Understanding Deep Brain Reorienting: A New Approach to Trauma Therapy

If you've been working in the trauma therapy world for any length of time, you've likely accumulated a growing list of modalities - EMDR, IFS, somatic experiencing, sensorimotor psychotherapy, and polyvagal-informed approaches. Each adds something unique. Each has its particular territory. Deep Brain Reorienting (DBR) is newer to most clinicians' awareness, but it's worth knowing about—not as a replacement for what you already do, but because it addresses a specific layer of traumatic experience that other approaches often don't reach.

I'm currently in DBR training and want to be transparent that I'm writing this as someone in the middle of learning, not as an established practitioner. What follows draws from published, peer-reviewed sources and is intended as an honest introduction to what DBR is, where it came from, and why it might matter for your clinical work.

Who Developed DBR and Why

Deep Brain Reorienting was developed by Frank Corrigan, MD, FRCPsych, a psychiatrist based in Scotland. He spent decades working with complex trauma and dissociation. Corrigan's central question was one that many trauma therapists will recognize from their own clinical experience: why do some clients continue to struggle with retraumatization despite insight, despite parts work, and despite what looks like genuine therapeutic progress?

His answer—developed over years of clinical observation and grounded in affective neuroscience—was that existing approaches, however sophisticated, were largely operating at the level of the cortex and the peripheral autonomic nervous system. They were missing something that happens much earlier and much faster in the brain's response to threat. The theoretical foundations of DBR were formally articulated in a 2020 paper in Medical Hypotheses, co-authored with Jessica Christie-Sands. This paper outlined the brainstem-based sequence Corrigan identified as the overlooked core of traumatic experience (Corrigan & Christie-Sands, 2020). The approach has since been expanded in the 2025 Routledge book Deep Brain Reorienting: Understanding the Neuroscience of Trauma, Attachment Wounding, and DBR Psychotherapy, co-authored with Hannah Young and Christie-Sands.

The Core Idea: Trauma Lives in the Brainstem

Most trauma therapies work at the level of memory, narrative, affect, or autonomic arousal. DBR goes further down—to the brainstem and midbrain structures that respond to threat before any of those other processes come online.

Corrigan describes a predictable neurophysiological sequence that occurs when the brain encounters something threatening or shocking. The sequence begins with orienting tension—a subtle muscular response in the face, head, and neck as the superior colliculi direct attention toward the source of threat. This is followed by preaffective shock, a rapid noradrenaline response from the locus coeruleus that occurs before any emotion has formed—a kind of alarm surge that precedes feeling. Finally, the affective response emerges through the periaqueductal gray, generating the emotional and defensive states we're more familiar with: fear, freeze, fight, and collapse (Corrigan & Christie-Sands, 2020).

The word "preaffective" is worth pausing on. Corrigan identifies something that happens before emotion—a brainstem-level shock that is distinct from the fear, grief, or rage that follows it. In clinical practice, this shows up as those fleeting sensations that clients often can't name: a sudden hollowing, a shudder, or a sinking feeling that passes before language can reach it. These aren't metaphors. They're the somatic signatures of locus coeruleus activation. Corrigan argues that in traumatized systems, they remain stored and continue to fire—often without ever being recognized or addressed (Corrigan & Young, 2025).

What Makes DBR Different

Most trauma approaches, when they work somatically, are working with the effects of the brainstem sequence—the autonomic arousal, the defensive postures, the emotional flooding, or numbing. DBR works with the sequence itself, starting at the very beginning with the orienting tension.

In a DBR session, the therapist invites the client to bring a specific activating stimulus to mind—a present trigger or a fragment of a traumatic memory. Then, the therapist guides attention to the subtle orienting tension that arises in the face, head, and neck. Rather than moving quickly into the emotional content, the therapist and client slow down and track the sequence as it unfolds: the tension, the shock, the affect. The goal is to allow each element to be metabolized in the order it originally occurred, without being overwhelmed by the layers above it (Corrigan, Young & Christie-Sands, 2025).

This slowing down is the heart of the approach. Corrigan has described how shock, by its nature, happens faster than awareness can follow. This speed is precisely why it tends to be missed both by clients and by therapists. By creating conditions where the sequence can be tracked in slow motion, DBR allows the brainstem to complete what was interrupted during the original traumatic experience.

Attachment Wounding and the Connection System

One of the most clinically significant aspects of DBR is how it understands attachment trauma. Corrigan and Christie-Sands describe the brainstem's innate drive toward connection—the orienting system that, from the first weeks of life, organizes the infant's movement toward or away from a caregiver. When early attachment is safe and responsive, the orienting system learns to approach. When it is frightening, inconsistent, or absent, the same system learns to hold both impulses simultaneously: the drive to connect and the imperative to withdraw (Corrigan & Christie-Sands, 2020).

This conflicted orienting pattern—what Corrigan describes as the paradox at the heart of disorganized attachment—is not primarily a psychological phenomenon. It is physiological, encoded in the brainstem before language or narrative exists. The pain that arises from unmet connection needs—loneliness, rejection, and the sense of fundamental unworthiness—is understood in DBR not just as emotional content but as a brainstem-level experience. This experience precedes and underlies the parts, the beliefs, and the relational patterns built on top of it (Corrigan & Young, 2025).

This framing has significant clinical implications. It suggests that some of what looks like psychological resistance, polarized parts, or entrenched relational patterns may have a physiological substrate at the brainstem level that needs direct attention—not just meaning-making or affect work above it.

What the Research Shows

DBR is a relatively young approach, and the evidence base is still developing. However, the first randomized controlled trial produced striking results. Kearney and colleagues randomized 54 individuals with PTSD to either DBR treatment or a waitlist control, delivering eight sessions of internet-based DBR. At post-treatment and three-month follow-up, the DBR group showed large between-group effect sizes, and 52% of participants no longer met PTSD criteria at follow-up (Kearney et al., 2023). These are meaningful numbers for a complex trauma population, particularly with such a short treatment course.

The researchers note that the approach specifically targets what other therapies tend to miss: the subcortical, pre-verbal sequences that persist in the nervous system regardless of how much cortical processing has occurred. That alignment between theoretical rationale and clinical outcome is part of what makes DBR worth following as the evidence base continues to grow.

How It Fits With Other Approaches

DBR is not positioned as a replacement for other trauma modalities—it's designed to work at a level that other approaches don't typically access. Clinicians already trained in IFS, EMDR, somatic experiencing, or similar approaches may find that DBR offers a way to address cases that have plateaued or to work more precisely with the physiological substrate beneath the parts system or the trauma narrative.

The approach is particularly relevant for clients whose trauma is pre-verbal or attachment-based—where the wound occurred before narrative memory could form and where talk-based or even parts-based work reaches a ceiling. It is also relevant for clients who appear to be doing well in therapy, accessing insight and even Self energy, but who continue to find themselves destabilized in ways they can't explain. This is because the brainstem layer running beneath the therapeutic work was never directly addressed.

For those of us who work at the intersection of nervous system and psychological approaches, DBR offers something genuinely new: a precise anatomical map of where shock lives, a sequenced method for approaching it, and a growing empirical foundation to stand on.

A Note on Training

DBR requires formal training and is not something to apply from reading alone. Training is structured in levels and is designed for licensed mental health professionals with a background in trauma treatment. For those interested in learning more, the starting point is Corrigan's published work—particularly the 2020 Medical Hypotheses paper and the 2025 Routledge book—and the official DBR training program.

I'm sharing this as someone who is genuinely excited about what I'm learning and who thinks this approach deserves more visibility in the trauma therapy community. We are always better served by understanding more of the territory, even—especially—when it asks us to look somewhere we haven't been looking before.

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References

Corrigan, F. M., & Christie-Sands, J. (2020). An innate brainstem self-other system involving orienting, affective responding, and polyvalent relational seeking: Some clinical implications for a 'Deep Brain Reorienting' trauma psychotherapy approach. Medical Hypotheses, 136, 109502. https://doi.org/10.1016/j.mehy.2019.109502

Corrigan, F. M., & Young, H. (2025). The psychopathological domains of attachment trauma: A commentary. Clinical Neuropsychiatry, 22(5), 387–391.

Corrigan, F. M., Young, H., & Christie-Sands, J. (2025). Deep Brain Reorienting: Understanding the neuroscience of trauma, attachment wounding, and DBR psychotherapy. Routledge.

Kearney, B. E., Corrigan, F. M., Frewen, P. A., Nevill, S., Harricharan, S., Andrews, K., Jetly, R., McKinnon, M. C., & Lanius, R. A. (2023). A randomized controlled trial of Deep Brain Reorienting: A neuroscientifically guided treatment for post-traumatic stress disorder. European Journal of Psychotraumatology, 14(2). https://doi.org/10.1080/20008066.2023.2238690

van der Kolk, B. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking.

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About the Author: Katie is a Licensed Professional Clinical Counselor (LPCC-S) and board-certified art therapist (ATR-BC) at Lacuna Counseling in Columbus, Ohio. She is IFS Level 2 Certified. Katie specializes in neurodivergent-affirming therapy, integrating Internal Family Systems, art therapy, and somatic approaches including Deep Brain Reorienting.

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