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ForwardThe DBR Model of Dissociation and Dissociative Disorders
Abstract
Dissociative disorders have a wide range of clinical presentations which often present challenges in trauma psychotherapy. Deep Brain Reorienting (DBR) uses a shock and pain model of dissociation to account for the clinical impact of early attachment disruptions and later abuse and neglect. This offers a focused way to work with complex and complicated histories of adversity and their consequent clinical syndromes. The DBR model of trauma and attachment disruption will be outlined and the applications to dissociative disorders will be described.
It is proposed that attachment shock and aloneness pain primarily activate the brainstem, and then the associated arousal can drive increased activity, sensory disruption and / or intense affects. The shock and pain brainstem arousal can also lead to various, involuntary, turnings away from the pain at the deep brain level; disruption of the coherence of integrated cortical function; and segregated circuitry for separated self-states.
This presentation will outline the brainstem structures involved in response to homeostatic threat as well as to external threat. Supracortical dissociation will be described as an involuntary inability to be with a painful reality, a turning away that is below the level of cognitive appraisal. Intracortical dissociation will be described as a shock-induced activation of cortex which leads to adaptive hyperconnectivity and clinical syndromes of derealisation, depersonalisation, and some somatoform disorders. Cortico-striato-thalamo-cortical circuitry underlying relatively independent self-states will also be proposed as a key mechanism in clinical presentations of dissociative disorders.
The therapeutic implications of these theories – with examples – will be considered. The presentation may, therefore, be of interest to clinicians working with complex trauma disorders who are planning to train in Deep Brain Reorienting (DBR). Formal training is essential – but not in itself always sufficient – for the use of DBR in dissociative disorders as other clinician and patient variables may be relevant to its safe and effective application.
Target Audience
Advanced
Learning Objectives
At the conclusion of this session, participants will be able to:
- Describe the different mechanisms of dissociation identified in the DBR model
- Identify the clinical characteristics of each mechanism
- Assess presentations in terms of the applicability of the DBR model
- Identify whether DBR training would be helpful in their clinical work
Frank Corrigan, MBChB, MD, FRCPsych
Frank Corrigan, MD, FRCPsych qualified in Medicine in 1976 (MBChB, Glasgow) and began his career in psychiatry in 1977. Throughout a career spanning over 30 years as an NHS Consultant Psychiatrist in Scotland, Frank combined his extensive clinical experience with research on the neurobiology of trauma and its underpinnings in major psychiatric disorders.
Frank is the developer of DBR. He is a Consultant Psychiatrist based in Scotland and was an EMDR Consultant and a CRM trainer. Frank has a special interest in the neuroscience and treatment of complex trauma and dissociative disorders and has published extensively in the field. He is co-author of Neurobiology and Treatment of Traumatic Dissociation: Toward an Embodied Self (Lanius et al., 2014), along with numerous scientific papers, and he co-wrote The Comprehensive Resource Model: Effective Techniques for Healing Complex Trauma with Lisa Schwarz, Dr Rajiv Raju and Dr Alastair M Hull in 2016. More recently, he co-wrote Deep Brain Reorienting: Understanding the Neuroscience of Trauma, Attachment Wounding, and DBR Psychotherapy with Dr Hannah Young and Dr Jessica Christie-Sands, published in 2025. He is involved in a clinical and neuroimaging study of the effects of DBR on PTSD with Professor Ruth Lanius at the University of Western Ontario, Canada.
Available Credit
- 1.50 APAThe International Society for the Study of Trauma and Dissociation is approved by the American Psychological Association to sponsor continuing education for psychologists. The International Society for the Study of Trauma and Dissociation maintains responsibility for this program and its content.
- 1.50 ASWB ACEThe International Society for the Study of Trauma and Dissociation (ISSTD), #1744, is approved as an ACE provider to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Regulatory boards are the final authority on courses accepted for continuing education credit. ACE provider approval period: 08/20/2024 – 08/20/2027. Social workers completing this course receive 1.50 continuing education credits.
- 1.50 ISSTD Certificate ProgramThis program is eligible for 1.50 credits in the ISSTD Certificate Program. No certificate of completion is generated for this type of credit.