Safe and Sound Protocol After Concussion: Gentle Auditory Support
Concussion scrambles more than memory and balance. It can shake the way the nervous system listens, filters, and responds to sound. Many people describe a new world of noise after a head injury: ordinary clinks and hums feel piercing, crowded rooms turn chaotic, and a single voice can fade inside a blur of background chatter. The nervous system is not just hearing, it is guarding. This is why a gentle auditory intervention can be helpful. The Safe and Sound Protocol, based on the polyvagal framework, offers carefully filtered music that aims to support regulation of the autonomic nervous system and tune the middle ear for cues of safety. When introduced with care after a concussion, it can add an important layer to rehabilitation.
I have supported athletes, teachers, and parents through the fog of post-concussion symptoms. For those with sound sensitivity, fatigue, headaches, and anxiety, the right input at the right pace matters more than any single technique. The Safe and Sound Protocol, often paired with somatic experiencing and other body-based practices, has helped many regain ease with sound and settle their physiology. It is not a magic switch. It is more like a series of small invitations to safety that, over time, can change how the nervous system listens.
Why concussion disturbs listening and regulation
A mild traumatic brain injury disrupts networks that coordinate attention, vestibular function, and autonomic regulation. The middle ear muscles, especially the stapedius, normally tighten reflexively to dampen low-frequency background noise and enhance the human voice. After a concussion these reflexes can delay or fatigue. The result is familiar to patients: the refrigerator hum feels intrusive, restaurant conversation dissolves into noise, and a meeting drains energy long before lunch.
At the same time, the autonomic nervous system often shifts toward a defensive set point. Some people feel revved and jumpy, others sink into fatigue and shutdown. Most move between the two. When the system no longer trusts the environment, it listens for danger first. Prosodic human voices are harder to parse when the ear is biased toward threat frequencies. This is the loop many people get stuck in after a head injury: noise overwhelms, tension rises, headaches sharpen, sleep fragments, and then concentration falls. Recovery slows.
What the Safe and Sound Protocol is trying to do
The Safe and Sound Protocol, created by Stephen Porges and colleagues, delivers filtered music designed to emphasize prosodic frequencies and stimulate a neurophysiological sense of safety. The listening is not about entertainment. It targets neural pathways connected to the vagus nerve and middle ear muscles, which together help the brainstem decide if it is safe to engage, digest, and connect.
The standard format spans about five hours of listening divided into short sessions. Many clinicians now spread those hours over days or weeks, especially after concussion, to protect against over-arousal. The technology is delivered through a dedicated app and calibrated audio. Over-ear headphones are usually preferred because they reduce environmental noise without pressing directly into the ear canal.
Research on SSP is growing but still early. Small controlled studies and case series indicate benefits for some people with anxiety, auditory hypersensitivity, and trauma symptoms. In concussion care, we have case reports and clinical experience more than large randomized trials. That means expectations must be modest and pacing must be individualized. When SSP works, people often report that everyday sounds feel softer and more organized, social interactions feel less taxing, and their body settles more easily after stress.
When to consider SSP in a concussion timeline
Timing depends on symptom profile. In the first one to two weeks after a concussion, the nervous system is already flooded with change. Most people benefit from relative rest, hydration, sleep protection, and gentle vestibular and visual support when tolerated. If sound sensitivity is extreme, starting with environmental quiet, soft voices, and basic nervous system settling techniques makes sense before adding targeted listening.
Between two and six weeks, if noise intolerance, irritability, or social fatigue persist, SSP can be introduced in very small doses. In later phases, especially for those with lingering post-concussive symptoms beyond three months, SSP may serve as a missing piece that helps other therapies take hold.
Red flags that warrant medical evaluation before starting include acute worsening headaches, repeated vomiting, seizure activity, new focal neurological signs, or concerning mood changes such as active suicidal thoughts. SSP is not a substitute for medical care. It can be a complement inside an integrative mental health therapy plan that also addresses sleep, pain, anxiety, cognition, and return to activity.
A readiness check before beginning
- Symptoms have been relatively stable for at least several days, without sharp daily swings.
- Environmental supports are in place, including a quiet room, comfortable chair, and the ability to pause at any moment.
- You have basic regulation tools that already work a little, such as paced breathing, orienting to the room, or a short body scan.
- Headphones fit comfortably, and the app or device is tested at very low volume without discomfort.
- A provider or coach is available to adjust pacing and to help interpret reactions.
The rest and restore approach to pacing
Think of SSP as part of a rest and restore protocol rather than a task to finish. After a concussion, the dose that heals is often smaller than expected. I usually start with five to ten minutes of listening at a low volume, then stop while things still feel easy. The nervous system learns more from stopping on a good note than from pushing until tired or irritable.
Rest means shorter sessions, often every other day at first. It also means pairing listening with quiet time afterward. A short walk, a cup of tea, or eyes-closed rest can help the system integrate. Restore includes gentle co-regulation if available, like being in the same room with a calm person or a pet. When the body learns to downshift in the presence of safety, it stores a new reference point. That reference point is what we want to strengthen.
Most people who do well with SSP after concussion increase by five minutes per session, watching for any uptick in headache, dizziness, mental fog, or anxiety. If symptoms rise, take two to three days off and drop the session length by half when you return. A small set of individuals will need micro-doses, two to three minutes at a time. A few can tolerate twenty minutes out of the gate, but there is no prize for finishing fast.
How somatic experiencing helps SSP land
Somatic experiencing, a body-based form of trauma therapy, pairs naturally with SSP. The goal in somatic work is to track sensations, impulses, and shifts in arousal without forcing them. During or right after listening, I invite people to notice small cues of settling: a longer exhale, warmth in the hands, a yawn, the eyes softening. If a wave of activation comes, we slow down and orient to the environment. Name three colors in the room. Feel the weight of the body in the chair. Listen for the quietest sound that still feels safe, like a clock tick or wind outside. These micro-skills become the handles a person can grab when sound in the world feels too bright.
In my experience, the combination of SSP with somatic experiencing improves tolerance for day-to-day noise more reliably than either alone. The listening nudges the physiology, and the somatic practice teaches the person how to ride the changes. That is especially important for those who carried high stress or trauma into the injury. The body remembers old alarms. Gentle auditory input can surface them. Having a way to land those alarms matters.
Practical details: headphones, volume, and environment
Over-ear, closed-back headphones are typically most comfortable because they reduce ambient noise without inserting anything into the canal. Avoid active noise cancellation at first. The shifting pressure from ANC can bother some people with vestibular sensitivity. If tinnitus is present, try a short trial with one ear slightly off the cup to prevent internal masking from becoming oppressive.
Volume should start low enough that you can speak over the music comfortably. Louder is not better. The goal is clarity, not intensity. Keep the phone or tablet on airplane mode during sessions to reduce interruptions. Place the device where you cannot see notifications. The nervous system reads even small visual pings as alert signals, which undoes some of what the listening is trying to teach.
Pick a time of day when energy is decent. Early afternoon, after lunch and a brief walk, often works better than right before bed. Some people sleep beautifully after SSP, others feel alert. It is safer to discover that pattern during the day.
A gentle session arc
- Arrive: Sit comfortably, feet supported, shoulders easy, jaw loose. Take two slow breaths.
- Orient: Name five neutral details in the room. Let the eyes rest on something pleasant but plain.
- Listen: Start the track at a low volume, five to ten minutes at most for early sessions.
- Notice: During tiny breaks in the music or between tracks, sense the state of your face, throat, chest, and belly. Only track what feels tolerable.
- Settle: Stop while still comfortable. Sit quietly for two minutes, then do a familiar calming practice.
What improvement looks like, and how to track it
Some gains appear quickly, others arrive as subtle shifts over weeks. The first changes people report are often about effort. The grocery store feels a little less draining. Voices stand apart from background noise more easily. The end of the workday comes with some energy left. Headaches may soften a notch or two, especially those triggered by sound or social stimulation.
I encourage simple tracking because the nervous system forgets how hard yesterday was. Rate two to four symptoms three times per week on a 0 to 10 scale, such as sound sensitivity, headache severity, brain fog, and social fatigue. If you already use a validated scale like the Post Concussion Symptom Scale, continue it. Also note sleep quality and a few sentences about daily function. When we look back after two weeks, we want to see a pattern of slightly lower peaks and faster returns to baseline, not perfection.
Integrating SSP with integrative mental health therapy
Concussion recovery crosses disciplines. The best outcomes I see involve a coordinated plan that draws from integrative mental health therapy. That can include sleep optimization, targeted nutrition support like magnesium glycinate at night or omega-3s if appropriate, vestibular and ocular rehab when indicated, pacing of cognitive work, and counseling that respects the body’s role in mood regulation. SSP fits into this plan as a helper for the autonomic system, not as a stand-alone cure.
For those with prior trauma, it is important to proceed with psychological support. Trauma therapy that honors pacing, like EMDR with strong resourcing or somatic experiencing, can keep the process contained. The polyvagal lens reminds us that social engagement cues, including prosodic music, can sometimes stir memories of times when safety was promised but not delivered. That does not mean we avoid the work. It means we build titration and choice into every step.
Case vignette: the teacher who feared the cafeteria
A middle school teacher in her 30s sustained a concussion in a bike crash. Three months later she could teach in a quiet classroom with the door closed but avoided the cafeteria and assemblies. Her headaches spiked with clatter and overlapping voices. She slept poorly after any loud day. Vestibular exercises helped her dizziness, yet noise remained the primary barrier.
We started SSP six months post-injury, long after the acute phase. The first week involved five-minute sessions every other day, volume just above a whisper. She learned three somatic tools before listening: feeling the ground under her feet, tracking her breath in her back, and letting her eyes rest on a neutral spot. By week two we increased to ten minutes on most days and paused for two days after a headache flare triggered by a loud fire alarm at work.
By the third week she noticed that the staff lounge felt less harsh. She could follow a colleague’s story while the microwave beeped and a chair scraped without losing the thread. Headaches remained, but the worst spikes became less frequent. After five total hours of listening over a month, she managed ten minutes in the cafeteria with earplugs in her pocket as a backup. She reported feeling less braced in her shoulders and jaw. This was not a miracle. It was enough ease to re-enter parts of her job with confidence, and it set the stage for further gains.
Titrating for edge cases: migraines, tinnitus, and vestibular issues
People with migraine, tinnitus, or vestibular dysfunction can still use SSP, but they need thoughtful adjustments. Migraine brains dislike change. Start with two to three minutes of listening at very low volume, and buffer sessions with hydration, light food, and low visual stimulation. Track triggers closely. If a typical migraine prodrome appears, pause the protocol and resume only after a quiet week.
Tinnitus can flare with any new auditory input. Use partial ear coverage at first or over-ear headphones with the cup gently lifted for five to ten seconds every few minutes. Some find that brief, regular breaks prevent the system from latching onto the internal noise. Over several weeks, as the system learns safety, the tinnitus either returns to baseline or becomes easier to ignore.
Vestibular sensitivity makes brains vigilant. Do not combine difficult vestibular exercises with SSP on the same day in early phases. Stagger them, and follow vestibular work with a rest window rather than more stimulation. A small number of people will feel woozy during listening. That is a cue to reduce session length and to add more orientation between tracks. If wooziness persists despite micro-dosing, it may be a sign to pause SSP until vestibular rehab has advanced further.
Co-regulation and the social piece
The polyvagal model emphasizes that safety is communicated through connection. When possible, pair SSP with co-regulation. This could be a trusted person reading quietly nearby, a therapist’s soft voice guiding a body scan, or even a calm dog asleep at your feet. The middle ear does not operate in isolation. The face, throat, and heart all adjust together when we feel seen and safe. People often notice their breath and posture change more during listening when another regulated nervous system is present.
I also coach families to adjust everyday interactions. Use a slightly slower, warmer voice. Reduce cross-talk during meals. Dim harsh overhead lighting in favor of more focused light. These small environmental shifts honor the work SSP is doing and prevent daily life from undoing it.
When SSP is not the right fit
There are times when SSP should wait. If a person is in acute crisis, sleeping less than four hours per night, or enduring uncontrolled pain, the system is too taxed to receive new input. Stabilization comes first. Similarly, if a person has no reliable quiet space or cannot set boundaries around session time, the protocol may create frustration. Build the container, then add the listening.
On the other end of the spectrum, a few people breeze through early concussion recovery and return to noisy environments without issue. For them, SSP is likely unnecessary. Not every intervention needs to be used simply because it exists. The art is in matching the tool to the need.
How providers can weave SSP into a broader plan
For clinicians, the decision to introduce SSP follows from a clear hypothesis. If a patient presents with sound sensitivity, social withdrawal due to noise, and an anxious or flattened affect that does not shift with standard care, SSP deserves a look. I inform patients that evidence is promising but not definitive, and that we will monitor closely. I also integrate a rest and restore protocol as a default, not an add-on. That means pre-teaching regulation skills, scheduling buffer time, and normalizing pauses.
I frequently combine SSP with brief somatic experiencing sessions, two to five minutes of tracking before and after listening. If trauma content surfaces, we slow and resource rather than analyze. For patients already in psychotherapy, I coordinate. Many therapists appreciate an intervention that helps the body receive safety messages, which can make cognitive and relational work more accessible.
The long view: repairing trust in sound
Recovery from concussion often requires repairing trust, not just in cognition or balance, but in the world of sound. Modern life is rich with sharp edges for a sensitive system. The Safe and Sound Protocol aims to reintroduce the nervous system to the human voice and to the subtle cues that say you are safe here. That reintroduction is best done slowly, with respect for the biology that protected you during and after the injury.
When SSP is offered with careful titration and integrated into somatic experiencing and trauma therapy when needed, it can shorten the path back to cafes, meetings, and family dinners. The stakes are not abstract. They are the difference between leaving a restaurant smiling or bolting for the door, between reading a bedtime story with steady breath or skipping it because your head cannot take another sound. Gentle auditory support can make those everyday moments possible again.
Bringing it into daily life
As gains appear, bring them into the world in controlled ways. Visit a small store at a quiet time rather than a big box store on a weekend. Eat at a cafe with soft furnishings before trying one with exposed concrete and metal chairs. Use musician’s earplugs that reduce volume evenly without muffling speech. Keep exit strategies kind and simple. A five-minute break outside can preserve the whole outing.
Over time, many people need SSP less and rely on their own regulation more. Some do a brief refresher a few months later if stress rises. Others do not return to the protocol at all, because daily life becomes its own training ground for safety. The aim is always autonomy, a nervous system that can listen without bracing, engage without exhaustion, and rest when it needs to.
https://collinqixz436.raidersfanteamshop.com/rest-and-restore-protocol-evening-routine-unwind-downshift-sleepGentle does not mean passive. It means precise. With the right dose, at the right time, the Safe and Sound Protocol can help a concussed brain remember how to filter the world and find the human voice again. Paired with integrative mental health therapy and paced somatic work, it becomes one of the quieter yet more powerful tools we have for helping people feel like themselves.
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Amy Hagerstrom Therapy PLLC provides somatic and integrative psychotherapy for adults who want mind-body support that goes beyond talk alone.
The practice serves clients throughout Florida and Illinois through online sessions, with Delray Beach listed as the office and mailing location.
Adults in Delray Beach, Boca Raton, West Palm Beach, Fort Lauderdale, and nearby communities can explore support for trauma, anxiety, chronic stress, burnout, and midlife transitions.
Amy Hagerstrom is a Licensed Clinical Social Worker and Somatic Experiencing Practitioner who works with clients in a steady, nervous-system-informed way.
This practice is suited to people who want therapy that includes body awareness, emotional processing, and whole-person support in addition to conversation.
Sessions are private pay, typically 55 minutes, and a superbill may be available for clients using out-of-network benefits.
For local connection in Delray Beach and surrounding areas, the practice uses 550 SE 6th Ave, Suite 200-M, Delray Beach, FL 33483 as its office and mailing address.
To learn more or request a consultation, call 954-228-0228 or visit https://www.amyhagerstrom.com/.
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Popular Questions About Amy Hagerstrom Therapy PLLC
What services does Amy Hagerstrom Therapy PLLC offer?
Amy Hagerstrom Therapy PLLC offers somatic therapy, integrative mental health therapy, the Safe and Sound Protocol, the Rest and Restore Protocol, and support for concerns including trauma, anxiety, and midlife stress.Is therapy online or in person?
The website describes online therapy for adults across Florida and Illinois, and some service pages mention limited in-person availability in Delray Beach.Who does the practice work with?
The practice describes its work as being for adults, especially thoughtful adults dealing with trauma, anxiety, chronic stress, burnout, and nervous-system-based stress patterns.What is Somatic Experiencing?
Somatic Experiencing is described on the site as a body-based approach that helps people work with nervous system responses to stress and trauma instead of relying on insight alone.What are the session fees?
The fees page states that individual therapy sessions are $200 and typically run 55 minutes.Does the practice accept insurance?
The website says the practice is not in-network with insurance and can provide a monthly superbill for possible out-of-network reimbursement.Where is the office located?
The official website lists the office and mailing address as 550 SE 6th Ave, Suite 200-M, Delray Beach, FL 33483.How can I contact Amy Hagerstrom Therapy PLLC?
Publicly available contact routes include tel:+19542280228, https://www.amyhagerstrom.com/, https://www.instagram.com/amy.experiencing/, https://www.youtube.com/@AmyHagerstromTherapyPLLC, https://www.facebook.com/p/Amy-Hagerstrom-Therapy-PLLC-61579615264578/, https://www.linkedin.com/company/111299965, https://www.tiktok.com/@amyhagerstromtherapypllc, and https://x.com/amy_hagerstrom. The official website does not publicly list an email address.Landmarks Near Delray Beach, FL
Atlantic Avenue — A central Delray Beach corridor and one of the area’s best-known local reference points. If you live, work, or spend time near Atlantic Avenue, visit https://www.amyhagerstrom.com/ to learn more about therapy options.Old School Square — A historic downtown campus at Atlantic and Swinton that anchors local arts, events, and community gatherings. If you are near this part of downtown Delray, the practice serves adults in the area and across Florida and Illinois.
Pineapple Grove — A walkable arts district just off Atlantic Avenue that is well known to local residents and visitors. If you are nearby, you can review services and consultation details at https://www.amyhagerstrom.com/.
Sandoway Discovery Center — A South Ocean Boulevard landmark that connects Delray Beach residents and visitors to coastal nature and marine education. If Beachside is part of your routine, the practice maintains a Delray Beach office and mailing address for local relevance.
Atlantic Dunes Park — A recognizable Delray Beach coastal park with boardwalk access and dune scenery. People based near the ocean side of Delray can learn more about scheduling through https://www.amyhagerstrom.com/.
Wakodahatchee Wetlands — A well-known western Delray destination with a boardwalk and wildlife viewing. If you are on the west side of Delray Beach or nearby communities, the practice offers online therapy throughout Florida.
Morikami Museum and Japanese Gardens — A major Delray Beach cultural landmark west of downtown. Clients across Delray Beach and surrounding areas can start with https://www.amyhagerstrom.com/ or tel:+19542280228.
Delray Beach Tennis Center — A public sports landmark just west of Atlantic Avenue and a familiar point of reference in central Delray. If you are near this area, visit https://www.amyhagerstrom.com/ for service details and consultation information.