An Overview of Deep Brain Reorienting

What is deep brain reorienting therapy?

Trauma can live in our bodies long after the danger has passed. Deep brain reorienting (DBR) therapy addresses this reality by directly engaging with the brain's subcortical structures where traumatic memories are stored. Developed by Scottish psychiatrist Dr. Frank Corrigan, DBR represents an innovative approach to trauma treatment that focuses on the physiological sequence that unfolds during traumatic events (Deep Brain Reorienting, 2022).

The science behind DBR centers on specific subcortical brain regions, notably the superior colliculi (SC), periaqueductal gray (PAG), and locus coeruleus, which are activated during threat response. These structures generate automatic physiological reactions before conscious awareness develops. By guiding clients to attend to the sequence of physiological aspects associated with traumatic memories, DBR helps process trauma at a deeper neurobiological level (Corrigan & Christie-Sands, 2020).

Techniques in DBR therapy typically include developing body awareness, identifying the activating stimulus (the first thing noticed during the traumatic event), and tracking the following physiological sequence. Practitioners guide clients to notice the orienting tension without becoming overwhelmed by emotional responses, allowing for the integration of traumatic experiences that may have resisted other therapeutic approaches.

How DBR differs from other trauma therapies

Deep brain reorienting takes a distinctive approach to trauma treatment that sets it apart from other established therapeutic modalities, such as trauma psychotherapy and eye movement desensitization and reprocessing (EMDR). While all trauma therapies aim to reduce symptoms and process traumatic experiences, DBR's unique neurobiological focus and methodology offer an alternative pathway for healing that may be particularly beneficial for certain clients.

• Subcortical focus: DBR specifically targets subcortical brain structures, which are involved in orienting responses to threats. Unlike therapies primarily with cortical processes, DBR addresses deeper brain structures involved in automatic threat detection and response.
• Physiological sequence: Rather than beginning with the emotional content of traumatic memories, DBR works with the precise physiological sequence that unfolds during traumatic events. This approach helps clients track physical sensations in a specific order, starting with the initial orienting tension that precedes emotional responses.
• Orienting tension: DBR uniquely focuses on the orienting tension that develops in response to traumatic stimuli, particularly in the neck, head, and upper back. This tension, which reflects activity in the deep brain structures, becomes a central access point for trauma processing in DBR.
• Pre-emotional processing: While many trauma therapies work directly with affective response and emotional intensity related to trauma, DBR addresses the pre-emotional phase of trauma response. By working with the physiological sequence before emotional activation occurs, DBR helps clients process trauma without becoming overwhelmed by intense emotions.

Benefits of DBR for trauma recovery

DBR offers several significant advantages for trauma recovery, making it a valuable addition to the clinical toolkit. These benefits include the following:

Reduced emotional overwhelm

DBR's focus on the physiological sequence that precedes emotional activation helps clients process traumatic memories or unresolved trauma without becoming overwhelmed by intense emotions. By attending to orienting tension rather than immediately engaging with emotional content, clients can develop a greater capacity to work with traumatic material that might otherwise be too activating.

Enhanced body awareness and interoception

Regular practice with DBR techniques enhances clients' body awareness and interoception capacity, or the ability to perceive internal bodily states. This increased awareness of physical sensations can support emotional regulation as clients become better able to recognize early signs of activation and respond effectively.

Improved emotional regulation

By addressing the subcortical structures involved in threat detection and response, DBR helps improve overall emotional regulation capacity. This enhanced regulation extends beyond trauma-specific triggers to support general emotional well-being and interpersonal functioning.

Who can benefit from DBR?

Understanding which clients might be most responsive to DBR can help inform appropriate referrals and treatment planning.

• Individuals with PTSD: People diagnosed with post-traumatic stress disorder often experience significant improvement with DBR therapy. The approach directly addresses the neurobiological underpinnings of PTSD symptoms, including hyperarousal, intrusive memories, and avoidance behaviors.
• Survivors of childhood trauma: DBR is particularly well-suited for addressing early developmental trauma and attachment wounding. The therapy's focus on physiological responses rather than narrative recall makes it accessible for processing preverbal or early childhood experiences that may be stored primarily in the body rather than in explicit memory.
• Individuals with somatic symptoms: Clients who experience their trauma primarily through physical sensations or somatic symptoms may find DBR particularly helpful. The therapy's emphasis on tracking physical sensations and physiological sequences aligns well with the experience of somatically oriented clients.

Case studies and research

Research on deep brain reorienting (DBR) continues to emerge, with several key studies providing preliminary evidence for its effectiveness as a trauma treatment approach. While the research base remains relatively limited compared to more established therapies, the existing studies offer promising insights into DBR's potential applications and outcomes.

Neurobiological foundations of DBR

A foundational study by Corrigan and Christie-Sands (2020) established the theoretical framework for DBR by examining the innate brainstem systems involved in interpersonal trauma. This model explains how traumatic experiences can create persistent patterns in these systems, contributing to maladaptive relational responses and trauma symptoms.

The researchers differentiated between pre-affective shock (generated by the SC and locus coeruleus) and affective shock (arising from excessive PAG stimulation), providing a neurobiological rationale for DBR's focus on orienting tension before emotional activation. While this study provided a compelling theoretical framework, it was primarily conceptual rather than experimental, representing a limitation in the empirical evidence base.

Randomized controlled trial of DBR

A more recent randomized controlled trial by Kearney and colleagues (2023) provided stronger empirical support for DBR's effectiveness. This study compared eight sessions of videoconference-based DBR therapy (n=29) with a waitlist control group (n=25) for individuals with PTSD.

The study found significant improvements across all PTSD symptom clusters, including re-experiencing, avoidance, negative alterations in cognitions/mood, and alterations in arousal/reactivity. This suggests that DBR's impact extends across the full spectrum of PTSD symptomatology rather than addressing only specific symptom domains.

Conclusion

Deep brain reorienting represents a promising advancement in trauma treatment, offering a neurobiologically-informed approach that addresses trauma at the subcortical level where many traumatic experiences are encoded. The emerging research suggests that DBR may be particularly valuable for certain trauma populations, including those with complex trauma, somatic symptoms, and early developmental wounding.

For practitioners seeking to address the physiological foundations of trauma, DBR provides a valuable addition to the clinical toolkit that complements existing approaches and may help reach clients who have not fully responded to traditional trauma therapies.

References

Corrigan, F. M., & Christie-Sands, J. (2020). An innate brainstem self-other system involving orienting, affective responding, and polyvalent relational seeking: Some clinical implications for a "Deep Brain Reorienting" trauma psychotherapy approach. Medical Hypotheses, 136, 109502. https://doi.org/10.1016/j.mehy.2019.109502

Deep Brain Reorienting. (2022, April 7). Dr. Frank Corrigan MD, FRC Psych. https://deepbrainreorienting.com/frank-corrigan/

Kearney, B. E., Corrigan, F. M., Frewen, P. A., Nevill, S., Harricharan, S., Andrews, K., Jetly, R., McKinnon, M. C., & Lanius, R. A. (2023). A randomized controlled trial of deep brain reorienting: A neuroscientifically guided treatment for post-traumatic stress disorder. European Journal of Psychotraumatology, 14(2), 2240691. https://doi.org/10.1080/20008066.2023.2240691