D t. Very rapidly. So you meant that the sessions couldn't be too long? Mmm. And that the muscles had to go through relaxation phase. And the frequency band that was used to start the whole procedure was a frequency band that was selected consistent with what's called the resident frequency of the middle ear, meaning that regardless of the status of your middle, your muscles, those sounds will get into the inner ear. And what that meant is, you get the sounds into the 1,000,000 there's not gonna be any fighting against it. Just go in there and then the frequency Dad would expand, and it was really hoped that that would send a feedback loop back down, just like going on a treadmill, where you're increasing both the angle of the speed. I would say we need a little more tension, but very little changes on. And so the band would expand and contract very slowly and very little over the first day and then over days would go further and further, and the actual five day or five hour package was basically serendipitous. I will admit that point. These shortness of the sessions were based on the ah fast, which notion that you couldn't 50 the system and you had to be very careful. And this was also I had to engage or least explain this to many types of therapists who believe that if something is good, more is better. And so we used to play with The metaphor is less is more that you have to invite the system to respond to the stimulus. So everything was about less auditory information. That's why the filters were there and that why is why the resident's frequency sounds. We're going through that the nervous system had to welcome the sounds and processing. And so basically the program of expanding and contracting frequencies had a starting point and have an ending point, and the ending point was to include all the frequencies necessary. You extract meaning from language and that the speech hearing scientists had already defined and they had initially used be called an articulation index on Dhe. Then it was later refined and called the speech sensitivity indexers speech in tow, Eligibility index and basically think of it as a M radio. More cellphone Broonzy certain with the cell phone. You're not getting the full a band of acoustic pregnancies. You're getting the frequencies that will convey speech. And that's really the model that ah, the SSP was built on would say this isn't about developing your hearing, uh, for to become an opera singer or a musician. It's about developing your ability to process vocalizations within human speech range. And so s So when I took the starting point of the ending point and the gradations that I wanted change it based about the timing of physiological cycles within the body, it actually fit nicely into fight with recessions. And I had no idea in the beginning that ah five when our sessions over, you know, when our session's over five sequential days would be overwhelming for some people. I actually saw it as people would get exhausted, so that is a very positive feature because the body of this system was being challenged. But in all the cases I was working with, which were Children at the time, they spontaneously recovered the next day. It was only when I entered into the world of trauma and where I started to get sick, in fact, that the experiences we're more complicated and were predictable. And so the SSP providers now had to be more trauma informed and more observant and attentive to their clients so that they had to basically trust the clients and had asked one How you doing and to use almost the terminology from somatic experience in the body had to resolve it. So these were challenged is the recurring and the body had to be respected in resolving and the body will tell. We tell people. So we initially had the SSP being delivered in. Some therapist who had severe severe trauma histories themselves decide they would try it themselves. Home alone, which became since the worst thing, because what I started to realize is safe and sound that there were two important components. When was the context of what you deliver it and one was the acoustics team, Really? So if you're doing it by yourself, you're not safe. You need a supportive person, or let's say even even your your dog, you need a supportive other to be in your proximity Now. I hadn't seen that with Children because Children were always coming into the lab or the clinic with a trusting parent. The parent was going take care of that and a therapist who was supportive. But the child didn't have to leave the clinic or the lab drive home or beyond their own when, when a double close of the situations there in the confines. But suddenly, once they leave, we'll go out the door. They have to take care of themselves. I usually have to have the capacity. Do you detect a predator? Words right? And most people are much but say they're hyper vigilant at a very low threat stroke. And so that's why the safety start to become so important and allowing is that's inviting. Declined to tell you how they felt. So contexts became extremely important to understand that it's not. It's not a magic till that affects everyone in the same way the body has to be welcoming. And they could go back to something that we discussed a few minutes ago, talking about dead Dana and going up and down the ladder and experiencing physiological states. Polly Vagal theory is all about the intervening variable, which is the physiological state now that intervenes between the context of the world stimulate and behavioral, psychological and physiological response we produced. So it's that intervening variable that if the physiological state changes, we process information differently, get different responses, and this includes how we process is the speed. So we have to be really aware of the physiological state of the other on. And as I was saying that when the commission's got this some of them, I couldn't wait to try it on themselves and and one I got a 27 page, single spaced letter from a psychiatrist, and this was really when the amazing letter because she had gone through it three times, she put it for herself. But first of all, she used to have to take medication before she saw her first client. And so she obviously had a whole let's say, a lot of history. The first time was it was disruptive to where she went through it. But she was gonna do it again, Right? Right. By the time she did 1/3 time, she basically went to clearly in her metaphor. Went through the tube, saw the world in a different way, and she wrote back to me and she in thee in Delicious is now I understand what people like music. She could hear it and enjoy. But the most it telling part of her note was that she now saw humor in her daughter's antics. No, no, she could see a different world. And so it's really you start learning that even though people appear to be successful in the world, namely hold jobs, they have hired education, grease and the pregnant of respected. But many of them have really great difficulties in living their lives.

Joanne McIntyre:   49:47
Yes, yeah, and I think everything you've just been talking about just highlights Maura. And what I really want to achieve with this podcast is that psycho it is really expanding the knowledge around had a support best outcomes for the protocol. It certainly is not a tool that you can have a technician's kind of head on. And it handed out that, uh, you need to support and bay attuned with clients to sort of say, Do we need to modify the implementation

Dr S Porges:   50:20
right? Well, I think this is a learning process for all of us, because, as I said, I started with autistic kids, and they were isn't in the safe protected environment. And then I started to see with adults, um, especially those with severe trauma histories that what I thought were accused of safety were to them the stabilisers bond that really I had to know work on that intellectually and emotionally. And I realized that when you start thinking about what are the most severe traumas that people carry with them, it's violation of trust of someone who was close to that some time with whom they felt safe. And that is the cue that's coming back to their body when they hear them of a slow a buyer. Here, the modulation that sounds from the body gives up defenses. But then, since the cues that giving up defenses is really taking on vulnerabilities. The body goes back Oh, and basically says to them, Get out of here on Dhe. That's what the therapist need to be a winner. When I initially saw this, I was so concerned because my world view is I don't want anyone injured. I want to be helpful. And I was saying, Okay, we don't we don't deliver it to adults. But then the world of the SSP providers start to inform me how clever and intuitive and creative they were in blending SSP with other therapies. So using it for a few minutes with other therapies starting changing people's state using in a cycle educational mode where people start to I understand that their body shifted states. I started to see a really a different brilliance of of a community that I had never you even boat was. I I hadn't come up with all this by B s and ah, it really it changed how I thought about SSP when I first up, negotiated with with I a less I wanted held to a very strict protocol. I didn't want creativity involved by this. I was more concerned that people would take something that was good and basically you overuse it in printing the system. I'm more concerned about overuse of SSP. But what I really have learned is that the the provider community and this is who we're talking to is extraordinarily observant and sensitive to the clients and trying to work with them with SSP as a tool, which is virtually all SSP providers are trained and several other treatment modalities, so they could now start seeing how this could be useful with their other treatment

Joanne McIntyre:   53:21
rolls. And my goal is to have complimentary to have episodes, talking about complimentary a project.

Dr S Porges:   53:32
So we did we have this. I create this organization called Traumatic Stress Research Consortium and people who are listening conjoining by sending an email troma at indiana dot gov. You. But we started to ah, surveys air telling us are that most trauma therapists are using, on average, eight different treatment modalities not using are trained in and the treatment modality. So it's not like you do one thing. People have an array, and what was also interesting is that many of the therapist saw their work is being pollinated with foreign. And so I was very, very thrilled by that. But but what they meant by it was it's not a poly vagal treatment. They have a better understanding of the physiological state, the intervening there when they're working with the clients. So I start to see how things are working. My, it's really personally very rewarding. She'll see to see ideas translated practice.