Effects of Safe and Sound Protocol on self-reported autonomic reactivity, anxiety, and depression in speech therapy clients with voice, throat, and breathing complaints

Medically unexplained oto-rhino-laryngeal symptoms (MUORLS) may have a pathophysiology related to brain-body state regulation. We use predictions from the Polyvagal Theory to investigate whether clients with voice problems have increased autonomic reactivity, anxiety, and depression. Study 1 included 54 clients with MUORLS, and a comparison group of 26 individuals without MUORLS. Outcome measures were anxiety and depression (Hospital Anxiety and Depression Scale, HADS), autonomic reactivity (Body Perception Questionnaire Short Form, BPQ-SF), and extent of voice handicap (The Voice Handicap Index, VHI) for the clients. The client group scored higher than the control group in supra-diaphragmatic reactivity, but there were no group differences in other measures. To extend the findings of Study 1, a feasibility study (Study 2) evaluated the effects of the Safe and Sound Protocol (SSP), a Polyvagal-informed protocol, on the same outcome measures. Study 2 included 33 clients with self-reported voice and throat complaints. Outcome measures assessed pre- and post-SSP were anxiety and depression (HADS) and autonomic reactivity (BPQ-SF). Results demonstrated a significant decrease in anxiety, depression, and autonomic reactivity post-SSP. In conclusion, a better understanding of the mechanisms that underlie MUORLS may provide guidance for using neurophysiologically based interventions, such as SSP, that target autonomic state regulation.