CO-PIONEERING THE WORK OF DBR-AT
Martin Warner
Martin Warner has over 40 years of experience working with people in an educational and therapeutic capacity.
In 1999, Don Weed trained Martin as an Alexander Teacher in the tradition of Master Teacher Marjorie Barstow who trained with F.M. Alexander.
Over a decade ago, whilst teaching in Glasgow, Martin was first introduced to Dr. Frank Corrigan, MD, FRCPsych (the originator of DBR.) . As a result of the last 11 years of collaboration, Martin and Frank have designed a Somatic (body-based) Interweave Component for Deep Brain Reorienting (DBR), which facilitates the release of long held shock from a client’s nervous system and helps them discharge emotions and affects linked to traumatic experience.
DBR Background
There are well-researched trauma psychotherapies which offer hope of full recovery as they are not dependent on top-down management of symptoms. These transformational approaches rely on the human brain having an inherent ability to find healing from emotional trauma when the memory of the initiating event is approached in a specific way.
However, it can often be difficult to get to the core of an adverse experience to liberate this healing flow. Sometimes it is difficult because returning to the event is emotionally overwhelming and there is a protective tendency to turn attention away from the memory as soon as possible. Sometimes there is a more evident dissociation from the present-day experience through numbing, blanking out, shutting down, or switching into a self-state like that which occurred at the time of the original trauma. Sometimes there has been a shock – before the emotions became intense – which replays so fast that it is easily missed during treatment. More commonly it is because the original experience that was so disturbing has been covered in layers of thoughts and feelings and distressing re-experiencing. It may also have been compounded by relational problems which themselves were precipitated by the continuing distress
DBR Development
Deep Brain Reorienting (DBR) aims to access the core of the traumatic experience in a way which tracks the original physiological sequence in the brainstem, the part of the brain which is rapidly online in situations of danger or attachment disruption. There may be threat and attachment wounding together when, for example, an experience of abandonment in infancy activates age-appropriate fears for survival.
The first structure capable of initiating a movement response is the superior colliculus (SC), which can direct eye movements. The SC also prepares the head for turning by bringing in tension in the muscles of the neck. This orienting tension, although often fleeting and unnoticed, is a major component of DBR. The focus in a DBR session on face and neck tension arising from turning attention to the memory of the traumatic event, or to whatever has been the present-day trigger, gives an anchor in the part of the memory sequence that occurred before the shock or emotional overwhelm that is leading to the continuing symptoms. Deepening awareness into this orienting tension provides an anchor for grounding in the present so that the mind is neither swept away by the high intensity emotions, nor diverted into a compartment holding a self-state frozen in time in which contact with the present is lost. Although the theory is simple the practice of DBR can be difficult. It does not work for everyone. Therapists who will find it most useful are those who use transformational trauma therapy approaches that are body-based, or “bottom-up”. These approaches do not rely on restructuring of thoughts or meanings at a complex verbal level for “top-down” control of symptoms, nor do they rely on exposure for establishing cortical control of fear responses.
DBR Clinical Applications
It is well-recognised that traumatic experiences can lead to the development of the full syndrome of post-traumatic stress disorder (PTSD) with its characteristic intrusive features, such as flashbacks and nightmares, and attempts to avoid triggers to further distress.
In more complex forms of PTSD there may be more derealisation and depersonalisation, consistent with the brain’s attempts to avoid being overwhelmed by shock and horror, and by intense affects of fear, rage, grief, or shame. The more dissociative forms of PTSD occur when there has been early life attachment disruption preceding other traumatic experience. Dissociative disorders may arise from early life separation experiences experienced as painful and unresolved even when there has been no later abuse. The pain of aloneness may be an internal driver of defensive and affective responses and may thus contribute to difficulties in regulating emotions. Any such difficulty may lead to efforts to control distress through substance abuse, eating disorders, or self-harm – or it may be expressed through troublesome anxiety or mood disturbance. It is not so much the clinical presentation which is important for DBR – but whether there is an underlying event or experience at the origin of the distress.
The Hypothetical Basis of DBR
Many authors have written about the importance of orienting in trauma. In DBR there is a focus on the principal brain structure for orienting – the superior colliculus of the midbrain.
Whenever there is a grabbing of the attention by a significant stimulus, the deep layers of the superior colliculi activate the muscles of the neck in readiness for head movement (even when no movement occurs). In humans, this orienting tension can also occur in the muscles around the eyes or in the forehead. Asking a person to focus on the Orienting Tension associated with a traumatic or highly triggering event provides an anchor against being overwhelmed or lost in dissociation. The Orienting Tension also keeps the memory’s “information file” open for processing; that is, the emotions and memories that come up are linked by the underlying sequence that has been identified. One sequence may underlie many different events or experiences so it can be economical of time and energy to allow the sequence to process rather than work through the individual traumas one by one.
The individual is first helped to become grounded in an awareness of where they are in the present moment. Then, the person accesses their initial awareness of the traumatic experience, as well as the orienting tension associated with this awareness. This isolates the body’s immediate response from the subsequent emotional and defensive responses. This Orienting Tension, although often fleeting and unnoticed, is a major component of DBR. The focus on upper face and neck tension gives an anchor in the part of the memory sequence that occurred before the shock or emotional overwhelm. Deepening awareness into the Orienting Tension provides an anchor for grounding in the present so that the mind is not swept away by the high intensity emotions that may arise during trauma memory processing.
When the stimulus that grabbed the attention has been shocking or horrifying there has been an immediate activation of the locus coeruleus, another brainstem structure which is in close, two-way, communication with the superior colliculus. This shock response is called preaffective in DBR because it happens before the affective and defensive responses. If preaffective shock is identified during a DBR session it can often be processed quickly, making easier any subsequent clearing of distress in relation to the traumatic event.
After the shock (if present), there is involvement of the periaqueductal gray (PAG), a columnar structure of the midbrain. The PAG is the critical brain area for defensive responses such as flight, fight, and freeze – and for the affective responses to trauma, such as fear, rage,grief, and shame. In DBR, we aim to promote memory processing that follows the logical course of trauma activation through the superior colliculi into the PAG.
As noted above, this work does not become overwhelming – or lead to dissociation – when there is a good anchor in the Orienting Tension. This has led many therapists to report good results with DBR-focused processing, especially for cases that include early attachment traumas such as those that underlie dissociative disorders. DBR has been observed to result in shifts in how people see themselves, others, and the world, with increases in self-compassion and reductions in trauma-related cognitive distortions, symptoms, and reactions.