Deep Brain Reorienting (DBR): What it is, and how it may help with Trauma and PTSD.
Sometimes, people understand exactly what happened to them.
They know the event is over. They know they are safe now. They may have talked about the experience, made sense of it and even developed helpful coping strategies.
And yet, their body still reacts.
A sound, smell, image, memory, facial expression or unexpected situation can trigger an immediate physical response: tension, panic, nausea, a racing heart, a sense of danger, shutting down, anger or the urge to escape.
This is one of the reasons trauma therapy often involves more than simply talking about what happened.
One approach designed specifically for this deeper level of trauma processing is Deep Brain Reorienting, or DBR.
What Is Deep Brain Reorienting?
Deep Brain Reorienting is a trauma-focused psychotherapy developed by psychiatrist Dr. Frank Corrigan.
DBR is based on the idea that when the brain detects a threat, a rapid sequence of physiological responses can occur before we have consciously made sense of what is happening.
Rather than beginning primarily with the story of a traumatic event, DBR focuses on carefully tracking the body and brain’s earliest responses to that experience.
The approach pays particular attention to the processes involved in orienting to threat, shock, defensive responses and the emotions that follow.
In very simple terms, DBR explores what happened in the nervous system at the moment the brain first registered that something was wrong.
Why Can Trauma Still Feel Present Long After the Event Is Over?
Trauma is not always about what we remember.
It can also involve what our nervous system learned.
After a frightening, overwhelming or deeply distressing experience, the brain may become highly sensitive to anything associated with the original event.
This can happen even when we logically know we are safe.
Someone may think:
“I know there is nothing dangerous happening right now.”
But their body may respond as though danger is very real.
This disconnect can be frustrating. People sometimes criticize themselves for reacting “too strongly” or wonder why they cannot simply move on.
Trauma responses, however, are not always conscious choices.
The systems responsible for detecting and responding to threat operate extremely quickly. Trauma therapy can therefore involve helping the nervous system process experiences that may never have been fully resolved.
How Is DBR Different From Traditional Talk Therapy?
Traditional psychotherapy can be extremely helpful for understanding patterns, beliefs, relationships and emotional experiences.
DBR approaches trauma from a somewhat different direction.
Rather than focusing mainly on discussing the event in detail, the therapist helps the client notice subtle physical responses associated with the traumatic experience.
This may include sensations related to orienting toward a threat, tension in particular muscles, changes in posture, feelings of shock or other internal responses.
The work is typically slow and carefully paced.
The goal is not to force someone to relive an overwhelming experience.
Instead, DBR aims to help the brain process aspects of the traumatic response that may have remained unresolved.
Do I Have to Tell My Therapist Every Detail of What Happened?
Not necessarily.
For some people, one of the appealing aspects of trauma-processing therapies is that treatment does not always require an extensive verbal retelling of every detail of the traumatic experience.
Your therapist still needs enough information to understand what you are working on and to make sure treatment is appropriate and safe.
However, DBR places significant attention on your internal experience rather than requiring the session to revolve around repeatedly recounting the entire story.
This can be particularly meaningful for people who have experienced events that feel difficult, painful or exhausting to describe.
What Does a DBR Session Feel Like?
DBR sessions tend to involve a significant amount of attention to what is happening internally.
Your therapist may help you identify a specific moment or experience connected with the trauma and then guide you to notice very subtle physical responses.
You may be asked to notice sensations around the head, neck, face, shoulders or body.
The therapist helps you remain connected to the present while carefully following whatever emerges.
Every person responds differently.
Some people notice emotions. Others notice changes in muscle tension, sensations, images, memories or shifts in how the original experience feels.
As with any trauma therapy, DBR should be provided by a clinician who has appropriate training and who can adapt the pace of therapy to the individual.
Can DBR Help With PTSD?
Research into Deep Brain Reorienting is still developing.
A randomized controlled trial involving 54 adults with PTSD compared eight sessions of DBR delivered by videoconference with a wait-list condition.
Participants receiving DBR experienced significant reductions in PTSD symptoms following treatment, with improvements continuing at the three-month follow-up.
These early findings are encouraging, but DBR is still a relatively new therapy and the research base is much smaller than that of longer-established trauma treatments.
More research, including larger studies and direct comparisons with established PTSD treatments, is still needed.
For people considering DBR, this means it can be viewed as a promising trauma-processing approach rather than a guaranteed or universally appropriate treatment.
Why Might DBR Be Relevant for First Responders?
First responders can experience trauma differently from someone exposed to a single traumatic event.
Police officers, firefighters, paramedics, dispatchers and other public safety personnel may experience repeated exposure to distressing situations throughout their careers.
Sometimes there is one particular call that remains vivid.
Other times there may be years of experiences that gradually accumulate.
A responder may continue functioning extremely well professionally while noticing unexpected reactions elsewhere.
They might experience:
irritability or feeling constantly on edge
difficulty relaxing after a shift
strong reactions to certain sounds, smells or locations
intrusive memories or images
sleep disturbances
emotional numbness
feeling unusually affected by certain calls
physical reactions that seem to appear before they consciously know why
Sometimes the most difficult call is not necessarily the most objectively dramatic one.
A situation may become particularly powerful because it involved a child the same age as the responder’s own child, reminded them of someone they love, created a sense of helplessness or occurred after years of accumulated exposure.
DBR may offer another way of approaching these experiences by working with the nervous system’s response rather than relying solely on verbal processing.
What About 911 Dispatchers and Communications Professionals?
Trauma exposure does not require physically being at the scene.
911 dispatchers and communications professionals may listen to intense fear, violence, grief, injury and life-threatening situations while simultaneously being expected to remain calm, gather information and coordinate a response.
They may hear events unfolding without ever knowing exactly how the situation ended.
For some dispatchers, particular voices, sounds or calls remain with them long after the shift ends.
Trauma therapy can therefore be relevant for both frontline responders and the people behind the headset supporting those responses.
How Is DBR Different From EMDR?
Both DBR and EMDR are trauma-processing therapies, but they approach trauma differently.
EMDR often involves identifying a traumatic memory along with the associated image, beliefs, emotions and body sensations, followed by bilateral stimulation while the memory is processed.
DBR places more emphasis on the very early physiological sequence associated with detecting and orienting toward threat.
Neither approach needs to be considered inherently “better.”
Different people respond differently to trauma therapy, and clinicians may choose an approach based on a person’s symptoms, history, treatment goals and tolerance for trauma processing.
Some trauma therapists are trained in several approaches and may integrate different therapies over the course of treatment.
Is Deep Brain Reorienting Right for Everyone?
No single trauma therapy is right for everyone.
Before beginning trauma-processing work, a therapist will typically consider factors such as:
current symptoms
trauma history
emotional regulation
dissociation
available supports
current life stress
safety and stability
previous therapy experiences
individual treatment goals
Sometimes the first phase of therapy focuses on stabilization, understanding symptoms and developing strategies to manage distress before trauma-processing work begins.
Trauma treatment should always move at a pace that feels manageable for the person receiving therapy.
When Your Mind Knows You Are Safe but Your Body Has Not Caught Up
One of the most confusing parts of trauma can be knowing intellectually that an event is over while continuing to experience reactions that feel automatic.
That does not mean you are failing to cope.
It may simply mean that parts of the nervous system connected with the original experience are still reacting to cues associated with danger.
Deep Brain Reorienting offers one approach to helping people process these deeper trauma responses.
At Mind Shift Therapy and Neurofeedback, we provide trauma-focused psychotherapy for adults, including first responders, spouses and partners of first responders, and individuals experiencing PTSD, anxiety, occupational stress and the effects of difficult or overwhelming experiences.
Our therapists draw from a range of trauma-informed approaches, including therapies such as EMDR and Deep Brain Reorienting, depending on the needs of the individual.
If you are curious about DBR or wondering which type of trauma therapy may be the best fit for you, connecting with a trauma-informed therapist can be a helpful place to begin.
Mind Shift Therapy and Neurofeedback provides in-person therapy in Barrie, Ontario, as well as virtual psychotherapy for adults across Ontario.
