Safe and Sound Protocol

1. Introduction

Version followed: the current commercial Safe and Sound Protocol (SSP) as distributed by Unyte (formerly Integrated Listening Systems), in its three-pathway form (SSP Connect, Core and Balance) as Unyte describes it on its website and in its SSP Pathways sheet (2021), and as described by Stephen Porges and Unyte's Karen Onderko, read alongside its research predecessor, the Listening Project Protocol (LPP) of Porges et al. (2014). Verification pass (October 2026): checked against Unyte's own pathway page and pathway sheet, product, clinical-resources, certification and support pages, and a Unyte blog on voice-related trauma; the pathway structure, provider eligibility and training route are now verified. Also checked: a 2023 adult pilot (Kawai et al.), a 2025 single-case-design thesis, a registered RCT protocol, and Grossman's 2023 critique of polyvagal theory with Porges's reply. Unyte's SSP Delivery Manuals, Remote SSP Facilitation Guidelines and intake form are available only to licensed providers, so their content is not reproduced here [uncertain]. Unyte's public pages list no contraindications, so the screening below draws on research exclusion criteria and is marked as such. Details taken from clinics that deliver SSP are marked where thin [uncertain].

What it is. SSP is a fixed course of about five hours of vocal music, computer-filtered to emphasise the frequency band of the human voice, listened to through over-ear headphones while the client is calm and accompanied by a regulating person [source: Porges & Onderko interview; Porges et al. 2014; NCT04999852 protocol]. It is a proprietary, licensed audio programme rather than a form of music therapy: the client does not make music, and the music is not chosen or improvised in response to the client. Porges calls it "an adjunctive therapy, not a standalone", used alongside psychotherapy, occupational therapy, speech and language therapy and similar care [source: Porges & Onderko interview]. In medical and rehabilitation settings it sits inside an occupational therapy or mental health episode; one US health system, for example, requires that any mental health diagnosis be "actively managed by a licensed mental health professional" while SSP is given [source: M Health Fairview].

Proposed mechanism (attributed theory). In Porges's account, the middle-ear muscles dampen low-frequency background sound so that the voice can be picked out; their neural regulation is linked, in his polyvagal theory, to a "social engagement system" of face, voice and heart regulation. The filtered music is framed as an exercise ("treadmill") for the neural regulation of these muscles, delivered in a safe social context, with the expectation that reduced sound sensitivity and calmer autonomic state open the way to social engagement and to other therapy [source: Porges et al. 2014]. Unyte describes the music as filtered to emphasise the middle frequencies of the human voice, using an algorithm Porges patented [source: Unyte SSP product page; Unyte SSP Pathways page]. These are Porges's theoretical claims, and the 2014 study did not measure middle-ear function directly [source: Porges et al. 2014 (limitations)]. Polyvagal theory is contested in physiology. Grossman (2023, Biological Psychology) argues that each of its five basic premises is untenable or highly implausible: the distinct ventral and dorsal brainstem control of heart rate, the mapping of that distinction onto immobilisation versus social behaviour, the evolutionary account, the use of respiratory sinus arrhythmia as the key index (which he calls a category mistake if read as vagal tone), and the claim that this arrhythmia is unique to mammals [source: Grossman 2023 (abstract)]. Porges replies that critics attack premises the theory never held, conflate analogy with homology across species, and rely on a flawed method for measuring respiratory sinus arrhythmia; he attributes oversimplification to popularisers rather than to the theory [source: Porges, Polyvagal Institute response page]. Present the mechanism to clients as one scientist's contested hypothesis, not as established physiology.

Evidence status (as sources give it). The founding evidence is two sequential randomised trials with autistic children (LPP, five daily sessions). Filtered music improved parent-reported hearing sensitivity compared with headphones alone and with unfiltered music. The main outcomes were parent reports, and control groups also improved [source: Porges et al. 2014]. Later published work is small and uncontrolled. In an exploratory pilot with six autistic adults in Japan (five daily 60-minute sessions, no control group), the only significant change was a family-rated social-awareness subscale at one month; self-reports and anxiety, depression, quality-of-life and sensory measures did not change significantly, and the authors call for larger randomised trials [source: Kawai et al. 2023]. A 2025 master's thesis using a single-case multiple-baseline design with eight adults with sound sensitivity, compared with unfiltered music, found no consistent evidence that SSP reduced sound sensitivity or improved wellbeing [source: Khatri 2025 (repository record)]. Other work includes an observational pilot in adults receiving trauma psychotherapy and a five-child occupational therapy series [source: NCT04999852 protocol; Cavaliere et al. 2026 abstract]. A blinded RCT in autistic children against unfiltered music, with Porges and Heilman as collaborators, was registered in Australia and was listed as not yet recruiting in 2026 [source: ANZCTR La Trobe SSP RCT record]. Unyte's website reports percentage improvement figures (for example in anxiety and mood) without citing the studies behind them [source: Unyte SSP product page]. Unyte states that its products are not medical devices, have not been evaluated by the FDA and are not intended to diagnose, treat, cure or prevent disease [source: Unyte SSP product page; Unyte SSP certification page]. No Cochrane or other systematic review of SSP is known [uncertain]; Heilman et al. (2023) and the Rajabalee et al. paediatric case report are not summarised here. SSP does not replace medical, audiological, psychiatric or developmental treatment.

2. Framework

Professional frame. SSP is not a regulated profession or a music-therapy method. It is a licensed product. Unyte offers its training to "licensed mental, neurodevelopmental and physical health professionals", and lists contributors from social work, occupational therapy, medicine, psychology, psychotherapy, marriage and family therapy, Somatic Experiencing and EMDR consulting. The foundational training is online, on demand and self-paced: Course I, The Science of Safety (autonomic nervous system and polyvagal theory, 1.5 contact hours); an Introduction and Delivery course (SSP components, intake and assessment, in-person, remote and hybrid delivery models, sensory considerations); and a Practical Integration course (logistics and business set-up). Continuing-education credit requires completing the course, scoring at least 80% on a learning assessment and submitting an evaluation. An active subscription is required to deliver SSP after training, and supplemental and immersion trainings follow certification [source: Unyte SSP certification page; Unyte SSP product page]. Practices list themselves as "Safe and Sound Protocol Certified" alongside their core licence (e.g. LPC, occupational therapist) [source: Full Bloom Counseling; M Health Fairview; Gateway Psychology]. Unyte's detailed provider criteria (for example, any rules for unlicensed practitioners) are unverified [uncertain]. Deliver it only within your own licensed scope (psychotherapy, OT, SLT, psychology), after the vendor training, and never as a substitute for that core therapy. Music therapists registered with HCPC/BAMT or CBMT/AMTA who use SSP do so as an adjunct product, not as music therapy [synthesis].

Stages as delivered in practice. Unyte publishes a three-pathway structure (Connect, Core and Balance; below), but no formal stage model with criteria for moving on. The sequence below combines Unyte's pathways with provider descriptions and the research protocols; the move-on criteria are synthesis [source: Unyte SSP Pathways page and sheet; Full Bloom Counseling; Gateway Psychology; NCT04999852 protocol]:

Assessment and preparation (1 session). Background, current concerns, sensory and sound sensitivities, current therapy and medical care, suitability. With children, carers attend. Introduce the idea, choose a playlist, set up the app and headphones, and sometimes begin a little listening.
- Move on when: the client (and carer) understand what will happen and can name a stop signal. The client has a calm, interruption-free place to listen, a regulating person available, and current mental health care in place [synthesis].
Familiarisation ("SSP Connect", optional). Unyte's Connect pathway is the music unmodified and unfiltered, in three 5-hour playlists (Classical, Adult and Child). The Adult and Child playlists are unfiltered versions of the music used in Core. Unyte suggests it as a warm-up offering a gentler introduction: it builds familiarity and expectancy, gets the client used to headphones, helps the provider judge the client's sensitivity and pacing, and helps decide whether Core should be delivered remotely or face to face. It can also be used ad hoc when a client is in distress. Unyte cautions that unfiltered "does not mean it is innocuous" [source: Unyte SSP Pathways page; Unyte SSP Pathways sheet 2021].
- Move on when: headphones are tolerated and listening is not distressing [synthesis].
Core filtered listening ("SSP Core", 5 hours). Core is the original SSP: the 5-hour Adult and Child playlists with progressive, dynamic filtering through Porges's patented algorithm, changing throughout each hour; Unyte calls it the strongest pathway [source: Unyte SSP Pathways page; Unyte SSP Pathways sheet 2021]. Unyte refers providers to its delivery manuals and remote-facilitation guidelines for Core; these are provider-only documents and their content is not given here [uncertain]. The research version gave five consecutive days of about an hour each ("less than 5 h" in total) [source: Porges et al. 2014; Kawai et al. 2023]. Current practice spreads the five hours more thinly. One clinic describes three weeks or so of regular sessions [source: Porges & Onderko interview]. Others describe about 15 minutes a day over several weeks [source: Full Bloom Counseling], or no more than about 20 minutes a day over roughly 20 days [source: SSP provider site]. In the adult psychotherapy pilot, about 30 minutes of listening took place within each one-hour therapy session [source: NCT04999852 protocol]. The filtering grows stronger and wider in its alternations across the tracks [source: Porges et al. 2014; NCT04999852 protocol].
- Continue or slow down: decide after each session, on the basis of state during and after listening, sleep, mood and any reactions over the next day or two (see Titration, section 4).
Integration and close (1 session, plus check-ins during the course). Review change, complete ending measures, and plan ongoing therapy. One UK service offers a three-month follow-up to advise on further SSP "as clinically indicated" [source: Gateway Psychology; Full Bloom Counseling].
Maintenance ("SSP Balance", optional). Balance uses the same underlying 5-hour Adult and Child playlists as Core, with a lighter, narrower filtering that does not change over time, so Unyte says it is not as potent as Core. Its purpose is to integrate and extend the gains of Core. Because every hour is filtered the same way, no order is required: hours or half-hours can be repeated, and speakers or any headphones may be used. Unyte lists uses including integrating Core, check-ins between sessions, warming up before a Core booster, and a daily state shifter once adverse reactions have been ruled out. It notes possibly greater benefit for clients prone to sympathetic arousal, and a slightly greater risk of mild side effects for clients in or prone to a dorsal vagal (shut-down) state, in polyvagal terms [source: Unyte SSP Pathways page; Unyte SSP Pathways sheet 2021]. Onderko says it was "formerly SSP Light" [source: Porges & Onderko interview].

Formats. Individual sessions in the clinic. Remote sessions with the clinician on video, which Onderko calls "very effective" and which became common during COVID; Unyte's training covers in-person, remote and hybrid delivery, and clients listen through the Unyte Health app while the provider manages the programme in MyUnyte [source: Porges & Onderko interview; Unyte SSP certification page; Unyte SSP product page]. Home listening between check-ins. Carer-and-child co-listening. Group delivery in inpatient settings, such as a weekly group at an inpatient psychiatric programme [source: Full Bloom Counseling; The Meadows]. One clinic package consists of 1 intake, 3 check-ins and 1 integration session around home listening [source: Full Bloom Counseling].

Pathway sequences (Unyte). Unyte describes three journeys. (1) Connect, then Core, then Balance: the most common, suggested for children, sensitive clients and clients affected by trauma; parents have noticed that a Core booster is sometimes needed after "3-4 months", and regular Balance listening may lengthen the interval. (2) Core, then Balance: for clients with fewer sensitivities and more resources, with Connect kept available if the client is destabilised; boosters start directly with Core. (3) Core alone. Unyte's general guidance is "less is more", safety comes before sound, and close connection and titration guide the choice of pathway, together with the client's response and clinical judgement [source: Unyte SSP Pathways sheet 2021].

Who it is offered to (vendor and clinic claims, not established indications): Unyte lists nervous-system dysregulation including trauma recovery, auditory and sensory processing differences, autism and other neurodivergence, autonomic dysfunction, and depression and anxiety, and its help centre names trauma and anxiety, auditory hypersensitivity, inattention, behavioural dysregulation, difficulty with social communication and preparation for therapy [source: Unyte SSP product page; Unyte support article]. Clinics list sound sensitivity, autism, trauma/PTSD, anxiety, chronic stress, attention difficulties, chronic pain and sensory processing difficulties, in children and adults [source: Gateway Psychology; Full Bloom Counseling; M Health Fairview]. A functional impairment is required before starting in at least one medical setting [source: M Health Fairview].

3. Guiding principles

Adjunct, not standalone. Always run SSP inside an ongoing therapeutic or rehabilitation relationship, with a plan for what it supports [source: Porges & Onderko interview].
Safety first, then listening. Listening is meant to take place in a state of felt safety. That means a quiet room, a calm activity and a trusted person present; if the client is not settled, settle them first [source: Porges et al. 2014; SSP provider site].
Co-regulation is an invitation. In Porges's words, co-regulation is "not an imperative. It's an invitation". So offer presence, and do not demand engagement or eye contact [source: Porges & Onderko interview].
Titrate. Porges describes the psychotherapist as titrating "through these experiences", especially with adult trauma survivors. In practice, give smaller doses and pause more when reactions appear; a slower pace is not failure [source: Porges & Onderko interview; SSP provider site].
Calm can feel dangerous. For some trauma survivors, the body becoming still is linked with past vulnerability, so anxiety may rise as the client calms. Name this in advance and treat it as information, not as a sign to push through [source: Porges & Onderko interview].
Listening is passive; the therapist's work is tracking. The client only has to listen. Your task is to notice state shifts, make sense of them, and support them during and after listening [source: Gateway Psychology; NCT04999852 protocol].
Either person can stop. Client and therapist may pause the music at any time to talk, then resume when the client is ready [source: NCT04999852 protocol].
Psychoeducation builds agency. Explain the theory (attributed to Porges) and help the client map their own nervous-system patterns, so changes have meaning [source: Porges & Onderko interview].
Gentle sound levels. The research protocol calibrated a 75 dBC peak, quiet enough that parents could not distinguish it from room noise; louder is not better [source: Porges et al. 2014].
Keep the course fixed; pace it individually. Keep the filtered course the same; adapt the minutes per day, the setting, the playlist choice and the support around it [source: Porges et al. 2014; Full Bloom Counseling; synthesis].
Gains can be fragile. Hypersensitivities may return after illness such as a fever, so plan follow-up and booster options rather than promising permanence [source: Porges & Onderko interview].
Honest framing. Describe the evidence as early and the mechanism as theory. Do not promise cures, especially for autism or for serious mental illness [source: Porges et al. 2014; synthesis].

4. Intervention inventory

SSP has a small set of fixed elements: preparation, familiarisation, filtered listening, pacing, co-regulation, processing, home or remote listening, integration and maintenance. Each is given below. The filtered audio itself cannot be adjusted by the clinician; your skill lies in everything around it [source: Porges et al. 2014; NCT04999852 protocol]. Example wording is illustrative throughout.

4.1 Intake, suitability screening and consent

Purpose / when: Before any listening. Establishes the goals, the risks and the therapy the SSP will support [source: Gateway Psychology; M Health Fairview].
Steps:
1. Take a background history: presenting concerns, the other therapies the client is receiving, and medical, developmental and trauma history. Also cover sound and light sensitivities, sleep, and any current mental health diagnosis and who manages it [source: Gateway Psychology; M Health Fairview].
2. Identify a functional goal, such as school, work or self-care participation, or tolerance of noisy places. Choose baseline measures: the adult pilot used PCL-5, GAD-7 and the Body Perception Questionnaire, and an OT series used COPM and Goal Attainment Scaling [source: NCT04999852 protocol; Cavaliere et al. 2026 abstract].
3. Hearing, ear and seizure check. Unyte's public SSP pages (product, pathways, clinical resources, certification, help centre) state no contraindications [source: Unyte SSP product page; Unyte clinical resources page; Unyte support article]. Research protocols, however, excluded people treated for a seizure disorder or with epilepsy, hearing-device users, people with a history of head injury or heart disease, and people with genetic or other neurological disorders [source: ANZCTR La Trobe SSP RCT record]; and people with epilepsy, schizophrenia or bipolar disorder, serious neurological or physical conditions, or severe hearing problems [source: Kawai et al. 2023]. A single-arm study with autistic children and adults admitted only people who tolerated music through headphones in a brief practice listen before enrolling [source: Heilman et al. 2023]; a short trial listen before committing to the course follows the same logic [synthesis]. These are study exclusions, not published Unyte contraindications. In practice, ask about seizures (including sound- or music-triggered), ear infections, ear pain, tinnitus, hyperacusis, hearing aids or cochlear implants, recent ear surgery and head injury, and consult the treating physician, neurologist or audiologist before starting if any is present [synthesis].
4. Screen for musical and sound triggers [synthesis]. Ask whether any kinds of music, songs, film soundtracks, singing voices or genders of voice are linked with frightening events or with a person who hurt the client. Ask also about voice-hearing, and whether headphones or a covered head feel unsafe.
5. Gain informed consent: explain that the evidence is early, that the mechanism is Porges's theory, what reactions may occur, and the right to stop at any time. With children, obtain carer consent and the child's own assent in age-appropriate words, and repeat the assent check each session [synthesis].
Example language (illustrative): "This is gentle music with the voice frequencies brought forward. Some people notice nothing at first, some feel calmer, and a few feel stirred up or tired. We go at your pace, and you can stop it at any moment."
Watch for: active psychosis, mania, acute suicidality, or an unmanaged diagnosis. Stabilise and connect the client with mental health care first, in line with the requirement that diagnoses be actively managed [source: M Health Fairview; synthesis for the specific exclusions]. The adult autism pilot excluded schizophrenia and bipolar disorder and stopped participation if the depression measure's self-harm item rose to a set threshold [source: Kawai et al. 2023].

4.2 Psychoeducation and nervous-system mapping

Purpose / when: In the first sessions and repeatedly during the course. Gives the client a frame for the shifts they notice [source: Porges & Onderko interview].
Steps:
1. Explain, as Porges's theory, the idea of states of safety, mobilisation and shutdown, and the role of the voice and the listening system [source: Porges & Onderko interview; Porges et al. 2014].
2. Help the client describe their own signs of each state: body sensations, thoughts and behaviours [source: Porges & Onderko interview ("their own nervous system patterns")].
3. Agree on the cues that mean "pause" and the strategies that help them settle [synthesis].
Example language (illustrative): "When you are on alert, what happens in your shoulders, breathing and hearing? And when you shut down? Let's make a map, so we can notice where the music takes you."
Watch for: clients taking the theory as fact or self-blaming ("my nervous system is broken"). Keep it descriptive and non-pathologising [synthesis].

4.3 Setting up the listening environment and hearing safety

Purpose / when: Before every listening session, in the clinic or at home [source: Porges et al. 2014; NCT04999852 protocol; SSP provider site].
Steps:
1. Use high-quality, closed-back, over-the-ear headphones with a flat frequency response, not earbuds or speakers [source: NCT04999852 protocol; Porges et al. 2014].
2. Keep the volume low and comfortable. The original trials calibrated a 75 dBC peak before each session [source: Porges et al. 2014]. Check the device volume yourself the first time, and tell clients and carers never to raise it to "feel more" [synthesis].
3. Choose a quiet, interruption-free room. The client should be seated rather than lying down, because lying down tends to cause drowsiness [source: NCT04999852 protocol; SSP provider site].
4. Provide a calm, low-demand activity, without screens or strenuous tasks (see 4.6) [source: Porges et al. 2014; SSP provider site].
5. Hearing safety [synthesis]. Stop at once if there is ear pain, ringing or a feeling of fullness. Do not use it during an ear infection. Let hearing-sensitive clients start with one ear-cup lifted, or with very short exposure. Clean shared headphones between clients.
Example language (illustrative): "It should be quieter than you'd expect, about the level of a soft conversation. If it ever hurts or rings, take the headphones off and tell me."
Watch for: hyperacusis or tinnitus flaring after a session, which means stopping and referring to audiology. Watch also for fiddling with the headphones as an early sign of discomfort [synthesis].

4.4 Playlist choice and familiarisation listening ("Connect")

Purpose / when: Before the filtered course (SSP Connect), to build a routine and tolerance of headphones, let the client choose music they can feel safe with, and gauge sensitivity and pacing [source: Unyte SSP Pathways page; Unyte SSP Pathways sheet 2021; Porges & Onderko interview].
Steps:
1. Offer the available playlists. Connect has three unfiltered 5-hour playlists, Classical, Adult and Child; Core and Balance use the Adult and Child playlists [source: Unyte SSP Pathways sheet 2021]. Porges and Onderko describe the music as including classical, radio-style popular songs and a children's selection from films [source: Porges & Onderko interview; NCT04999852 protocol]. Unyte suggests the Classical playlist as a first step for clients who need to get used to headphones, especially to vocal music [source: Unyte SSP Pathways sheet 2021].
2. Let the client sample unfiltered tracks and choose. A carer may choose for a young child, but watch the child's response [source: SSP provider site; synthesis].
3. Musical trauma triggers. Check that no track or style is linked with a frightening event or a harmful person; if it is, switch playlists. A familiar children's soundtrack can be soothing to one client and evocative to another, for example of a childhood home where abuse occurred [synthesis]. For clients whose trauma is linked to the human voice, Unyte recommends non-vocal playlists that carry the same filtering as the original pathways, introduced gradually within the therapeutic relationship and co-regulating activities [source: Unyte voice-trauma blog 2024].
Example language (illustrative): "Listen to a bit of each. Does any of this music bring back a person, a place or a time you'd rather not be taken to?"
Watch for: startle, freezing, dissociation or sudden mood change on particular songs. Note the track and avoid that playlist [synthesis].

4.5 Core filtered listening session

Purpose / when: The central element: about five hours of filtered vocal music given over days or weeks [source: Porges et al. 2014; Porges & Onderko interview].
Steps:
1. Check in on the client's state today, sleep and reactions since the last session, and whether they are willing to listen today [synthesis; source: Full Bloom Counseling (check-ins)].
2. Settle the client first if needed, for example with a brief relaxation or grounding exercise [source: SSP provider site].
3. Play the next segment in order. The tracks are sequenced so that the filtering alternates between narrowing and widening and grows progressively stronger [source: Porges et al. 2014; NCT04999852 protocol]. Do not skip ahead.
4. Play only the amount agreed for today (see 4.7). In the adult pilot this was up to about 30 minutes inside a one-hour therapy session, and listening could be broken into parts [source: NCT04999852 protocol].
5. Stay present and mostly quiet. In the trials, staff and parents stayed quiet and interacted only to keep the child calm [source: Porges et al. 2014].
6. Afterwards, ask about state and sensations, and record the minutes listened and the response notes [source: NCT04999852 protocol].
Example language (illustrative): "Just let the music be there. If something shifts in your body, or you want to stop, lift a hand." Afterwards: "What did you notice, in your body, in your mood, in how sounds feel now?"
Watch for: relaxation, softer breathing, more eye contact or spontaneous talk, and easier tolerance of sounds as signs it is landing [synthesis]. Agitation, irritability, headaches, tiredness, poor sleep or emotional flooding are signs to slow down (see 4.7). In the adult autism pilot some participants had mild, temporary headaches, sleeplessness and fatigue, and one became irritable and aggressive, which the authors linked to an emerging inner conflict [source: Kawai et al. 2023; SSP provider site].

4.6 Calm co-activity during listening

Purpose / when: During listening, especially with children and highly activated clients. Keeps the client calm and engaged without demands [source: Porges et al. 2014; SSP provider site].
Steps:
1. Offer quiet play or low-effort activities: books, a dollhouse, cars, pretend kitchen, soft toys and colouring were used in the trials [source: Porges et al. 2014]. A later study offered colouring, puzzles, quiet games, tactile toys, clay, cards and room to move, let participants bring a favourite toy, and discouraged computers, phones, reading and dancing during listening [source: Heilman et al. 2023]. Drawing, kinetic sand, mindfulness, or nature films with the sound off are suggested for older clients [source: SSP provider site].
2. Avoid screens with sound, strenuous activity, eating or drinking, a lot of talking, and stressful tasks [source: SSP provider site].
3. In expressive formats, follow the listening with art, movement, poetry or tracking of sensations and emotions to process what arose [source: The Meadows].
Example language (illustrative): "You can draw, or play with the sand, or simply sit. There's nothing you need to do."
Watch for: the activity becoming a task or a performance, or absorbing attention so fully that the client stops noticing their state [synthesis].

4.7 Titration (pacing the dose)

Purpose / when: Throughout the course, especially with adult trauma survivors and highly sensitive clients [source: Porges & Onderko interview].
Steps:
1. Start low. Unyte advises titrating the timing and duration of listening for each playlist and introducing all pathways gradually, because sensory sensitivity varies; its watchword is "less is more" [source: Unyte SSP Pathways sheet 2021]. Provider descriptions give a "gentle build-up", with sessions of about 15–20 minutes a day or less [source: SSP provider site; Full Bloom Counseling]. For very sensitive clients, begin with a few minutes, or with Connect [synthesis; Unyte SSP Pathways sheet 2021 for Connect]. Where the vestibular system is sensitive, Unyte suggests gentle movement such as stretching, yoga or walking to help integrate listening [source: Unyte SSP Pathways sheet 2021].
2. After each session and at the next check-in, review sleep, mood, energy, sensitivity and any reactions in the following days. Note that the largest changes often appear over the days and weeks afterwards [source: Full Bloom Counseling].
3. If reactions appear, reduce the minutes, add rest days, or return to familiarisation listening, then resume in agreement with the client [source: SSP provider site ("adjusted with the provider"); synthesis for the specific options]. In one study most participants listened without asking for breaks while others needed frequent breaks; the authors suggested planned breaks, spreading the listening over more days, or non-lyrical music for such clients [source: Heilman et al. 2023].
4. If the client falls asleep, replay that segment [source: SSP provider site].
5. Complete the Core sequence in order rather than skipping filtered segments, because its filtering progresses through each hour [source: Unyte SSP Pathways page (progressive filtering); synthesis for the rule]. Unyte's public pages do not say whether or when Core segments may be repeated [uncertain]; one university counselling service describes the non-vocal Classical Flow version as suited to people repeating SSP and to people who react to lyrics [source: Maynooth University Counselling Service]. Balance, by contrast, can be repeated in any order [source: Unyte SSP Pathways sheet 2021].
Example language (illustrative): "Yesterday's tiredness tells us something. Let's halve today's listening and see how the next two days go."
Watch for: the client pushing to finish quickly. Faster is not better: the research version used daily hour-long sessions with children, but current practice has moved to smaller doses [source: Porges et al. 2014; Porges & Onderko interview].

4.8 Therapist or carer co-regulation

Purpose / when: In every session. In Porges's model a safe social context is part of the intervention [source: Porges et al. 2014; Porges & Onderko interview].
Steps:
1. Be calm, warm and unhurried in voice and face, and keep your own state settled [source: Porges & Onderko interview (therapist co-regulates); synthesis for the specifics].
2. Offer connection without demanding it: sit nearby, be available, and do not insist on eye contact or talk [source: Porges & Onderko interview ("an invitation")].
3. With children, invite a regulated carer to be present or to co-listen. Some families listen together, each person with their own playlist [source: Porges & Onderko interview; Gateway Psychology]. Coach the carer to stay quiet and soothing, as in the trials [source: Porges et al. 2014].
4. Help a dysregulated carer settle before the child's session, because, in Onderko's words, dysregulation is "highly contagious, but so is co-regulation" [source: Porges & Onderko interview].
Example language (illustrative, to a carer): "Your calm is part of this. You don't need to entertain them; just be close and easy."
Watch for: a stressed carer hurrying the child or quizzing them about effects. If that happens, coach the carer, or have the child listen in clinic instead [synthesis].

4.9 Pause-and-process

Purpose / when: When something shifts during listening: a memory, an emotion, a body sensation, or a wish to talk [source: NCT04999852 protocol].
Steps:
1. Either person stops the music [source: NCT04999852 protocol].
2. Track what is happening, using the client's nervous-system map (4.2) [source: Porges & Onderko interview; synthesis].
3. Support the shift with your usual modality skills, such as grounding, orienting, or naming and normalising [synthesis].
4. Resume "when client is ready", or end listening for the day [source: NCT04999852 protocol].
Example language (illustrative): "Let's pause. You went quiet just then. What's happening inside? ... Would you like more music today, or is this a good place to stop?"
Watch for: rising anxiety as the client relaxes, which is the calm-as-vulnerability pattern Porges describes. Name it and slow down [source: Porges & Onderko interview].

4.10 Remote and home listening with check-ins

Purpose / when: When clinic attendance is impractical, or as the main format in some practices [source: Porges & Onderko interview; Full Bloom Counseling].
Steps:
1. Give the client a written schedule and instructions: the same time each day, a quiet place, seated, and no other tasks [source: SSP provider site].
2. Run the early sessions live on video if possible, so you can see the client's state [source: Porges & Onderko interview (virtual sessions); synthesis for live early sessions]. In one home-delivery study the device was sent with an instructional video, and a researcher held a video call before the first session to demonstrate it, watch the participant practise and advise on suitable activities; caregivers then ran the sessions with a therapist supervising remotely [source: Heilman et al. 2023]. A university counselling service frames remote listening with an assessment session, a counsellor check-in before and after each listening session, and a closing evaluation session [source: Maynooth University Counselling Service]. Unyte suggests using Connect to help decide whether Core should be facilitated remotely or face to face, and refers providers to its Remote SSP Facilitation Guidelines and a remote-facilitation certificate course, which are provider-only [source: Unyte SSP Pathways sheet 2021; uncertain on their content].
3. Arrange check-in sessions to track progress and adjust pacing, and tell the client how to contact you between sessions if they have reactions [source: Full Bloom Counseling; SSP provider site].
4. If the client lacks a distraction-free space or suitable headphones, offer listening in the clinic [source: NCT04999852 protocol].
Example language (illustrative): "Same time, same chair, headphones at the quiet level we set. If anything feels off, stop and message me. Don't push through."
Watch for: listening doses creeping upward, multitasking, listening at bedtime while lying down, or missed check-ins [synthesis].

4.11 Integration with ongoing therapy

Purpose / when: During and after the course. SSP is used to increase readiness for other work, not to replace it [source: Porges & Onderko interview; Full Bloom Counseling; The Meadows].
Steps:
1. Name in advance what SSP is meant to support: for example, tolerance for processing trauma later in EMDR, participation in OT or speech therapy, or engagement in family work [source: Full Bloom Counseling; Porges & Onderko interview].
2. After listening, use expressive or reflective processing: art, movement, poetry, or tracking of sensations and emotions [source: The Meadows].
3. Watch for, and build on, increased openness to other therapies [source: The Meadows; SSP provider site].
Example language (illustrative): "You've said noise feels less sharp this week. How might we use that, maybe trying the supermarket step we'd parked?"
Watch for: the therapy becoming "just the listening". Keep the treatment plan's main goals in view [synthesis].

4.12 Group delivery (inpatient or programme settings)

Purpose / when: In residential or inpatient programmes [source: The Meadows].
Steps: Run a weekly group listening session with paired expressive activities, under clinical oversight; The Meadows describes this model in a Level One inpatient psychiatric facility [source: The Meadows]. Add individual screening, a staff member able to step out with a distressed member, individual headphones and volume checks, and a debrief [synthesis].
Example language (illustrative): "Everyone has their own headphones and their own pace. If you need a break, take them off and signal; a staff member will join you."
Watch for: group contagion of distress, and members who cannot pace themselves within a fixed group schedule [synthesis].

4.13 Tracking outcomes

Purpose / when: At baseline, after the core course and at follow-up [source: NCT04999852 protocol].
Steps: Repeat your chosen measures. The adult pilot measured after the fifth hour and five weeks later [source: NCT04999852 protocol]. Use functional goals such as COPM or GAS for occupational participation [source: Cavaliere et al. 2026 abstract]. Use carer reports of sound sensitivity, listening, speech and emotional control for children, which were the domains of the original trial questionnaire [source: Porges et al. 2014]. Do not reproduce licensed instruments; administer them under their own terms.
Watch for: carer-report bias. Improvements also appeared in the trial control groups, so pair carer impressions with functional observations [source: Porges et al. 2014].

4.14 Closing, follow-up and maintenance ("Balance")

Purpose / when: At the end of the core course and over the following months [source: Gateway Psychology; Porges & Onderko interview].
Steps:
1. Hold an integration session. Review the changes and ending measures, and point the client to ongoing support [source: Gateway Psychology; Full Bloom Counseling].
2. Offer a follow-up at about three months. One service uses this to advise on further SSP "as clinically indicated" [source: Gateway Psychology].
3. Where licensed, offer SSP Balance for independent use: hours can be repeated in any order, and it can serve as a daily state shifter once adverse reactions have been ruled out. If gains fade, Unyte describes a Core booster, sometimes needed after about three to four months, with Balance possibly lengthening the interval [source: Unyte SSP Pathways sheet 2021; Porges & Onderko interview].
4. Warn the client that sensitivities may return after illness (for example, a fever) and agree what to do if they do [source: Porges & Onderko interview].
Example language (illustrative): "If things flare after a cold or a hard month, that isn't undoing the work. Get in touch and we'll decide together whether some maintenance listening makes sense."
Watch for: dependence on listening as the only coping strategy, and requests to repeat the full course without a clinical rationale [synthesis].

5. Handling problems

The public sources give little guidance on difficulties beyond pacing, pausing and contacting the provider. Most of what follows is clinical synthesis and is marked as such.

Dysregulation after listening (irritability, headaches, poor sleep, fatigue, tearfulness, or children becoming more defiant). Providers report these reactions as temporary, and the adult autism pilot reported mild, temporary headaches, sleeplessness and fatigue [source: SSP provider site; Kawai et al. 2023]. Unyte notes that dysregulation can occur during listening [source: Unyte voice-trauma blog 2024]. Response: pause listening for one or more days, then resume at a lower dose. Strengthen co-regulation and settling before each session, and review the timing (not before bed or a stressful event) [source: SSP provider site for adjusting with the provider; synthesis for the specifics]. Unyte keeps Connect available if the client is destabilised [source: Unyte SSP Pathways sheet 2021]. If reactions are severe or persistent, stop and reassess, including medical or audiological review [synthesis].
Anxiety rising as the body calms (feeling exposed, unsafe or "too still"). Response: name the pattern Porges describes, in which calm is linked with past vulnerability [source: Porges & Onderko interview]. Shorten segments, keep eyes open and orienting to the room, and allow movement or holding an object. Process the experience in therapy before continuing [synthesis].
Overwhelm, flashbacks or dissociation during listening. Response: stop the music [source: NCT04999852 protocol]. Ground the client with orienting, breath, contact with the chair and your voice. Do not resume that day. Check for a musical trigger and switch playlists if one is found. Return to stabilisation work before resuming [synthesis].
Musical trauma triggers (a song, genre, singing voice or children's soundtrack linked with abuse or loss). Response: screen for these at intake, switch playlists, and never insist on "getting used to" a triggering track. If every playlist is triggering, SSP may not be suitable for this client at present [synthesis].
Hearing problems (ear pain, ringing, fullness, increased sound sensitivity). Response: stop at once, check the volume (it should be low; the trials used a 75 dBC peak [source: Porges et al. 2014]), and refer to audiology or a physician. Do not continue during ear infections [synthesis].
"Nothing is happening" or stuck progress. Some people feel very little at first, and the largest changes often appear over the following days and weeks [source: Full Bloom Counseling]. Response: review functional goals and carer observations rather than in-session feelings; check adherence and the listening conditions (headphones, multitasking, volume); and continue the main therapy. Do not raise the dose to force an effect [synthesis]. After the course, decide with the client whether SSP has added anything and whether to stop [synthesis].
Non-adherence with home listening. Response: move listening into sessions or the clinic, set a fixed daily time, make the dose smaller, and use carer support [source: SSP provider site (routine); NCT04999852 protocol (clinic room option); synthesis].
Child refusing headphones or listening. Response: respect the refusal, because assent matters. Let the child explore the headphones and play with them first, try short exposures with a favourite activity, and have a calm carer co-listen [source: Porges & Onderko interview (co-listening); synthesis]. Never restrain a child or hold headphones on [synthesis].
Carer over-expectation or pressure (expecting a cure, quizzing the child about effects). Response: reset expectations to the early evidence and to the plan that SSP supports, and coach the carer in quiet co-regulation [source: Porges et al. 2014 (parent-report limits); synthesis].
Ruptures (the client feels dismissed as "just a nervous system", or the clinician seems more invested in the product than in them). Response: acknowledge the rupture, return to the client's own goals and story, and offer to pause or stop SSP without penalty [synthesis].
Psychosis, mania, acute suicidality or unmanaged diagnoses. Response: do not start SSP, or pause it, until the client is stable and under active mental health care [source: M Health Fairview (diagnosis actively managed); synthesis]. One anecdote reports hallucinations resolving after a session [source: Porges & Onderko interview]. Do not present this as a treatment claim [synthesis]. Follow standard suicide risk assessment and safety planning; SSP is not a crisis intervention [synthesis].
Requests to use SSP instead of medical care (for autism, chronic pain, concussion or neurological symptoms). Response: explain that SSP is an adjunct, keep medical and rehabilitation care in place, and coordinate with the treating team [source: Porges & Onderko interview; M Health Fairview].
Safeguarding with children and young people. Response: new disclosures can emerge in a calmer, more communicative child. Follow local safeguarding and mandatory-reporting procedures. Do not interpret a child's reactions to the music, or their play during listening, as evidence of abuse [synthesis].
Losses after illness or stress. Response: expect possible regression (for example after a fever) [source: Porges & Onderko interview]. Review the situation, use maintenance listening where licensed, and avoid treating the regression as failure [synthesis].
Scope creep and training gaps. Response: deliver SSP only after the vendor training and within your licensed scope; Unyte offers the training to licensed mental, neurodevelopmental and physical health professionals [source: Unyte SSP certification page]. Seek supervision for complex trauma and dissociation [synthesis]. Unyte's consultation arrangements and detailed provider criteria are unverified [uncertain].

Sources

Sources consulted:

Added in the October 2026 verification:

Not summarised in this guide [uncertain]: Unyte's provider-only SSP Delivery Manuals, Remote SSP Facilitation Guidelines and intake form; Rajabalee et al.; the full texts of Cavaliere et al. (2026) and Grossman (2023).

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