Deep Brain Reorienting (DBR), Disconnection Pain and Dissociation 

October 22, 2023
Abstract
Deep Brain Reorienting (DBR) is a clinical approach to the treatment of traumatic experiences which has been developed from an understanding of brainstem responses to adversity. The underlying hypotheses have been constructed from clinical observations combined with information from relevant brain imaging and laboratory studies. In addition to systems mediating alarm and defence we postulate an innate connection system, which provides a sensorimotor base for more complex attachments, and we consider the pain of disconnection from others to be a fundamental wound in many situations of adversity. Attending to this disconnection pain, rather than primarily to the associated affects, is a core part of DBR.
One of the most clinically useful ideas which has emerged from the development of DBR is the concept of preaffective shock. This is a brainstem and body reaction to a traumatic experience which can precede the affective and defensive responses. It has been found that the energetic impact of shock is often missed in therapy, leaving the body activation to heighten the subsequent emotional states and make them more resistant to treatment. This presentation will outline the clinical manifestations of shock and the therapeutic approach to these.
We will also consider how shock contributes to derealisation and depersonalisation and propose a model of dissociation in which these are considered separately, for clinical purposes, from neurochemical and structural forms of dissociation. Processing of adverse experiences in DBR sessions occurs from a grounded state hypothesised to be based in a midbrain-based attentional pivot which functions always to know where the body is in relation to all that is around it. Neurochemical dissociation is defined as a capping of extreme affective states by intrinsic mechanisms for preventing damaging, even lethal, physiological activation. The basic affective and defensive states will be described in terms of their origins in the midbrain and hypothalamus. Structural dissociation is considered in terms of circuits based in cerebral cortex that have become largely independent of the affective circuitry of the brainstem. These hypothetical mechanisms are clinically useful in promoting the resolution of distressing post-traumatic states.
 
Potential to Distress:
No

Target Audience

Intermediate

Learning Objectives

At the conclusion of this presentation, participants will be able to:
  • Explain the fundamental orienting mechanisms of the upper brainstem and the importance of the orienting tension in DBR
  • Discuss how to elicit the clinically significant elements of orienting to the memories of traumatic experiences
  • Describe the impact of shock and horror on the brainstem and body and the separate effects of affective and defensive responses
  • Explain the putative mechanisms of structural dissociation in the DBR model
  • Discuss the role of disconnection pain in early neglect
Course summary
Available credit: 
  • 1.50 APA
    The 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 ACE
    The International Society for the Study of Trauma and Dissociation (ISSTD), #1744, is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved as ACE providers. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. ISSTD maintains responsibility for this course. ACE provider approval period: 08/20/2021 – 08/20/2024. Social workers completing this course receive 1.50 continuing education credits.
  • 1.50 ISSTD Certificate Program
    This program is eligible for 1.50 credits in the ISSTD Certificate Program.
Course opens: 
07/19/2023
Course expires: 
12/31/2050
Event starts: 
10/22/2023 - 12:00pm EDT
Event ends: 
10/22/2023 - 1:30pm EDT
Part of: 
(Re)building Hope, (Re)orienting Safety, and (Re)stabilizing Treatment with Complex Trauma and Dissociation - Day Two
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Presenter: Frank Corrigan, MBChB, MD, FRCPsych

Presenter Bio: Frank Corrigan 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.

His research broadly explored the intersection between affective Neuroscience and the science of healing culminating in the development of Deep Brain Reorienting (DBR). This new and novel psychotherapeutic approach emphasises the importance of tracking a distinctive neurophysiological sequence embedded in ‘deep brain’ systems. One of the most unique aspects of DBR as a trauma-focused therapy, is the embodiment of a natural healing process that is consonant with the evolutionary process of the developing brain and nervous system.  Preliminary results of a clinical and neuroimaging study of DBR in London, Ontario, have been accepted for publication.

Available Credit

  • 1.50 APA
    The 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 ACE
    The International Society for the Study of Trauma and Dissociation (ISSTD), #1744, is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved as ACE providers. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. ISSTD maintains responsibility for this course. ACE provider approval period: 08/20/2021 – 08/20/2024. Social workers completing this course receive 1.50 continuing education credits.
  • 1.50 ISSTD Certificate Program
    This program is eligible for 1.50 credits in the ISSTD Certificate Program.
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