my personal journey from a theoretical dream to a clinical ......permi ssi on f rom the author. for...

The Safe and Sound ProtocolTM

My Personal Journey from a Theoretical Dream to a Clinical Reality

Stephen W. Porges, PhD

Distinguished University Scientist, Kinsey Institute, Indiana University

Professor Psychiatry, University of North Carolina

Where it Started (1966-1970)

The Autonomic Nervous System:A Paired Antagonism Perspective

The Autonomic Nervous System:A Paired Antagonism Perspective

Vagus

(Parasympathetic

Nervous System)

Sympathetic

Nervous System

The Autonomic Nervous System:What We Missed?

Supra-diaphragmatic

(myelinated/ventral)

vagus

Sub-diaphragmatic

(unmyelinated/dorsal)

vagus

When Technology Caught Up With Application(1985-1994)

When Technology Caught up with Application(1985-1994)

When Technology Caught up with Ancient Traditions (1985-1994)

Putting It Together: Polyvagal Theory(1994/1995)

Evolution as an Organizing Principle

“Old” Vagus Spinal Sympathetics

“New” Vagus

The Autonomic Nervous System:What We Missed?

Supra-diaphragmatic

(myelinated/ventral)

vagus

Sub-diaphragmatic

(unmyelinated/dorsal)

vagus

Sympathetic Nervous

System

Hierarchical Model of Autonomic State Dissolution (Evolution in Reverse)

Copyright © 2019 Stephen W. Porges

Myelinated (supra-diaphragmatic) Vagus

Sympathetic Nervous System

Unmyelinated (sub-diaphragmatic) Vagus

Insights from Polyvagal Theory:Seeds for SSP as a Polyvagal-Informed Therapy

• Evolution– During different stages of vertebrate evolution the structure and function of the

ANS changed

– Newer circuits inhibit older circuits

• Dissolution (Evolution in reverse)– Disease, damage, and adaptive reactions to survival demands sequential recruit

more ancient circuits

• Autonomic regulation is the core process underlying behavioral/emotional regulation

• Autonomic state provides an intervening variable in how we respond to the world

• Autonomic state provides a window and target for intervention

Insights from Polyvagal TheoryEmbedded Optimism

• A world without state regulation disorders!– Emotional state regulation

– Behavioral state regulation

– Physiological state regulation

– Autonomic state regulation (role of the vagal ‘brake’)

Introduction of the Vagal Brake(1996)

Introduction of the Social Engagement System(1997/1998)

Cranial Nerves

V,VII,IX,X,XI

Muscles of

Mastication

Middle Ear

Muscles

Facial

MusclesLarynx Heart

Head Turning

Bronchi

Pharynx

Cortex

Brainstem

Environment

Deconstructing the Social Engagement System


Features of a Dampened Social Engagement System


• Lack of prosody

• Poor eye contact and difficulties in social communication

• Blunted facial expressivity

• Difficulties in behavioral state regulation (hypervigilant, anxious, distractible,

impulsive, tantrums, hypoarousal)

• Compromised vagal regulation (e.g., state regulation, digestion)

• Difficulties in listening, following verbal commands, speech-language delays

• Sound sensitivities

• Oral motor defensiveness (e.g., ingestive behaviors)

Auditory HypersensitivitiesA Common Clinical Symptom?

• Without functioning middle ear muscles, we are hypersensitive to the low

frequencies (background) sounds that trigger anticipation or presence of

predator!

• Difficulties extracting human voice.

• Auditory hypersensitivities are associated with PTSD, trauma history, ADD,

autism, and several mental disorders and behavioral problems.


Facial Nerve (cn VII)Muscles of the Upper Face

Copyright © 2001 WebMD Corporation

Facial Nerve (cn VII)

Facial Nerve (cn VII)Neural Regulation of Middle Ear Structures

Detached Middle Ear BonesA Defining Feature of Mammals

• Detached middle ear bones are a defining feature of mammals.

• Living mammal species can be identified by the presence in females of

mammary glands. Since mammary glands and other soft-tissue features are

not visible in fossils, detached middle ear bones are used.

• Without “detached” middle ear bones, low amplitude sounds in higher

frequencies would not be heard. Thus, enabling mammals to communicate

in a frequency band that is difficult to hear for reptiles.


Structures of the Ear

Listening: An Integrative Exercise of the Social Engagement System

Middle Ear Sound Absorption System: MESAS(2009-2013)

1997 videos of autistic children

Eye Tracking System


OFF % EYE % MOUTH %

32.6 57.18 10.22

Control: 12 Year Old Male

Eye 57%

Copyright © 2018 Stephen W. PorgesCopyright © 2019 Stephen W. Porges

OFF % EYE % MOUTH %

39.31 1.15 59.54

Before InterventionAutism 10 year old male

Eye 1%


OFF % EYE % MOUTH %

26.15 71.38 2.47

Post Intervention: Autism 10 Year old

Eye 71%


Missing Concepts

• Neuroception – the mechanism through which the Social Engagement System could be ‘awakened’ and would ‘come out and play’

• Neural Exercise

• Acoustic vagal nerve stimulator

Neuroception(2003/2004)

NeuroceptionUnconscious Evaluation and Detection of Risk

• The nervous system’s detection of risk in others – without awareness.

• Can dampen defensive systems and facilitate social behavior (safety).

• Can promote defensive strategies of mobilization (fight/flight) or

immobilization (shutdown, dissociation).


NeuroceptionOur Personal TSA Agent

Neuroception

• Behaviors


Environment Behavior

Physiological State

Safe

Fight/FlightDanger

Life Threat Shutdown

Social Engagement

Neuroception

• Behaviors


Environment Behavior

Physiological State

Safe

Play

Intimacy

Social Engagement

Social Engagement or Fight/Flight

Three Circuits, Five States

Social Communication

• Behaviors


Circuit Behavior

Physiological State

VVC Social Engagement

Play/Dance

• Behaviors


Circuit Behavior

Physiological State

VVC

Mobilization

Social Engagement

SNS

Fight/Flight

• Behaviors


Circuit Behavior

Physiological State

MobilizationSNS

Intimacy


Circuit Behavior

Physiological State

IntimacyDVC

Social EngagementVVC

Shutdown/Dissociation


Circuit Behavior

Physiological State

ImmobilizationDVC

Neural Exercise(2015)

!Copyright!©!2015!Stephen!W.!Porges!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Page!1!

Pl a y a s a n eu r a l ex er c is e :

In s ig h ts f r o m t h e Po ly v a g a l Th e o r y Step h e n W. Po r g e s , Ph D

Dep a r tm en t o f Psy c h ia tr y Un iv er s ity o f No r th Ca r o l in a a t Ch a p el Hil l

We often think of play as an amusement or a diversion from the “real” work in our lives. When

we observe children playing, we might judge the time engaged in play as a distraction from

opportunities to learn. This view, denigrating play and revering classroom learning opportunities,

is consistent with our cultural view of education. Educational systems attempt to maximize

opportunities for classroom instruction and to minimize opportunities for social interactions

available during recess and other interactive forums such as team sports, music, and theater.

From an educator’s perspective, play is the antithesis of learning; play steals the precious time

that could be dedicated to learning. This perspective is based on assumptions derived from

learning theories that were outlined by behaviorists about 100 years ago. What if this

perspective, prevalent in our society, is outdated? What if play, rather than displacing learning

experiences, actually provides a neural exercise that would facilitate learning?

Is our conceptualization of play inadequate? Are our views of play restricted interpretations

dependent on a limited understanding of learning embedded in our educational institutions,

parenting styles, and expectations of socialization? Can we take a different perspective and

emphasize that play provides opportunities to exercise features of our nervous system that would

foster learning and social behavior? If play were perceived from this perspective, then play, as a

neural exercise, might foster state regulation, enabling individuals to transition efficiently from

active to calm states. Consistent with this perspective, the ability to move rapidly into a calm

state would facilitate efficient learning and optimize spontaneous and reciprocal social behavior.

The importance of play is dismissed in the cognitive-centric world of education. Within

theoretical models of learning, little importance is placed on how bodily feelings, as an

intervening variable, influence the ability to learn. Although we may want to sit and attend, at

times our body may want to run, fight, or hide. Calmly sitting enables us to attend and to

efficiently learn. However, when our body wants to run, fight, and hide, we are in a

physiological state that supports defense. During these physiological states, neural feedback from

our body to the higher brain structures will interfere with cognition and learning. Missing from

the cognitive-centric perspective is the role that play may have in strengthening the neural

circuits that can rapidly down regulate defense systems to foster learning by enabling us to sit

calmly and attend.

The roots of play are linked to the evolution of a neural mechanism that enables mammals to

shift between mobilized fight/flight and calm socially engaging states. From an evolutionary

perspective, mammals had to rapidly detect whether a conspecific was safe or dangerous. If the

GAINS is grateful to our Advisory Board Member, highly respected and influential neuroscientist Stephen Porges, PhD,

for sharing this new, pre-publication chapter on play. Please do not quote, reference or distribute this without direct

permission from the author. For more about Stephen Porges and his work see author information at end.

Porges, S. W. (2015). The Power of Play for Mind Brain Health. Mindgains. org, GAINS, 3-7.

Neural Exercise

• Exercising the Vagal Brake and the Social Engagement System

• Expectancy and violation of expectancy (peek-a-boo)

• Resilience (humor versus fear)

The Emergence of Polyvagal Informed TherapiesPortals for Neural Exercise

• Face-to-face social interactions

• Team sports

• Drum circles

• Singing

• Wind instruments

• Breathing exercises

• Posture shifts (e.g., baroreceptor stimulation)

• Listening

• Synchronous and reciprocal behaviors

– Expectancies, predictability


Polyvagal-Informed TherapyGeneral Principles


Neuroception:

Safety

Passive Pathway

Cues of Safety

Social Engagement

System

Client Client

Active Pathway

Neural Exercises of

the Vagal Brake

Context and

Therapist

Therapist

Social

Engagement

System

+Resilience

+Physiological Regulation

+Emotional Regulation

+Behavioral Regulation

+Communication Skills

+Quality of Life

Client

Patent(2018)

The Listening Project Protocol: Triggering the Social Engagement System with

Auditory Cues of Safety


The Safe and Sound Protocol™ A Portal to Social Engagement


How and Why Does It Work?

Recovering Social Engagement System Function

• Can deficits be ‘rehabilitated’ through the ‘listening’ portal of the social engagement system?

• Can music be altered to efficiently stimulate the Social Engagement System?


Sounds in Our Environment

Frequency Band of Perceptual AdvantageSocial Communication

Safe and Sound ProtocolTM

Middle Ear MusclesListening versus Hearing

Borg E, Counter SA.The middle-ear muscles. SciAm (1989) 261:74–80.

Frequencies of Social Communication

The Engineering of the Safe and Sound ProtocolTM

• Vocal music is modified to convey cues of safety that change physiological

state to support mental and physical health.

• Acoustic cues of safety support the nervous system’s capacity to optimize the

regulation of visceral organs (i.e., promote homeostasis) and social behavior.


Polyvagal-Informed TherapySafe and Sound Protocol


Neuroception:

Safety

Passive Pathway

Cues of Safety

Social Engagement

System

Client Client

Active Pathway

Neural Exercises

Context and

Therapist

Therapist

Social

Engagement

System

+Resilience

+Physiological Regulation

+Emotional Regulation

+Behavioral Regulation

+Communication Skills

+Quality of Life

Client

Pre-SSP Interview With a 10 Year-Old

Donnalea Goelz

Post-SSP Interview With a 10 Year-Old

Donnalea Goelz

Our Nervous System is Waiting for Johnny Mathis

• The modulation of vocalizations in the filtered music signals safety to our

nervous system.

• Cues of safety down regulate the metabolic costly mechanisms of defense

and optimize homeostatic processes that support mental and physical health.

• In adult clients with severe trauma histories cues of safety may be triggers of

violation of trust and abuse.


A New Paradigm

• If social behaviors are not learned, are they emergent properties of specific neurophysological states?

• Could intervention strategies be focused on manipulating or supporting the neurophysiological states (e.g., engaging and exercising feedback loops) from which social behavior would spontaneously occur?

• Listening as acoustic vagal nerve stimulation.


Future Applications SSP-Related TechnologiesApproved Claims

Safe and Sound ProtocolTM

Proposed Mechanisms

• Listening is dependent on and influences autonomic state.

• Listening provides opportunities to exercise neural circuits that support mental and physical health.

• Music evolved to support our biology of connectedness and our capacity to co-regulate.

• The altered music used in the SSP has the capacity to efficiently convey cues of safety to our nervous system and function as an acoustic vagal nerve stimulator.

• The acoustic cues of safety embedded in the SSP down regulate the metabolic costly mechanisms of defense and optimize homeostatic processes that support mental and physical health.

• The technology embedded in SSP have the potential to ‘calm’ nonhuman mammals.


Introducing Minna Porges

Polyvagal Blues

my personal journey from a theoretical dream to a clinical ......permi ssi on f rom the author. for...

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