Dr Stephen Porges’ Polyvagal Informed Listening Therapy has gained increasing recognition as an effective intervention for children and adolescents who may be facing a range of emotional and behavioural challenges. The listening therapy we deliver at Portobello Behavioural Health is called The Safe and Sound Protocol (SSP), it is a treatment tool based on Dr Stephen Porges’ Polyvagal theory. Polyvagal theory is a biobehavioural theory which explains how the autonomic nervous system, particularly the vagus nerve, influences our health, behaviour and social interactions. SSP can be used as a therapeutic tool to support children and adolescents facing a range of challenges with their emotional and social development, from Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), anxiety, trauma, sensory processing difficulties among others.
To understand the benefits SSP can offer, it is important to consider the neurobiology behind the theory. Let’s take a brief tour down the vagus nerve and meet some important organs along the way! The vagus nerve is a pair of nerves, one on the left side of the brain stem and one on the right, which contain about 100,000 fibers each. It is the longest nerve in the autonomic nervous system and connects the brain to the body. Vagus is the Latin word for wandering, and the vagal nerves quite literally take a long winding course through the body, starting at the brain stem, the medulla oblongata, and stopping at the large intestine. Along the way the nerves connect with the neck, chest, heart, lungs, abdomen and digestive tract. The vagus nerve has a vital role in many different functions in the body as it carries signals between the brain, heart and digestive system, allowing the brain to monitor the body’s functions.
Why is this important? Let’s put it into context, have you noticed when your child is at the supermarket, shopping centre or a birthday party they often need the toilet at inconvenient times, or a tummy ache that kicks in right before school drop off? Perhaps you’ve noticed your adolescent loses their appetite or gets frequently unwell during exam season? These can all be signs that the body and mind are overstimulated and the child or young person are having difficulty regulating their nervous system. The vagus nerve has an important role in involuntary sensory and motor functions, including; digestion, heart rate, blood pressure, respiration, immune system responses, mood, mucus and saliva production, skin and muscle sensations, speech, taste and urine output.
The autonomic nervous system is a system which controls involuntary physiological responses, it is divided into two, the sympathetic and parasympathetic nervous system and each branch is associated with a different adaptive behavioural strategy. You have probably heard of the fight or flight response, which is activated when we sense danger, this is the sympathetic nervous system responding and providing the tools we need to negotiate the danger. The parasympathetic nervous system is the second branch of the vagus nerve, and it is made up of two parts, ventral vagal, at the front, the more restful in nature, which is responsible for the social engagement system. The dorsal vagal, at the back, the more active in nature, which is responsible for the freeze or shut down response. The freeze or shutdown is our second level of defence, it is activated when we cannot escape the danger using fight or flight and so our last form of defence is to immobilise. We often see this in animals when they play dead. You may even have experienced it yourself as an involuntary response, for example when crossing the road if a fast car approaches and your brain analyses there is not sufficient time to escape your muscles may tighten and your body may feel rigid and stuck in position, this is a response from the parasympathetic branch, specifically the dorsal vagal.
To understand Polyvagal theory, it is essential to grasp the concept of ‘neuroception’, the subconscious process through which we continuously monitor our environment for signs of safety or danger. This information is relayed from the brain to the body via the vagus nerve, triggering physiological adjustments that aligns the body with the current state of the nervous system. When the sympathetic nervous system is activated in response to perceived danger, our body prepares for a potential threat by initiating the following changes; muscles tense, pupils dilate to reduce peripheral vision and sharpen focus on the threat, digestion slows as energy is diverted away from non-essential functions, glucose production increases to boost energy, and the middle ear muscles adjust to better detect high-frequency sounds which can help identify potential predators. In contrast, when the parasympathetic nervous system is activated, signalling safety, the body shifts to a restorative state. In this state heart rate and blood pressure decrease, digestion resumes, the liver engages in metabolic support and the middle ear adjusts to better hear human voices against background noise which facilitates connection and communication. These responses enable stillness and energy conservation, supporting either a freeze response or access to the social engagement system. In essence, when our environment feels safe, the body relaxes, allowing us to be open for social bonding and connection. We can see from the information previously considered how the vagus nerve links up so many important organs, this helps us to make sense of typical complaints from children and adolescents in the face of dysregulation; tummy aches, headaches, nausea, an urgency to evacuate their bladder or bowel, hypervigilance, sensitivity to sound or touch, difficulty with memory, concentration or focus, changes in appetite, changes in mood including low mood, hyperactivity, tearfulness, anger, illogical or irrational behaviour among other things can all be signs of dysregulation or overstimulation in the nervous system.
Polyvagal theory suggests that emotional regulation and a sense of safety are essential for activating the social engagement system. This supports what has long been understood in attachment theory, that consistency, attunement and a sense of safety are fundamental for a child to form secure attachments with their primary caregivers. Children rely on their primary caregivers to co-regulate, which in time allows them to develop the skills needed to self-regulate. If the environment or relational dynamic does not allow for this it may leave the child predisposed to a dysregulated nervous system and an over-sensitivity to threat, which in turn could prevent them from forming safe and reliable bonds and inhibit easy access to their social engagement system. The many links between Polyvagal theory and Attachment theory could suggest that Polyvagal theory helps us to conceptualise the biology of attachment. In the clinical setting I have observed some correlations between attachment style and a person’s pattern of defense. Specifically, when securely attached, the adequate safety experienced both bodily and in relationship allows a person to enter into the social engagement system easily. When anxiously attached, disorganised proximity seeking behaviours can often be observed perhaps indicating a predisposition for a sympathetic fight response. When avoidantly attached distancing behaviours can often be observed, which could indicate a sympathetic flight response.
That should cover Polyvagal theory, with a touch of attachment theory, in just enough detail to make sense of the next part, so let’s dive back into SSP! SSP is a research-based, non-invasive listening therapy designed to improve autonomic nervous system regulation and foster a sense of safety, calm, and social engagement. SSP works by utilising specific sound frequencies, delivered through specially filtered music, which stimulate the vagus nerve and help to support children and adolescents in calming their nervous system. Over time this can significantly assist their capacity to regulate their stress responses and enhance their emotional well-being and overall development. When thinking about ways SSP can be helpful I have broken it down into five core categories:
1. Improved Emotional Regulation
One of the primary benefits of SSP is its ability to help children regulate their emotions more effectively. Many children, particularly those with anxiety, ADHD or trauma histories, have difficulty managing their emotional responses. By stimulating the vagus nerve and improving the functioning of the parasympathetic nervous system, SSP helps children move from a state of hyperarousal, fight or flight, to one of calmness and centeredness. This can make it easier for children to manage strong emotions like fear, anger, or frustration, leading to better self-control and emotional balance.
2. Enhanced Social Engagement
SSP promotes improved social connection by calming the nervous system, fostering a state of safety, and enhancing access to the social engagement system. Children with difficulties in social interactions, such as those with ASD, often experience heightened stress in social situations. SSP encourages the brain to process and respond to social cues more effectively, improving eye contact, facial recognition, and engagement in conversation. As a result, children can be better equipped to face social situations which can in turn lead to improved social relationships.
3. Reduction in Anxiety and Stress
Children who experience chronic stress or anxiety often have difficulty coping with everyday challenges. SSP helps by reducing the physical symptoms associated with anxiety, such as rapid heart rate, shallow breathing, and muscle tension. This calming effect can help children feel less overwhelmed and more grounded in their environment. For children with trauma or sensory sensitivities, SSP can help reduce their response to stress-inducing stimuli, leading to a more adaptive coping strategy.
4. Better Attention and Focus
The calming effects of SSP can enhance a child’s ability to concentrate and stay focused. Children with attention-related difficulties, such as ADHD, may experience challenges with tasks requiring sustained attention in academic or social settings. By helping to regulate the nervous system SSP promotes an increase in focus and a potential reduction in mental distractions by helping to calm a busy mind.
5. Supports Neurodevelopment
Research indicates that SSP can support the development of crucial neural pathways, especially in areas related to social communication and emotional processing. For children with neurodevelopmental conditions like ASD, ADHD or sensory processing disorders, SSP can facilitate improved sensory integration and communication skills. The therapeutic sound helps children tune into environmental sounds, recognise vocal tones, and engage more fully in interactive experiences, all of which are essential for healthy brain development.
To conclude, we considered earlier how the social engagement system activates when we feel safe, Polyvagal theory highlights the role of social relationships in understanding trauma and suggests a new approach to healing by supporting the body’s natural systems for regulating arousal. SSP presents a promising, innovative and exciting method to enhance the emotional and social development of children and adolescents by improving autonomic nervous system regulation, fostering a sense of safety, reducing anxiety, and building stronger social connections. When used in conjunction with psychotherapy, the existing therapeutic relationship built on a foundation of trust and safety, supports SSP by providing a supportive and containing environment so the child or adolescent can feel held and experience the maximum benefit of the treatment.
