What is Cognitive Processing Therapy (CPT)?

Cognitive Processing Therapy is a type of cognitive behaviour therapy that has been found to be very effective for Post-Traumatic Stress Disorder (PTSD). It involves 12 structured sessions. It works by changing thoughts that are preventing people from healing from their trauma.

What is Cognitive Processing Therapy?

Cognitive processing therapy (CPT) is a structured type of cognitive behavioural therapy developed for PTSD. It that has been effective in reducing symptoms of PTSD. It is usually delivered over about 12 sessions. Moreover, it helps individuals learn how to challenge and modify unhelpful beliefs related to the trauma. In so doing, the person creates a new understanding and conceptualization of the traumatic event so that it reduces its ongoing negative effects on current life.

Theory Behind Cognitive Processing Therapy

The theory behind Cognitive Processing Therapy is that individuals organize information into schemas (cognitive shortcuts) to make sense of the world, interpret new information, and exert some level of prediction and control over their experiences. Traumatic events can disrupt schemas, particularly around beliefs related to safety, trust, power/control, esteem, and intimacy. PTSD can result when disruptions in these schemas manifest in inaccurate statements about self or the world, called “stuck points,” that interrupt normal recovery from the traumatic experience.

Assimilation and over-accommodation are the 2 primary types of stuck points that can maintain PTSD. During the process of assimilation, trauma information is altered to fit within the existing belief system. For example, if the existing belief is, “good things happen to good people and bad things happen to bad people,” then an abused child may believe they were abused because they were bad. On the other hand, the process of over-accommodation involves extreme alteration of existing belief systems based on the new trauma information. For example, a person who was abused by a doctor may believe that no doctor can be trusted.

These processes are contrary to accommodation which involves a more balanced modification of an existing belief system to integrate the new information from the traumatic experience. For example, “Sometimes bad things happen to good people” or “This happened despite my reasonable effort to prevent it.” The process of accommodation promotes recovery from the traumatic event. Correcting inaccurate assimilated and over-accommodated stuck points and developing more accommodated, balanced beliefs is a primary goal of CPT.

Cognitive Processing Therapy

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What is Cognitive Processing Therapy Like?

Cognitive Processing Therapy (CPT) is typically delivered over about 12 sessions and starts with psychoeducation regarding PTSD, thoughts, and emotions. The client writes an impact statement that details the current understanding of why the traumatic event occurred and its impact on beliefs about self, others, and the world. Next, the individual begins more formal processing of the trauma(s), by identifying stuck points and learning skills through worksheets on how to change those stuck points into more adaptive thoughts.

Finally, once the person has developed skills to identify and address unhelpful thinking, she or he uses those skills to continue evaluating and modifying beliefs related to traumatic events. At this point, the therapist is helping the patient develop the ability to use these adaptive strategies outside of treatment to improve overall functioning and quality of life. Additionally, focus is brought to the areas of life that are commonly affected by traumatic experiences, such as safety, trust, power, control, esteem and intimacy.

There are individual, group, or combined individual and group formats for Cognitive Processing Therapy. Although research suggests that the individual format is the most effective. CPT can be effectively delivered on a weekly basis or more often as long as all the homework is completed between sessions. This includes times where the client had 2 sessions a day for 5 days (in total 10 sessions). It has also been effective when delivered through an interpreter and telehealth.

Research on Cognitive Processing Therapy

Cognitive Processing Therapy (CPT) is one of the most researched treatments for PTSD. CPT has the strongest recommendation as a treatment for PTSD from a number of sources. CPT produces large treatment effects in regard to PTSD symptom reduction. Treatment gains were found to be maintained 5-10 years after the completion of treatment.

Additionally, CPT has also been shown to improve common comorbid symptoms and clinical correlates of PTSD such as:

  • Depression
  • Suicidal ideation
  • Health-related concerns
  • Sleep
  • Physiological reactivity
  • Dissociation
  • Functioning across important life domains
  • Personality disorders
  • Traumatic brain injury (TBI)

In Summary

Cognitive Processing Therapy is a powerful structured therapy for PTSD that has been successful for most that put in the work. It can provide healing in less time than other forms of therapy for trauma.

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Why Your Coping Techniques May Not Be Working for You?

You may find it frustrating when you do something that is recommended or are told that it will help you and it doesn’t work for you. There are reasons why your coping techniques may not be working for you. There are things that therapists sometimes do that can play into this. As well as barriers that may be within you that interfere with the techniques being ineffective. So how can you make some of these techniques more likely to work for you?

Techniques not working

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Why Your Coping Techniques May Not Be Working for You: Mistakes that Therapists May Make

Failure to present the techniques as something that may help you

There are few techniques that work for everyone which is why it is important for therapists to present techniques as something that may work for you rather than a statement that creates the expectation of the technique helping if you engage in it. This can reduce the pressure if you are having difficulties with it. It can also prevent you from feeling like there is something wrong with you because it doesn’t seem to be helpful.

Fail to give clients sufficient psychoeducation

It is important for you to know why a certain technique may be helpful and what the purpose of it is. By understanding the purpose, you may be able to problem solve it yourself. Often as therapists have used a technique over and over again, they may drop portions of the instruction that don’t seem as important anymore but are actually really important for you if you’re learning the technique for the first time.

For example, an important part of mindfulness is the observational status of just letting thoughts come in, observing them, and letting them leave. There is a calmness to this status. If someone doesn’t do mindfulness with the relaxed observational status, they may not get the benefit expected.

It is also important for you to receive certain psychoeducation about your condition or your experiences to help you understand why a certain technique is likely to help you. For example, mindfulness can be beneficial for helping to lessen the amounts of fear a person with chronic pain or trauma is experiencing. Therefore, psychoeducation about the role of fear in those conditions is also important.

Implementation Instructions are Faulty

It is important for you to understand how to do the technique properly, when to do it, and how often to do it.

First, you need to be comfortable doing the technique on your own. If the instructions are simple it may be enough to practice it in a therapy session. But many times, it is easy to forget some of the instructions so a handout with the instructions can be helpful.

Second, you need to know when to do it and when to do something else. You should not introduce a new non-crisis skill when you’re in a lot of pain, feeling extreme emotions or dealing with a trauma trigger. Those are times for crisis and self-soothe skills. Deep breathing that has been established in calmer situations may be effective in crisis situations later on but not until it has been established as a skill that bring calm.

Finally, you need to know how often to do it and when not to do it. It is important to practice the skills of retraining the brain so that retraining can actually happen. Usually, this means practicing them daily, several times a week, or several times a day. Most skills should avoided when the threat level in your body is high. The threat level needs to be brought down before using these skills. You can bring down the threat level with crisis skills and grounding techniques.

Lack of preparedness for techniques not working and problem solving solutions

I have heard stories of therapists not knowing what to do if a technique doesn’t work for a client. This can be very frustrating for you and if you’re prone to self-blame you may blame yourself. So it is important that therapist approaches the situation in a way that will lessen the chance of you blaming yourself.

First, a therapist can acknowledge that not all techniques work for everyone so let’s find something that works for you.

Second, a therapist can work through a problem-solving lens to figure out what went wrong and what barriers may be interfering with the effectiveness of the technique.

Both these approaches can reduce the blame that you may feel and engages you in way that tells you that they are working with you and want to help you figure it out.

Techniques not working

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Why Your Coping Techniques May Not Be Working for You: Barriers on the Client’s Side

Perceived Threat Level is Too High

Except for crisis skills, psychological skills should be practiced when the threat level is moderate or low. When practicing these skills when the threat level is high, they are likely to be ineffective. It can create more problems because your brain has more examples of times were the technique wasn’t successful and therefore can interfere with retraining your brain away from threat. It can also interfere with the long-term success of the technique.

Perceived threats can come from outside of your body, such as busyness, noise levels, and unpredictable environments. But they also can come from inside your body in the form of fear, excessive worries, mental pressure, and high pain levels.

Psychological techniques tend to be process techniques that bring benefit through practice. These psychological techniques are not one-off techniques. In fact, they are process techniques that work through practice and retraining the brain to operate differently.

If the threat level is too high, you can use crisis skills or self-soothing techniques to bring yourself to a state where the threat level is lower. At that point, you can engage in the psychological techniques meant to retrain your brain or bring you other benefits.

Too Much Intensity or Pressure

Sometimes it’s not about the technique itself, but how you are approach the technique. When you do techniques with too much intensity or pressure, you can bring a level of threat to the technique. This level of threat can prevent you for receiving the benefits that the technique could bring you.

Types of inner pressure and intensity that can interfere these techniques include:

  • Needing to do it right
  • Watching to see if it changes your pain or another symptom
  • Wanting to do it best
  • Trying to not make mistakes
  • Desperation for the technique to work

Previous Training or Conditioning

I remember the first time a therapist recommended that I do deep breathing regularly to reduce my pain. I actually experienced an increase in pain. Afterwards, I realized that I had done deep breathing so often when my pain was really severe that my brain was conditioned to think she’s doing deep breathing, the pain must be bad. I was getting pain when doing deep breathing because my brain associated deep breathing with pain. Deep breathing was not going to reduce my pain until I changed association between deep breathing and pain.

You can literally create an association between anything and pain if your brain gets used to the pain happening while you are doing the activity or you get introduced to something during a stressful or traumatic experience. This doesn’t just happen with pain, it can also happen with other challenging symptoms, sensations, or emotions. There are ways to change previous training or conditioning that have created associations between your symptoms and deferent activities.

How to Do Your Coping Techniques More Effectively

If you are interested in a technique but it isn’t working you may want to try to figure out the possible reasons for it. Once you figure out the possible reason you may be able to figure out what changes need to be made to make the techniques work for you.

Intensity or Pressure

If you find yourself bringing more intensity or pressure, you may need to figure out what is behind that intensity or pressure. Sometimes even once you understand what’s causing you to bring that intensity and pressure all the time, can help you to release it. Trauma could be interfering your with ability to relax because there’s a part of you that is still protecting itself or feels it needs to be on guard.

Lack of Instruction

If you feel that a technique may not be working because of lack of instruction. Here are some suggestions of what you can do:

  • If you are in therapy, ask your therapist for more instruction or help with problem solving.
  • Research the technique on the internet from people who are experts in that technique (for example, if interested in mindfulness you may want to read stuff by Jon Kabat-Zinn or Tara Brach)
  • Read a highly rated book on the technique or collection of techniques. Often these books do a good job of explaining why the techniques work and how to make them work for you.

Adjustments or Accommodation Needed

If you find yourself reacting to a part of a technique, you may be able to adjust it so that it works for you. For example, if you are in an extending depression episode and the technique asks you to come up with a pleasant experience from a past few days and you have trouble coming up with one. You can extend the timeframe so that you can find a pleasant experience whether it becomes a few months or a few years. It is about making the technique work for you. It doesn’t matter if it is done exactly like the way it was presented as long as it works for you and stays with the purpose of the technique.

Remember, just because you are not having success with a technique doesn’t meet it can’t be an effective tool for you. There are various things that may be getting in your way. You have the ability to overcome them, though sometimes you may need a little help. Life can get better.

Conclusion

Your coping techniques may not be working for you because you don’t have all the pieces together or they just aren’t suited for you. When you gain the necessary knowledge and implement your coping techniques at the right time you may find them working for you.

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What is Pain Reprocessing Therapy?

Pain Reprocessing Therapy is a therapeutic modality based on chronic pain and neuroscience research. It is a system of psychological techniques that retrain the brain away from threat causing pain towards a better sense of safety. There is a strong research study that supports its use for neuroplastic pain.

What is Pain Reprocessing Therapy?

Pain reprocessing therapy was developed by Alan Gordon. By the same token, it is recently developed and they are still researching its usefulness for various conditions and whether it can be used effectively in groups.

Additionally, it builds on, combines and extends existing psychological treatments. Such as cognitive-behavioural therapy and methods based in acceptance and mindfulness have been found to increase functioning and suffering in chronic pain sufferers by decreasing pain catastrophizing and enhancing coping. Furthermore, it borrows from exposure-based therapies by focusing on the idea that painful activities are not injurious and that exposure to those activities when the threat level is low does not increase pain. Nevertheless, the combination of approaches in Pain Reprocessing Therapy in the research so far has found substantially larger reductions of pain over the typical results from the therapies that it has borrowed from.

What is involved in Pain Reprocessing Therapy?

Pain Reprocessing Therapy (PRT) is a system of psychological techniques that retrains the brain to interpret and respond to signals from the body properly, subsequently breaking the cycle of chronic pain. It has five main components:

  • Education about the brain origins of pain (neuroplastic pain), the pair-fear cycle and reversibility of pain.
  • Gathering and reinforcing personal evidence for the brain’s involvement in their pain and potential to reverse their pain.
  • Helping them to see their pain as mistaken interpretations by the brain, interrupting the fear-pain cycle, and allowing them to see their pain through a lens of safety and lightness.
  • Addressing other non-pain threats that may be impacting their pain and wellbeing. For example, anxiety, self-criticism, self-pressure, trauma, and perfectionism are things that the brain can interpret as threats.
  • Shifting from a threat-sensitive lens of looking at the world towards one that welcomes more safety. We do this through encouraging positive sensations, experiences, and feelings.

To sum it up, if the pain comes from the brain, the brain can be used as a solution.

Pain Reprocessing Therapy

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What can Pain Reprocessing Therapy be Used to Treat?

Pain Reprocessing Therapy was created to treat neuroplastic pain. However, it can be effective for any condition where lowering the threat level and increasing a sense of safety can bring benefit. Some of the types of neuroplastic pain, it has been used effectively for include fibromyalgia, irritable bowel syndrome, and nonspecific back pain.

Research

A randomized controlled study at the University of Colorado Boulder supported the effectiveness of Pain Reprocessing Therapy for chronic pain. In the study, they randomized 151 chronic back pain patients to different groups. 50 received PRT twice a week for four weeks, 51 received a placebo treatment, and 50 received treatment as usual. In the PRT group, 98% of patients improved and 66% of patients were pain-free or nearly pain-free at the end of treatment. These outcomes were largely maintained one year later. 20% of the participants who received the placebo gained the level of pain-free or nearly pain-free. 10% of the treatment-as-usual group achieved pain-free or nearly pain-free levels.

They also found that the people who received PRT had:

  • Substantial reductions in brain activity in several regions associated with pain processing.
  • Substantial reductions in pain intensity,
  • Significant reductions in disability and anger
  • Improvements in sleep and depression
  • High satisfaction with treatment

Correspondingly, more research being done on Pain Reprocessing Therapy to substantiate the results of this research study. Additionally, there are also a lot of practitioners who have anecdotal evidence for these methods or similar methods having significant improvements for people with neuroplastic pain.

Conclusion

Pain reprocessing therapy is a therapy that is based on other approaches that work for neuroplastic pain and similar conditions. So far, the research is showing significant promise. There are reports of it helping a number of people. If your pain is brain-related, it may work for you.

Further Resources

Further Reading: Book

“The Way Out” By Alan Gordon and Alon Ziv

Additional Resources: YouTube

This Might Hurt – YouTube

This is a channel that is dedicated to the documentary “This Might Hurt”. Moreover, it has a number of videos about Pain Reprocessing Therapy and how it can be helpful for various conditions.

Official Website

Pain Reprocessing Therapy

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What is Neuroplastic Pain and Why is it Treatable?

Neuroplastic pain is one of three main types of pain. It is the main type of pain behind chronic pain. It is just as real as the types of pain that are more based on structural issues, such as nerve damage or broken bones. There are ways to figure out if the pain is neuroplastic or one of the two structural types of pain (nociceptive or neuropathic). There is research that shows it is treatable with the right psychotherapeutic techniques.

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What is Neuroplastic Pain?

Neuroplastic pain, also called nociplastic pain or primary pain, is generated by the brain, despite there being no significant damage to the body that is causing the pain. It is real pain. It is legitimate pain.

Pain as a Danger Signal


Pain is a danger signal, usually warning you that something is wrong and you should pay attention to it. Unfortunately, neuroplastic pain is a software issue. There is no significant damage or danger that you need to be warned about. The brain is making mistakes by interpreting non-dangerous sensations or stimuli as dangerous and creating a pain response. Neuroplastic pain can also be pain that has remained after an injury has healed and the brain keeps the pain signal in the “ON” position. It is like a fire alarm going off in an apartment building and the fire department needs to turn it off, but the fire department has not shown up and the alarm keeps going despite there not being a fire.

Mixed Pain

Even when there is nociceptive or neuropathic pain (pain caused by damage to the body), there can still be neuroplastic pain. A mixed presentation of pain (both neuroplastic pain and either nociceptive or neuropathic pain) can mean that the pain caused by these other types of pain can be amplified. The actual damage to the body could be experienced as a 2 or 3 on a pain scale, but the neuroplastic part of the pain presentation could cause that pain to be experienced as much higher on a pain scale. A mixed presentation of pain is like the volume control on your TV, where you can amplify the sound, but it’s the things that your brain is sensing as dangerous that is amplifying the pain.

The Distress of Neuroplastic Pain

Neuroplastic pain can get very intense. This may be very distressing for you because your limitations due to the pain can change and increase as the pain wants to be heard and it spreads to other parts of your body. Furthermore, the distress caused because doctors can’t figure out why you are in severe pain can make it worse. Ultimately, it can be disabling and severely affect your mental health.

Symptoms of neuroplastic pain?

• Pain that did not start with an injury (neuroplastic pain can develop from an injury that is still causing pain after the injury has healed).
• Pain or symptoms began during a time of stress.
• Symptoms are inconsistent (Symptoms move or spread; delayed onset, such as after an activity or exercise).
• Pain or symptoms that do not make sense by Known Structural Conditions
• Symptoms that are triggered by factors that have nothing to do with the body, such as stress, trauma, or conditioned responses.
• Co-occurring mental health conditions (they carry similar vulnerabilities and mechanisms)

What can make it more likely that you would develop neuroplastic pain?

• History of childhood adversity
• Presence of certain common personality traits, such as perfectionism, conscientiousness, people pleasing, and anxiousness.
• Family history of chronic pain

Neuroplastic Pain Based Conditions

These are some of the conditions that are often considered to be neuroplastic pain based or mostly neuroplastic pain based…

  • Migraines
  • Tension Headaches
  • Fibromyalgia
  • Complex Regional Pain Syndrome
  • Chronic Low Back Pain
  • Irritable Bowel Syndrome
  • Bladder Pain Syndrome
Neuroplastic Pain

Is Neuroplastic Pain Treatable?

The best part of neuroplastic pain is that it is treatable by retraining the brain. Since the pain is caused by mistakes the brain is making in interpreting sensations and signals from the body as threats, it can be treated by retraining the brain that those sensations and signals are not dangerous but safe. There are techniques and strategies that have been found to be very effective in scientific studies. This may not be easy as for many people they have been stuck in the same patterns for years desperate for relief but relief from neuroplastic pain is possible.

Pain Processing Therapy

Pain Reprocessing Therapy is a system of psychological techniques for use with neuroplastic pain. It is focused on breaking the fear-pain cycle by retraining the brain away from faulty misinterpretations fueled by fear and threat towards a more accurate view that is based on safety. In the Boulder Back Pain study, it was found that Pain Reprocessing Therapy improved the pain for 98% of patients and 66% of patients were pain-free or nearly pain-free at the end of treatment (2 sessions per week for 4 weeks) and that these outcomes were maintained one year later. You can read more about the study here: https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2784694

Emotional Awareness and Expression Therapy

Emotional Awareness and Expression Therapy is a form of psychological therapy that is designed to help patients attribute their pain and other symptoms to emotionally activated central nervous system mechanisms and become aware of, experience, and adaptively express their emotions stemming from adversity, trauma, or conflict. In various studies, Emotional Awareness and Expression Therapy was found to be effective for Fibromyalgia, Somatic Symptom Disorder, Irritable Bowel Syndrome, Chronic Pelvic Pain, Medically Unexplained Symptoms, and Chronic Pain.
https://www.frontiersin.org/articles/10.3389/fpsyt.2021.620359/full
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5680092/
https://pubmed.ncbi.nlm.nih.gov/32451528/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7309024/

Also see: Chronic Pain

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My Approach to Grief Counselling

Grief can be very challenging, confusing and distressing for you to deal with. Grief Counselling can help you process that grief. Furthermore, grief is not something that completely resolves, but something that you come to terms with. The pain and suffering usually starts to lessen over time with moments of grief that come up when something reminds you of the loss.

Grief is the response to loss, and it encompasses a broad range of feelings, cognitions, physical sensations, and behavioural changes. It can come from losses beyond the death of a loved one, such as the loss of an ideal/dream (partner changed after marriage, raising a child alone, not being able to have children), loss of ability (due to accident or medical condition), loss of wellness, loss of connection or belonging, loss of safety/security, or the loss of a pet. Ultimately, it is the process of coming to terms with a loss. There is a dance that involves the non-linear process of grief. As a matter of fact, there is no particular journey that grief takes, each individual has their own experience. Consequently, it can also be difficult when your way of processing grief is different from loved ones.

Grief Therapy

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Working with You where You are in your Journey

My approach to grief counselling starts with working with you where you are in your journey with loss. If needed, I may give psychoeducation or techniques to help you in your journey. I will work with you and your grief as a listener with compassion. I am a witness to your pain. If you lost a loved one, I am a witness to the love you had for the person you lost as well as someone who is walking with you as you come to terms with the loss. On the other hand, if you have conflicting feelings about the loss, I can provide a safe, empathic and understanding place for you to process those feelings. If you lost something else, I am a witness to how much that thing meant to you and someone you can talk to figure out the next step in your life without that loss.

Grief Counselling can Help You with the 4 Tasks of Grieving

The 4 Tasks of Grieving are:

  1. To accept the reality of the loss.
  2. To process the pain of grief.
  3. To adjust to a world without the person/thing you lost.
  4. To find a way to remember while embarking on the rest of one’s journey through life.

I am here for the part of the journey that you wish for me to be a part of. Whether it is the processing of the pain and readjustment after loss or something else. I will be there as a witness and support as you process your grief. I will be there to listen and hear you as you deal with the world you live in after the loss and the struggles to figure it out.

Grief is never easy and there is no one way to do it. Sometimes you need some help along the way and that’s okay. That is why I approach grief counselling the way I do.

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How Can a Therapist Help Improve Your Sleep?

There are several ways that counselling help you improve your sleep. Therapists often know the background to why certain items are listed on sleep hygiene lists and help you figure out how to use them to get you a better sleeping routine. Some of the things listed on sleep hygiene lists may not be practical for certain living situations (i.e., having your bedroom only for sleeping when you are living in a tiny studio or 1-bedroom apartment) and a counsellor can help you figure out what matters.

Cognitive Behaviour Therapy for Insomnia

Counselling can help improve your sleep by using Cognitive Behaviour Therapy for Insomnia (CBT-I) to help with thoughts, emotions, and beliefs interfering with sleep. This involves working with your beliefs, thoughts, and emotions to increase your sleep and help to remove mental barriers to sleep. CBT-I is an evidence-based approach to insomnia that helps improve sleep for 70-80% of people with insomnia that have tried it.

Counselling for Sleep

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EMDR for Sleep

EMDR can be used to help with sleep, especially sleep problems that came after traumatic events. It can help when you experience hypervigilance interfering with sleep, such as waking up alert in the middle of the night. It can also be used to instill routines that promote sleep and falling back asleep after waking.

Problem-Solving around Sleep

A counsellor can help improve your sleep with problem-solving around what affects your sleep with consideration of your personality, mental health challenges, your nervous system, living situation, work/life balance, and so on.

  • What matters to you as an individual?
  • What is stimulating to you?
  • What is your sleep routine and are there improvements that can be made?
  • What habits may be preventing you from having a good sleep?
  • Do you have a good sleep space?
  • What challenges do you have that you need to problem-solve around?

Treating Mental Health Symptoms that could be interfering with sleep:

  • Anxiety (rumination can be stimulating)
  • Hypervigilance (can prevent you from relaxing enough to fall asleep)
  • Depression
  • Trouble relaxing
  • Bad dreams/nightmares (can make a person try to avoid sleep to avoid the bad dreams/nightmares)

A counsellor can also provide psychoeducation about sleep, teach you skills that enhance your ability to fall asleep, and techniques to work with some of the barriers that are interfering with you getting a good night’s sleep.

Limitations of Therapy for Sleep

Despite all the strategies and knowledge a therapist can bring to improving your sleep, there are a couple of limitations solving sleep issues with a therapist. A therapist is not going to be able to help your sleep problems if they need medical interventions. Additionally, if you don’t apply your gaining knowledge and strategies about sleep to your sleep routine and issues, your sleep may not improve.

Conclusion

There are a number of ways that a therapist can help you improve your sleep. Ultimately, it’s about working together to figure out the best treatment plan for what is affecting your sleep and you applying that plan to your sleep routine.

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What is the Safe and Sound Protocol (SSP)?

What is Safe and Sound Protocol (SSP)?

The Safe and Sound Protocol (SSP) is an evidence-based listening therapy designed to reduce sound sensitivities and improve auditory processing, behavioural state regulation, and social engagement behaviours through filtered music.

As a practical application of Polyvagal Theory, the Safe and Sound Protocol acts as a non-invasive, acoustic vagal nerve stimulator, helping to re-tune the nervous system to better support connection, collaboration, and resilience.

The Safe and Sound Protocol involves listening to specially filtered music through headphones alongside a provider, in-person or remotely. Suitable for children and adults, the SSP has demonstrated results for individuals with trauma, anxiety, sensory processing differences and more. It activates the client’s social engagement system, helping to accelerate and enhance therapeutic outcomes. It suppers physiological state regulation, allowing for greater resilience.

You can find out more information about the Safe and Sound Protocol at http://www.whatisthessp.com

Who is Safe and Sound Protocol beneficial for?

  • Trauma
  • Chronic pain
  • Anxiety
  • Long covid
  • Stress-related disorders
  • Misophonia
  • Sleep disorders
  • Overactive/underactive emotional states
  • Sensory challenges
  • Fear/phobia-related disorders
  • ADHD
  • Digestion issues related to physiological state (or stress)
  • Attention difficulties.
Safe and Sound Protocol

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What is Required for the Safe and Sound Protocol?

To access the Safe and Sound Protocol, you need a smartphone with the app installed. You need an account activated for remote listening by your therapist. The listening requires over-the-ear headphones without noise cancellation features (or the noise cancellation features turned off).

Doing the listening as recommended by your therapist, as your therapist will create a program plan based on your symptoms and experiences as well as how your nervous system reacts to the Safe and Sound Protocol. Check-ins with your therapists for remote listening sessions (outside of counselling sessions) to email or secure messaging.

How long will it take?

It can take anywhere from 5 days to a year, depending on your nervous system. Everyone’s nervous system is different and responds to the Safe and Sound Protocol differently. It will depend on how dysregulated your nervous system is and how your nervous system responds to the Safe and Sound Protocol. It is important to understand that it is important not to rush the process and to listen to your nervous system. Working with your therapist to get the most out of the SSP.

What is the process?

If you are a current client, once you decide to invest in the Safe and Sound Protocol, I will send you an assessment for you to fill out in your own time. We will take a session to fill in any needed resources, explain the psychoeducation to support the SSP and discuss how we will implement it. Generally, we will do a bit of listening during that first session to see how your nervous system is handling it. If appropriate, we will transfer the rest of the listening to remote access, with email or secure messaging check-ins, and check-ins with each of your counselling sessions.

If you are a new client, I will send you an assessment for the Safe and Sound Protocol along with your intake and informed consent forms. It will take about 2 – 3 sessions for history taking (allowing your therapist to understand what may be affecting your nervous system), resource and skill building, essential psychoeducation, and exercises to better understand your nervous system.

Once enough support has been established. We will do a bit of listening during a session to see how your nervous system responds to it before having you listen to it independently through the app with email/secure messaging support and regular check-ins during your counselling sessions.

It is important to go through the listening process as slowly as your nervous system needs. Some people may need to take breaks or do activities that are more regulating while doing their listening. Your therapist can help you to understand what to pay attention to and what the proper balance is.

Find out more:

https://www.whatisthessp.com/

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What is Polyvagal Theory

Polyvagal theory is based on the influence of the vagus nerve on different physiological (body) processes as well as psychological states. It also describes how there can be nervous system dysregulation and the process to gain more regulation in the nervous system.

The Vagus Nerve

The Vagus Nerve is the longest cranial nerve in the body and it stretches from the brainstem to the stomach. It influences both our emotional and physiological states. It wanders throughout your body connecting with most of the organs in the body.

Polyvagal Theory

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What is Polyvagal Theory?

The polyvagal theory was developed by Stephen Porges and recognizes a hierarchical autonomic nervous system, which evolved to help us survive through communication, connection, and collaboration.

It describes three primary physiological states of the autonomic system, guided by a division of the vagus nerve (CN X) into dorsal and ventral components. The three states can be associated with the window of tolerance where your window of tolerance is your ventral vagal state, hyperarousal is your sympathetic state, and hypoarousal is your dorsal vagal state.

Dorsal Vagal

The dorsal vagal state responds to cues of extreme danger through immobilization and helps us to survive by shutting down important physiological functions (i.e., digestion) in the presence of a life threat. It is a state of hypoarousal that communicates that you are unreachable and can be confusing to others. It’s a story of despair where the body enters conservation mode. A person in this state may feel like they are going through the motions but not connected. They may feel alone, lost, abandoned, unreachable, hopeless or that they have disappeared.

Sympathetic

The sympathetic state responds to cues of danger through mobilization and helps us to survive through activation and action. It is a state of hyperarousal and high alertness where you can’t access your Prefrontal Cortex (PFC) like you are used to and are unable to truly connect with others. It is part of the spinal nervous system that regulates breath and heart rhythms. Moreover, it is a story of an unsafe world and unsafe people. It is a state of looking and listening for danger and in this state, people tend to miss and misread signs of safety. There is a sense of separation and being disconnected from self, others, the world, and spirit.

Ventral Vagal

The ventral vagal state responds to positive cues and supports feelings of being safe and relaxed. It is the state of co-regulation and connection and where health, growth, and restoration happen. It is where the social engagement system is and engaging socially cannot happen in a state of threat. Furthermore, it is the state that creates healthy homeostasis, allows for hope, compassion and self-compassion and is resourced and resourceful. It is this state of cooperation that is essential for survival where you reach out for, and offer, support.

In any event, these states are on a continuum, and we can experience blended states, where a pattern of response is influenced by more than one state. You can have one state in the foreground and another in the background.

Influence of Different States

Different physiological states can affect your behaviour, emotions, and cognition. It can bias your perception of the environment and prepares you to be either welcoming or defensive toward other people and situations. The better we can regulate our states and the more flexibly and smoothly we can move between them, the better our health (physical, emotional, mental) will be. Additionally, when we are more regulated we are able to connect with others better and have better relationships.

There are psychotherapeutic techniques and practices that can help to regulate your nervous system and promote the sense of wellness. Ultimately, this can improve your sense of safety, health, connection, and wellness in the world.

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How Do You Tell If Your Nervous System Is Dysregulated?

Nervous system dysregulation can create a lot of stress in your body. You may not know why you are feeling the way you are and not understand that it could be your nervous system. There are a lot of signs that can point to nervous system dysregulation, as well as experiences that can contribute to it. However, there are things we can do to help regulate your nervous system.

What Happens when Your Nervous System is Regulated?

A person’s nervous system generally spends most of the time with the parasympathetic (ventral vagal) nervous system activated to bring the nervous system to a calm state. When a person faces an emergency situation or crisis their sympathetic nervous system gets activated and after the crisis is over, the parasympathetic (Ventral vagal) nervous system brings the nervous system back to a normal state and calms it down.

What Happens When Your Nervous System is Dysregulated?

When a person’s nervous system is dysregulated, this process fails to work as it is supposed to. A dysregulated nervous system easily turns to “danger” responses such as fight, flight, freeze or fawn. A person with a dysregulated nervous system can be agitated or shut down. Also, their nervous system has trouble returning to a calm, parasympathetic state.

Signs of Nervous System Dysregulation

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What are the Signs & Symptoms of a Dysregulated Nervous System?

A person with a dysregulated nervous system won’t have all these signs and symptoms, but if you recognize a pattern of some of these symptoms in yourself, you may have a dysregulated nervous system:

  • Difficulty relaxing
  • Hypervigilance
  • Seem to be caught in a “fight or flight” trauma response or stuck in a “freeze or fawn” trauma response.
  • A person who is a “People-pleaser.”
  • Engages in “toxic positivity” to the point where they become out of touch with their own vulnerable emotions and the emotions of others.
  • Thrill-seeking behaviours
  • Auto-immune disorders and diseases, irritable bowel
  • Constantly on edge, overwhelmed and/or overstimulated.
  • Frequently snappy, irritable, and reactive
  • Chronic pain and illness; unresolved aches and pains; somatization
  • Highly sensitive to sensory stimuli
  • Sleep problems (disrupted sleep, insomnia) and daytime fatigue
  • Chronic attention and concentration problems; executive dysfunction
  • Cravings and extreme appetite changes
  • Immune and hormonal symptoms/compromised immune system (keep getting sick)
  • Skin and gut conditions/ Digestive Issues/Nausea
  • Highly sensitive to other people’s emotional states
  • Constantly anxious, agitated, stressed and/or worried.
  • Hard time controlling your emotions or the inability to feel emotions.
  • Executive dysfunction
  • Stonewalling
  • Depression
  • Elevated or irregular heart rate.
Signs of Nervous System Dysregulation

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What can Contribute to a Dysregulated Nervous System?

  • Traumatic experiences
  • Adverse Childhood Experiences (ACEs)
  • Childhood trauma, especially chronic childhood trauma
  • Witnessing Domestic violence
  • Medical trauma
  • Chronic stress
  • Lack of social support
  • Unfavourable living experiences
  • Chemical imbalances
  • Experience-dependent plasticity, resulting in a combination of symptoms and functional impairments.

What can be Done to Regulate a Nervous System that has become Dysregulated?

Some people need help to get back to a regulated state and techniques such as breathing exercises, using music to regulate, using exercise to self-regulate, grounding techniques, and many other techniques.

A person’s nervous system can get stuck in a dysregulated state, in this situation a person needs help to get to a regulated state. For these people, the relaxation, breathing, and grounding technique might not work to get them back to a regulated state or they take longer to create the effect that is desired.

  • Polyvagal Theory gives a theoretical basis to understand how you can train your nervous system to regulate.
  • Safe and Sound Protocol is an approach based on filtered music that is based on Polyvagal Theory to help a person regulate their nervous system. It can be adjusted to the unique needs of a person’s nervous system.

Cognitive techniques can also help to regulate the nervous system by adjusting the thought processes that can promote dysregulation. For example, if we can adjust your thinking so that the world doesn’t seem as dangerous, this can calm the nervous system.

Conclusion

Once you understand the signs of nervous system dysregulation and what it means. You can work to help it get regulated or in some cases, bring it back into a regulated state. It’s about training your nervous system to be regulated.

References:

Tanasuggarn, Annie. (November 5, 2022). The Health Risks of a Dysregulation Nervous System. Psychology today: https://www.psychologytoday.com/us/blog/understanding-ptsd/202211/the-health-risks-dysregulated-nervous-system

Hogue, Loren. (August 10, 2022). 9 Signs You have a Dysregulated Nervous System. Link-in: https://www.linkedin.com/pulse/9-signs-you-have-dysregulated-nervous-system-may-considered-hogue/

Elbers, J., Jaradeh, S., et al. (2018). Wired for threat: Clinical Features of nervous system Dysregulation in 80 Children. https://doi.org/10.1016/j.pediatrneurol.2018.07.007

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The Benefits of Online Therapy

There are many benefits of online therapy, but also some drawbacks. Both online therapy and in-person therapy have been found to have similar rates of effectiveness in studies that compared them for the same type of therapy. It is important to figure out what works best for you rather than just relying on what the research says is effective.

When it comes to tele-counselling, there are different formats for online counselling. Counselling can be done in person, through various video platforms, by telephone, or through text or chat programs. In both in-person and video counselling, the therapist and client can still see each other and observe non-verbal forms of communication. While with telephone counselling, you can still have communication through vocal tones and words. With Text and chat-based counselling, the counselling is based on words and is more prone to misunderstandings. I generally find that it is more difficult to create a therapeutic alliance with my clients the more forms of communication that are removed. In-person and video counselling are similar in effectiveness and which is more effective for a person depends on personal aspects and preferences.

I have described some of the benefits, considerations, and challenges of online counselling below. Please note that most of these are based on video counselling rather than telephone and chat-based counselling.

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Benefits of Online Therapy

More Convenient & Accessible

A person can access online counselling from their own home. This helps people who have trouble getting out of the home or have busy lives and have a hard time finding the time to travel to and from appointments. You are generally able to find a comfortable place to sit at home to attend your counselling sessions.

Online therapy can often be squeezed into an hour during your day, such as your lunch hour. Occasionally, you can also have shorter appointments, if that is all you have time for.

Often can have comfort items with you

Often you can have a counselling session in a room in your home that is comfortable for you and you can have pets or things with you that can be calming for you and enable you to be more present in the counselling session.

Finding a provider that fits your needs

Effective counselling often means a good fit between client and counsellor. You want a counsellor that has the skills and techniques to work with the issues and challenges that you are bringing to therapy. The counsellors in your area may not have the skills to effectively work with your issues, but when you have online counselling, you can have a greater selection of counsellors to choose from.

Establishing a Therapeutic Relationship

A lot of people have found that they have been able to secure a good therapeutic relationship through online therapy. Therapists have found different ways to deepen a therapeutic relationship when not in the same room as the client.

Attunement and Body Language

With video therapy options, a therapist can still read a lot of the information that they would if it were in person. This is not the case for telephone or text-based therapies where the therapist cannot observe the face and shoulders.

More flexible, customizable

If you have trouble finding privacy at home, you might want to talk to your therapist while on your smartphone while walking or in a park. If you have chronic pain, you may be able to sit in positions that are more comfortable than if you attended counselling sessions in person. Often there is a lot of flexibility and adaptations that can come with a therapeutic experience that is online.

Reduced Stigma and Increased Confidentiality

There is reduced stigma because people do not see you walking into a therapist’s office or see you in a waiting room. There is also increased confidentiality because you are not seen attending therapy. This means that you are in control of who finds out that you are attending therapy.

The rules around privacy and confidential client information for online therapy are strong and part of the ethical framework of therapeutic associations. Therapists are expected to use encrypted programs for therapy sessions, so what you say in therapeutic sessions should be as private as you are able to make it on your end (secure network, private space where others cannot overhear, etc.).

Benefits of Virtual Therapy

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Making Online Therapy Better

Creating more privacy

There are ways to increase the privacy of your end of therapeutic sessions. If you are afraid of being overheard, you can use a white noise machine between you and the door. You can find a quiet, private space for doing your sessions in, such as a car, a large closet (clothes and fabrics also help to dampen the sound), a large pantry, or a bathroom, if necessary.

Reducing Distractions

Work with those around you to create boundaries around your therapy sessions, so that there are fewer interruptions and distractions.

What are some of the Challenges with Online Therapy?

Certain Mental Health Conditions

People with intellectual disabilities and schizophrenia are among those who would be more appropriate to be seen in person.

Personal Preference

Some people prefer meeting a therapist in person and have trouble connecting over video, if that is the case for you, you might want to pursue in-person counselling.

Technical Difficulties

With using technology to access counselling, there are chances that the technology could fail (Internet/power outages, device malfunctions, etc.). Usually, the therapist has a plan for technology issues.

What is best for you?

While there are a lot of benefits for online therapy, what is best for you depends on your personal preferences and what is important to you. Most research that have compared online and in-person therapy have found no difference between the two. Researchers have compared in-person versus online therapy in multiple modalities (EMDR, DBT, CBT and Cognitive Processing Therapy) and did not find a difference in the effectiveness. Whatever makes you more comfortable and you feel you can stick with is probably the best option for you.

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