What Is Deep Brain Reorienting Therapy?
A clinician’s introduction to the principles and process of DBR. Understand how this modality works with the body’s instinctive responses to support deeper trauma resolution.
I have recently been coming across this new therapy called DBR. So, we did a deep dive. I hope you enjoy and would love to hear your thoughts on it or if you’ve trained in it!
Many people who have experienced trauma find that talking about what happened helps, but only to a point. Some describe feeling “stuck” even after years of therapy, aware of their triggers yet unable to change their bodily reactions. This is where Deep Brain Reorienting (DBR) offers a new perspective.
Developed by psychiatrist Dr. Frank Corrigan after years of clinical and neurobiological research, DBR approaches trauma not through stories or thoughts, but through the body’s earliest, instinctive responses to threat.
What is Deep Brain Reorienting (DBR) Therapy?
DBR is a trauma-focused psychotherapy that helps clients access and process the physiological foundations of traumatic experience. Rather than focusing on cognitive restructuring or exposure, DBR starts with the body’s natural orienting response that occur before conscious emotion or defence.
The approach is built on a simple idea: the human brain and body already know how to heal from trauma if the original sequence of reaction is allowed to complete safely.
By returning attention to these subtle, pre-verbal responses, DBR helps clients release the residual tension and shock that can keep traumatic memories locked in the nervous system. 1
The Step By Step Process of DBR
First: Grounding
The therapist establishes safety through mindfulness-based awareness and gentle body-focused attention. The goal here is to anchor the client’s attention to present-moment body awareness so that when trauma arises, the client can stay connected to both the memory and current safety.
Second: Observing the Trauma
The therapist then asks the client to bring to mind a specific trigger, scene or situation (not the full trauma story) that activates the distress and the client is asked to briefly name or imagine the trigger to produce the minimal activation needed to generate the automatic orienting response (tension in the neck, changes in breathing, squinting the eyes etc.). The therapist observes these subtle changes and asks the client to notice what happens in their body.
Third: Emotional Processing
The therapist and the client work through the emotional responses more thoroughly. This can involve exploring the feelings and bodily sensations that arise more deeply, and the therapist guides the client to notice patterns or underlying emotions more explicitly.
Fourth: Integration
The therapist and client work together to make sense of the emotional and physical responses that came up in the previous steps. The therapist can help the client connect these insights with their overall experience, and find ways to incorporate new understanding and coping mechanisms. This step is essentially about reorganising the traumatic experience in the conscious awareness in a more adaptive way.
Fifth: Reorienting
The last step is about rewiring and reshaping the neural pathways that were affected by the trauma. During this step, the therapist helps the client to develop new, healthier responses and perspectives to reinforce positive change and to build resilience. In this step, the therapist and the client can practice new coping strategies for when they encounter a trigger in the future. These strategies could be breathing exercises or imagining places where they feel safe and relaxed.
The Theorised Science Behind DBR
DBR is proposed to work through the following mechanisms. (Lots of brain science here, scroll to the layman’s section below if feels overwhelming!).
The superior colliculus (SC) in the midbrain rapidly detects the approaching or threatening visual stimuli and converts them into instinctive defensive responses, such as fight or flight. It acts as a crucial bridge between sensory perception, motor coordination, and emotional processing, linking visual input with neck and eye movement control and signalling threat information to areas like the amygdala. 23
The responses are given as orienting reflexes. The superior colliculi activate the muscles in the head and neck, including the eyes and forehead, to initiate movement for fight or flight response. 4 The activation of the superior colliculus is one of the first steps in the process of detecting and responding to trauma or threatening stimuli.
In DBR, the mechanism of this brain area is significant as it is responsible for orienting tension which refers to the subtle muscular tension around the eyes, neck and face that appears just as attention turns toward a memory or trigger, which is before emotional or defensive reactions occur. During therapy, the therapist asks the client to focus on the orienting tension when recalling the triggering memory, which helps the client stay grounded and not dissociate. 1
The locus coeruleus (LC) is located in the part of the brainstem called the pons. It is another significant brain area for DBR as there is a two-way communication between the LC and SC. The LC helps control how strong and fast defensive reactions are. During distress, the LC becomes more active and sends signals to the SC, which makes the body react more quickly to threats. Thus, threatening stimuli can make instinctive fear responses happen faster and feel stronger, because the LC-SC pathway increases alertness and sensitivity to danger. 5
The final step of trauma activation that is significant for DBR is the activation of the pariaqueductal grey (PAG). The PAG is the escape and defensive command center of the brain, coordinating instinctive reactions to immediate threat. These reactions include fight, flight, or freeze as well as affective responses, namely, fear, greed, shame and rage.6 In DBR, it establishes the physiological sequences that therapists guide clients to notice, helping resolve frozen or dys-regulated trauma responses.
What This All Means in Layman’s Terms
When something feels threatening, the brain automatically gets the body ready to protect itself. First, it notices danger (through the eyes and head muscles), then it increases alertness and prepares for action, and finally it triggers instinctive reactions like fight, flight, or freeze.
In Deep Brain Reorienting (DBR) therapy, these same body and brain responses are gently worked with rather than avoided. By noticing the small physical tensions that appear before emotional reactions, like tightness around the eyes or neck, clients can stay grounded while processing painful memories. This helps the body and brain complete the trauma response naturally, instead of getting stuck in it.
In DBR, the goal is to facilitate the processing of memories by guiding them along a natural pathway of trauma activation, starting from the superior colliculus (SC) to the pariaqueductal grey (PAG). This ensures that the memory is encoded in a healthier, more adaptive manner.
Comparison with TF-CBT
Top-Down vs. Bottom-Up
Deep Brain Reorienting (DBR): Bottom-up approach. It targets subcortical trauma responses such as fight, flight and freeze through bodily sensation and implicit memory, calming the nervous system before conscious processing.
Cognitive Behavioural Therapy (CBT): Top-down approach. Focuses on conscious thought and beliefs, using exposure, reasoning and cognitive restructuring to change emotions and behaviours.
Explicit vs. Implicit
Deep Brain Reorienting (DBR): Focuses on implicit memory and consequential bodily procedural responses and emotions and analyses unconscious processing.
Cognitive Behavioural Therapy (CBT): Focuses on the explicit conscious thoughts, beliefs and recent events. May bright to light previously unconscious meanings.
Regulation vs. Completion
Deep Brain Reorienting (DBR): The goal is to calm and stabilise the nervous system when a trigger is encountered. The anticipated outcome is emotional and physiological regulation.
Cognitive Behavioural Therapy (CBT): The goal is to expose, resolve and restructure trauma-related thoughts and beliefs. The outcome is cognitive and behavioural closure; adaptive coping and less triggers in the present.
Recent Studies on DBR
A recent study, which included the founder of DBR, Dr. Frank Corrigan, as one of its researchers, investigated the impact of DBR on PTSD patients. 54 PTSD patients were randomly assigned to DBR and waitlist (control) groups.
The patients in the DBR group had 8 sessions of video conference based DBR. The PTSD symptoms severity was measured using the Clinician Administered PTSD scale (CAPS-5), at baseline, post-treatment and 3- month follow-up. The results indicated significant differences between the DBR and control groups, where there were significant decreases in PTSD severity in the DBR group, with a 36.6% reduction in pre- to post-treatment and a 48.6% reduction from baseline to 3-month follow-up of treatment.
On the other hand, there were no significant reductions of PTSD severity in the waitlist group.7 This study provides emerging evidence that DBR is a well tolerated and potentially effective treatment for PTSD.
Moving Forward with DBR. Could It Be Combined with CBT?
Deep Brain Reorienting (DBR) offers a revolutionary way to approach trauma by working with the body’s instinctive responses rather than the mind. By guiding trauma through its natural neural pathway, DBR helps release stuck tension, regulate emotions and reshape how the brain responds to threat. It is a newer therapy with limited research, but it does raise the question as to whether it may provide a bottom-up approach that could be combined with CBT?
Could focusing on the body’s instinctive responses be the break-though therapists have been searching for in trauma treatment?
Author: Alara Kayran
I’ve been alerted to DBR in particular as it’s been proposed as a treatment for depersonalisation-derealisation disorder, a condition for which very few treatments exist. Whilst it’s certainly interesting, I think the very limited research to date places it firmly in the ‘let’s wait and see’ category.
Such a brilliant therapy! Great to read a deep-dive about it.