DEEP BRAIN REORIENTING (DBR)
Many clinical treatments for PTSD involve a process called “top-down” cognitive processing, meaning a process that begins with our thoughts (from “higher” brain areas), and trickles down to lower, more primitive brain areas. These more primitive areas help regulate basic body functions (e.g., heart-rate, breathing, and fight/flight). For example, in Cognitive Behavioural Therapy (CBT), a patient might be asked to consider the likelihood of their fears coming true to help them better manage their emotions.
Top-down processing can be very effective for a number of mental health issues, but it can have limited success with PTSD. Our clients often tell us, for example, that logically they know they are safe, but that their body and brain still react as if they are in danger. In this case, something seems to be getting in the way of their lower brain areas fully understanding the present safety. It is almost as if a fear or trauma gets stuck there.
Our DBR study is meant to evaluate a relatively new “bottom-up” treatment for PTSD, called Deep Brain Reorienting, which targets lower brain areas, with the idea that its effects might trickle up to higher brain areas (of logic, reason, etc). This could be helpful in connecting the logical knowledge of safety to a felt sense of safety in the body.
DBR was designed by Dr. Frank Corrigan, a Scottish psychiatrist interested in how effective trauma therapy impacts the brain. The DBR process involves bringing up a recent traumatic trigger (e.g., the harsh tone of a stranger’s voice) while mentally focusing on what happens in the muscles of the shoulders, neck, head and face. These are the muscles we use to pay attention to a threatening person or situation – we turn our head and eyes toward the threat, even before any emotion sets in.
We hope that the DBR process of slowing down a traumatic memory, and paying attention to the related muscle tension might help people process the traumatic experience(s). Processing the memory in this way, from the bottom up, might change how it is stored in the brain, perhaps reducing PTSD symptoms. Part of our excitement with DBR is that discussing the details of the memory is not necessary. Discussing these details is often too triggering for people, which can make talk therapy rather intimidating.
Study participation includes being assigned randomly (e.g., like by the flip of a coin) to either the DBR treatment condition, or the wait list condition (where DBR is postponed for approximately 21 weeks). All participants will be asked to complete psychological assessments and fMRI (functional Magnetic Resonance Imaging) scans.
By comparing results from the assessments and fMRI scans in our treatment and wait list conditions, we hope to learn whether DBR can be an effective treatment for PTSD. We also hope to learn how this treatment might impact brain functioning, including responses to trauma reminders.
Our first study on DBR was published in 2023. The results showed significant symptom improvements in people with PTSD, and after receiving DBR therapy, many participants no longer met the criteria for a diagnosis of PTSD.
SMART (SENSORY MOTOR AROUSAL REGULATION TREATMENT)
We are conducting a randomized controlled trial, which is one of the strongest forms of research, to evaluate SMART (Sensory Motor Arousal Regulation Treatment), which is a bottom-up/body-based intervention for trauma-related disorders. We are recruiting adults with PTSD (Post-traumatic Stress Disorder). Study participation involves a set of 8 treatment sessions, as well as pre-treatment, post-treatment, and 3-month follow-up assessments. Assessments include a psychological interview, online self-report questionnaires, sensorimotor evaluation, and fMRI scan to be completed pre- and post-treatment/wait list, and then an additional psychological interview, and online self-report questionnaires completed at the 3-month follow-up assessment.
SMART is an embodied treatment approach that promotes the connection between mind, brain, and body in the present moment via the person’s sensory-motor engagement of the body, along with the support of the therapist. The model was originally developed to address the treatment challenges for children and adolescents with complex developmental trauma whose behavioral and emotional dysregulation precluded use of existing treatment approaches that depended on narrative ability or the capacity for symbolic play (Warner et al., 2020). Preliminary exploration with adults in a SMART room supplied with some basic equipment has indicated the potential value of this approach for adult clients.
Placing somatic regulation at the center of treatment has been effective for children and teenagers in increasing behavioral organization. Focusing on somatic regulation has also proven clinically to support both embodied and verbal processing of trauma, and to provide opportunities to create effective rhythms of interpersonal engagement for children and teens with histories of attachment adversity and their caregivers. The sense of self that emerges when afforded the opportunity to engage fully with their bodies in the therapy space is full of vitality, often joy and pleasure, awareness of their surroundings and connection to the people—loved one or therapist —available to help them.
SMART aims to intervene at the level of intrinsic brain networks that are impacted by trauma, and addresses the three levels of sensory systems that we refer to as "inputs": tactile, proprioceptive, and vestibular, known collectively as the movement senses, and reduce fear that people with PTSD feel in their body.
Although it remains to be officially evaluated whether the SMART approach will promote significant shifts in organization of states at the level of sensory motor engagement, emotions, social engagement, and cognition, evidence from brain science suggest the validity of upstream effects. The current study is designed as a pilot evaluation of SMART for adults with PTSD. The protocol is designed to be tailored to each person’s individual needs.
We are actively recruiting for this study! If you are interested in participating, please contact our research coordinator Suzy Southwell at suzy.southwell@lhsc.on.ca.
PTSD DISSOCIATIVE SUBTYPE
This study explores the dissociative subtype of post-traumatic stress disorder (PTSD-DS), and how it might affect brain function in people diagnosed with this condition. Individuals with PTSD-DS often feel disconnected from their own body and experiences (e.g., feeling as if their hands are not theirs, or that they are floating above their body, or that the world around them seems distorted or unreal).
Participation in this study typically involves 3 separate visits - a psychological assessment interview and questionnaires, an fMRI scan (functional magnetic resonance imaging), and a visit that involves a series of tasks investigating emotional awareness, self-awareness, and self-concept – all perceptions that are typically impacted by PTSD-DS.
TOUCH
Touch is one of the first senses to develop after we are born, and it is one of the most basic ways in which we connect with the world. Touch helps us communicate with others, and it plays an important role in emotional well-being. At the best of times, touch can soothe, assure, and/or communicate affection, among other things. Sadly, however, touch can be misused - either via harmful touch, or by not providing enough loving touch.
Our participants have taught us how dangerous touch can seem, even when someone is no longer in an abusive relationship. Knowing this, we wondered how, exactly, trauma/abuse might change someone’s perception of touch, and how their brain activity might be impacted.
This study will investigate touch among individuals with PTSD and healthy volunteers. Through a variety of measures (including body awareness/touch assessments and fMRI/functional magnetic resonance imaging) we hope to begin exploring how trauma impacts the sense of touch.
We are actively recruiting for this study! If you are interested in participating, please contact our research coordinator Suzy Southwell at suzy.southwell@lhsc.on.ca.
REAL-TIME NEUROFEEDBACK
This study will investigate how neurofeedback impacts the brain and underlying brain networks in participants with post-traumatic stress disorder (PTSD). Neurofeedback is a brain-training process that allows a person to try to change what their brain is doing, based on information (or “feedback”) from their own brain activity. In particular, we are interested in what happens in the brain during this “training”, as it is occurring (i.e., in “real time”).
Participation in this study includes a psychological assessment interview, and on a separate day, an fMRI (functional magnetic resonance imaging) brain scan while the participant completes neurofeedback training. This will help us understand what happens in the brain during neurofeedback, and it may help identify differences that impact how well a person can regulate their emotions.
MORAL INJURY
This study investigates a type of mental health injury referred to as a “moral injury”. Moral injury refers to an emotional and spiritual injury caused by participating in, witnessing, and/or being victimized by actions that go against your own moral values or beliefs. This type of trauma is commonly seen in military personnel and first-responders, and can result in strong feelings of guilt and shame. For example, a first-responder might need to make a split-second decision regarding whom to rescue first from an accident scene. Leaving someone behind, even for only a minute, may have life-threatening consequences that can haunt the first-responder for years.
Another good example takes place during the COVID-19 pandemic, when a healthcare provider has only one ventilator but two patients who need it, and they must choose which patient gets the life-saving treatment. Their choice may mean that the other patient dies. These are often impossible situations with no satisfactory options, and moral injury can be the result.
With this study, we hope to learn how moral injuries affect the brain – e.g., what changes take place with this type of trauma? Participation in our Moral Injury study includes a psychological assessment interview, including the identification of a moral injury you may have experienced, and an fMRI brain scan. The results of this study will not only help us better understand moral injury, but they may also contribute to the development of more effective treatments for this specific type of trauma.
GAIT AND BALANCE
Our Gait and Balance Study investigates how gait (i.e., how a person walks) and balance might be impacted by PTSD. This idea intrigued us because a number of our clients and research participants with PTSD have reported being “clumsy” or “uncoordinated”, and some of our previous studies have suggested there may be neurological reasons for this.
For this study, we are assessing and comparing gait and balance in participants with and without PTSD to see how they might be different. We are also investigating any differences between the classic and dissociative types of PTSD. Participation in this study includes a psychological assessment interview, an fMRI (functional magnetic resonance imaging) brain scan to investigate any neurological differences between the groups, and a variety of gait/balance tasks and assessments. We are hoping this study will help us learn more about how PTSD impacts the mind and body in regard to gait and balance.