Deep Brain Reorienting Therapy in Massachusetts and Rhode Island

Deep Brain Reorienting (DBR) is a relatively new form of psychotherapy for working with the effects of stress and trauma, developed by Scottish psychiatrist Frank Corrigan. DBR works with a sequence of responses that ordinarily unfolds too quickly for us to notice.

Think about what happens when you hear a sudden, unexpected sound: your attention shifts and you may turn your head toward it before you've even had time to figure out what's happening. That's the orienting response.

DBR proposes that another response follows this initial orienting: shock. In the DBR model, shock consists of powerful but fleeting sensations in the body that arise after we orient toward something stressful or threatening, but before we experience emotions or defensive responses like fight, flight, or freeze. A central idea in DBR is that healing can happen when we slow this rapid sequence down and give the sensations of shock time to process.

Why does it matter that shock comes first?

According to the DBR model, shock can amplify the emotions and defensive responses that follow. Fear may become more intense, for example, or the impulse to flee or shut down may become more powerful. Working directly with the shock gives us an opportunity to address some of what may be contributing to the intensity of the response.

The DBR model assumes that the brain has a natural capacity to heal when we can create the right conditions for it. Rather than trying to force a particular response or make something happen, we give your system the time and support it needs for healing to unfold.

What does DBR actually look like in a therapy session?

DBR sessions involve focusing on your internal experience, and especially on sensations. You don't need to tell the story of what happened. You don't even need to have a memory of the earlier experiences that may be contributing to how you respond now. Instead, we identify something specific and recent that caught you by surprise—perhaps the look on someone's face, the sound of a phone ringing, or a touch on the shoulder. That's all we need to begin.

If we decide to use DBR together, we’ll start with something relatively innocuous. We aren't looking for the most distressing thing that has happened to you. In fact, in DBR we generally aim to work at about a 3 on a 10-point scale of distress—enough activation that we can notice what happens in your system without overwhelming it. As the work progresses, we generally stay at about that same level of activation.

We begin by looking for the orienting tension—the subtle muscular tension involved in turning your attention toward something significant. The orienting tension is generally noticed around the eyes, across the forehead, at the base of the skull, or in some combination of these places.

From there, we slow down to be with the sensations of shock as they emerge. We give them time to process without rushing or trying to make anything happen. That doesn't mean we expect to move through this entire sequence in every session. We may spend many sessions working primarily with shock before emotions or defensive responses begin to emerge. When they do, you might notice feelings such as fear, anger, or sadness, or an impulse to move, pull away, fight, or freeze in place. At any point in the sequence, if the experience starts to feel overwhelming, we can use the orienting tension as an anchor to help you stay present.

Trauma isn't always one terrible event

Not everyone who has been through hard things can point to one event and say, That was the trauma. Sometimes what shapes us is what happened repeatedly: living with chronic stress or unpredictability, being frequently criticized or frightened, having to stay alert to someone else's moods, having to handle too much too soon, or repeatedly feeling powerless or alone.

In DBR, we can also work with the small moments of shock that can be part of experiences like these. A brief moment of fear, disconnection, humiliation, or helplessness can pass quickly and still have an impact. When moments like these happen again and again, their effects can accumulate over time.

You don't need to have PTSD—or even think of what happened to you as trauma—for DBR to potentially be helpful. We can consider whether something you've lived through may still be contributing to the reactions or difficulties that bring you to therapy, and whether DBR might be a useful way to work with it.

Could DBR be helpful for what I'm struggling with?

Sometimes we understand why we react the way we do, but the reaction keeps happening anyway. Other times, we may have no idea why something affects us so strongly.

Something happens that seems relatively small, but your reaction doesn't feel small at all: you want to get away, shut down, or say things you don't mean. You can't stop thinking about what happened long after the moment has passed.

You feel a rush of fear when you sense that someone is upset with you, even someone who has never given you a reason to be afraid.

You find yourself flooded with shame when you make a mistake or think you've disappointed someone, even though a part of you knows it really isn't such a big deal.

Maybe you go blank and lose the ability to think or know what you feel when someone is angry with you, or find yourself agreeing, apologizing, and trying to make things okay before you've had a chance to notice how you actually feel.

DBR can offer a way to work with reactions like these without requiring us to work directly with memories of experiences that might be contributing to them. We can begin with what's happening in your life now and work with the responses that emerge.

You don't have to know ahead of time whether DBR is the right approach. We can get to know what's happening for you and consider together whether DBR—or another way of working—might be helpful.

How does DBR fit with IFS and Somatic Experiencing?

Internal Family Systems (IFS) and Somatic Experiencing (SE) are complementary approaches that we can weave together organically in our sessions, according to what works best for you. Together, they give us ways to listen to the different parts of you, pay attention to what is happening in your body and nervous system, and allow defensive responses that were interrupted in the past to find their way toward completion. The work isn't only about what happened in the past; it can also help you have greater access to your vitality and to what feels safe, good, and pleasurable in the present.

DBR is a little different. When we decide to use DBR, we set aside a distinct period of the session for it, with a clear beginning and endpoint. Having more than one way to work gives us flexibility to respond to what you need as the therapy unfolds.

Why I chose to train in DBR

I first became interested in DBR after hearing colleagues and consultants talk about their work with it and seeing the approach demonstrated. I was particularly intrigued by DBR's focus on shock, and by the idea that shock may amplify the emotions and defensive responses that follow. I was also drawn to the possibility that working directly with shock might offer another way to help people heal from experiences that continue to affect them, while working at a relatively low level of distress.

I have completed Level 2 training in Deep Brain Reorienting and continue to deepen my understanding of the approach through ongoing training and monthly consultation.

Interested in working together?

If you're curious about whether DBR might be a useful approach for you, we can talk about what's bringing you to therapy and whether working together feels like a good fit.