EASY-TO-UNDERSTAND SUMMARY:
DEEP BRAIN REORIENTING (DBR)
What is Deep Brain Reorienting (DBR)?
Given what we now know about the neurobiology of PTSD and how the brain processes shock and traumatic experiences, it’s very important that we integrate neuroscientifically-guided therapies into PTSD treatment. DBR is one such treatment. DBR is a neuroscience-based treatment for PTSD that targets the sequence of events that occurred in the brainstem at the time of the traumatic event. The sequence of events at the time of the initial shock during a traumatic event occurs through 3 areas of the brain in the brainstem and the midbrain: the superior colliculus, locus coeruleus, and periaqueductal grey.
When something shocking occurs, the brain’s superior colliculus moves your eyes towards or away from the shocking experience before the higher levels of your brain (like your cortex) can think through what is happening and before you have an emotional response to what is happening. Therefore, since DBR therapy targets this sequence of the initial shock through this part of the brain, DBR could be an important way to process the initial moments of shock of a traumatic experience.
So what happens in a DBR session? 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. When we are faced with a threatening person or situation, we use these muscles to pay attention to it – we turn our head and eyes toward the threat, even before any emotion sets in. Throughout the session, the therapist guides the client to notice the tension, and slowly notice any sensations that change in the tension and any instincts to move their head. The therapist also helps the client mindfully observe if any emotions arise in response to the changes in tension.
At the end of the session, the therapist helps the client feel present and asks if their sense of themselves or their sense of the world has changed. By the end of the session, the client often feels a sense of relief physically and emotionally and has new perspectives, which they are encouraged to remain aware of after the session.
We anticipate 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. The person does not need to talk about the traumatic experience, which is one reason we are very excited about DBR, since talking about traumatic experiences can be too triggering for many people.
Does DBR help people with PTSD, and if so, how big of an effect does it have?
Kearney BE, Corrigan FM, Frewen PA, Nevill S, Harricharan S, Andrews K, Jetly R, McKinnon MC, Lanius RA (2023). A randomized controlled trial of Deep Brain Reorienting: A neuroscientifically guided treatment for post-traumatic stress disorder. European Journal of Psychotraumatology. June 2023 14(2):2240691 DOI:10.1080/20008066.2023.2240691
We conducted a randomized controlled trial of DBR, which is one of the most well-respected ways to conduct a study. It means that one group received the treatment and one group did not receive the treatment, so we were able to compare how effective the treatment was compared to receiving no treatment. It also means that we randomly assigned people to either receive the treatment or not receive the treatment. This helps make the two groups non-biased and able to be compared. This way, we could see the effect of the DBR treatment on the group that received the treatment.
We flipped a coin to randomly assign 54 people with PTSD into two groups. One group (the treatment group) received DBR therapy and the other group (the control group) was on the waitlist and did not receive the DBR treatment. We administered 8 sessions of DBR virtually through video chat (like on Zoom) for 90 minute sessions individually with each person in the treatment group. Using a well-established PTSD assessment scale, we assessed all participants’ PTSD symptoms at baseline before the study started, after the period of time of the 8 sessions, and after 3 months.
The people who did the DBR therapy had very large improvements in all areas of their PTSD symptoms after the 8 sessions of DBR therapy and even more improvements at the 3 month follow up. The people in the waitlist group had no significant improvements in their symptoms over the same period of time. This shows that the large improvement in symptoms in the group who did DBR therapy is because DBR was effective. In fact, the 8 sessions of DBR were so effective that after the 8 sessions, 48.3% of the people in the DBR group no longer met the criteria for PTSD, and at their 3 month follow up, 52% of the people in the DBR group no longer met the criteria for PTSD.
One common issue with other PTSD therapies is that people find it very emotionally difficult and triggering, or for other reasons, there are often high drop-out rates of greater than 18% of people dropping out of other PTSD therapies. Our study was also important because it showed that DBR treatment was well-tolerated and had a very low drop out rate. In our study, only one person did not complete the DBR treatment, and only 8 people did not come back for a 3 month followup.
This shows that not only was DBR very effective, but people were also able and willing to complete the treatment. This makes sense since with DBR, people are able to process trauma on a neurological level without talking about the trauma, which makes it easier for people. Also, with DBR, if the client starts to get overwhelmed or shows signs of dissociation, the therapist guides the person to focus on the “Orienting Tension”, a tension that the client identifies in their face, head or neck. By focusing on this tension, it helps bring the person back into their body and helps prevent people from getting overwhelmed or dissociating during DBR therapy, which could make DBR better tolerated than other PTSD therapies.
