Post-Traumatic Stress Disorder
Targeting Traumatic Shock With Deep Brain Reorienting (DBR)
The promising trial of an emerging trauma therapy that targets the brainstem.
Posted August 28, 2025 Reviewed by Margaret Foley
Key points
- Deep Brain Reorienting guides attention to sensations linked to the brainstem's first response to threat.
- DBR is one of the first therapies to directly target traumatic shock at the brainstem level.
- Interim results of a randomized controlled trial suggest effectiveness similar to gold-standard treatments.
- DBR may complement cognitive therapies by easing the intensity of raw emotions.
Trauma is pervasive, and thus numerous therapies have been developed to address its distressing symptoms. However, recent estimates suggest up to 50 percent of people with PTSD undergoing psychotherapy still do not respond sufficiently, and up to 25 percent drop out. To address these gaps, we have extensively researched brain adaptations after trauma to inform treatments. Many first-line trauma therapies use cognition—changing our thoughts to change how we feel. But what if how we feel, or what our bodies experience, can change our thoughts and beliefs?
A new therapy may address this—by treating shock at the brainstem level. Shock is the moment of realization during trauma, where our anticipation or prediction of an incoming perception misaligns with the actual incoming sensory input. It’s the "gasp" while falling, or bracing when unable to escape. By addressing shock, we may address a major obstacle in recovery: the sense that a traumatic reaction is "stuck" or "held" in the body and inaccessible to traditional treatments.
This is where Deep Brain Reorienting (DBR) comes in. DBR is an emerging trauma treatment developed by Dr. Frank Corrigan, first written about in 2020 and explored in his recent book. Our team set out to conduct the first-ever randomized controlled trial on DBR and share the promising results below.
Why is DBR unique?
DBR treats the foundation of the trauma response. The trauma response is hypothesized to begin in the midbrain within the brainstem (the “Survival Brain”), so we need therapies that address this directly. The theory underlying DBR is that it treats traumatic shock through the sequence of events that are thought to occur in the midbrain. This is where the brain first registers and responds to threat and the prediction error associated with traumatic shock. Therefore, DBR is suggested to treat trauma at a deeper, foundational level.
Imagine this: The brain is a house, where the cortex (the “Thinking” part) is the roof, the limbic system (the “Emotional” part) is the frame, and the brainstem (the “Survival Brain”) is the house’s foundation. Repairing the house’s foundation first could enhance success when repairing the house’s roof (like with cognitive-based therapies). We use this metaphor and apply it to treatments, with practical strategies for clinicians, in our recent book, Sensory Pathways to Healing From Trauma. DBR helps secure the foundation so deeper healing can occur.
How else is DBR unique? By targeting the brain’s foundation, DBR is one of the first therapies that treats shock directly. Shock is not only part of the brain’s initial trauma response, but it is also thought to interfere with processing overwhelming emotions after trauma. As the only current treatment that addresses shock, DBR may play a unique role in reducing the intensity of raw emotions after trauma. This could potentially make it easier to process emotions in cognitive-based therapies.
What is involved in DBR?
To begin the session, the individual identifies an "activating stimulus"—a moment of realization that cascaded into a sense of overwhelm or trauma-related symptoms. Another unique facet of DBR is that there is no need to revisit the main, or "big T," traumatic event because present-day triggers (a critical look from a boss, an argument with one’s partner, seeing a distressing news story) can be just as effective. This can come as a relief to those who become too distressed by revisiting the main traumatic memory.
After identifying a current-day trigger or target, the therapist helps the client feel grounded and aware of where their body is in space. The therapist then guides them to briefly bring up the trigger or memory in their mind’s eye, thereby eliciting an orienting response. This response has a related Orienting Tension, which is often associated with subtle sensations in the base of the neck and around the eyes. This reflects the brainstem’s first response to turn toward or away from threat.
The therapist then guides the client to notice sensations associated with shock. These can include tension behind the eyes or in the shoulders, as well as shivering, shuddering, and a feeling of hollowness throughout the body. The session is spent deeply noticing sensations of shock, followed by noticing sensations from arising emotions. This process can ultimately lead to a sense of resolution and a renewed perception of oneself.
The results
We conducted the first-ever randomized controlled trial of DBR. We randomly assigned 54 people with PTSD into two groups. The treatment group received eight sessions of DBR therapy online, each for 90 minutes. The waitlisted control group did not receive therapy.
Our interim findings show that after eight sessions of DBR, 48.3 percent of people who did DBR no longer met the criteria for PTSD. At the three-month follow-up, 52 percent of people who did DBR no longer met the criteria for PTSD. The waitlist group showed no significant change. The improvements were very significant, with a large effect size, in the total PTSD scores and on all symptom subscales.
How much did symptoms improve? Comparing before treatment to soon after eight sessions of DBR, there was a 36.6 percent reduction in total symptom scores. Comparing before treatment to three months after finishing DBR, patients showed a 48.6 percent improvement in total symptom scores. This shows the improvements continued even after DBR stopped. The waitlisted control group showed no significant improvements.
These interim results strongly suggest that the effectiveness of DBR may be comparable to current gold-standard treatments for PTSD.
Only one person dropped out of the study, a 4.3 percent dropout rate, which is much lower than in other trauma-focused treatments that can have an average dropout rate of 18% or more. This shows that DBR may be more tolerable for some, particularly those who become overwhelmed by revisiting the main traumatic event(s) directly.
A larger sample size will help provide a better sense of how DBR impacts people. We are working on this, and we are analyzing functional magnetic resonance imaging (fMRI) data from this study to see how people’s brains changed from DBR. The preliminary results are fascinating, and we are excited to share them with you soon.
