The Hong Kong Psychology Practice®
Complex Trauma, Sexual Assault & Dissociation
ONLINE & IN-OFFICE WAN CHAI

 

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Deep Brain Reorienting (DBR)

A neuroscience-based approach to processing trauma at its source

Deep Brain Reorienting (DBR) is a trauma-focused psychotherapy designed to access and resolve traumatic experience by tracking the brain’s original sequence of physiological responses to threat or attachment disruption. Rather than working exclusively through thoughts, narratives, or repeated exposure, DBR focuses on the earliest, pre-conscious stages of trauma activation - where the nervous system first registered danger.

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The theory behind DBR

DBR is grounded in contemporary neuroscience and draws on research into the brainstem structures involved in orienting, shock, and defence. When something threatening or relationally rupturing occurs, the brain does not respond all at once. Instead, activation follows  a rapid and predictable sequence.

One of the first structures involved is the superior colliculus, a midbrain centre responsible for orienting attention toward significant stimuli. This activation is accompanied by subtle, often unnoticed tension in the muscles of the neck, upper face, or eyes as the body prepares to turn toward - or away from - danger. DBR uses this orienting tension as a precise anchor, allowing the original trauma sequence to be accessed without overwhelming the system.

If the event is sufficiently shocking or horrifying, the locus coeruleus may activate immediately, producing a pre-affective shock response before emotions fully emerge. This is followed by activation of the periaqueductal gray (PAG), which governs defensive responses such as fight, flight, freeze, and collapse, along with intense affects such as fear, rage, grief, or shame.

DBR works by carefully tracking this sequence in the order it originally occurred. By staying anchored in the earliest orienting response, processing can proceed without flooding, dissociation, or loss of present-moment awareness.

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The evidence base

DBR is a developing, evidence-informed trauma therapy with a growing clinical and research base. It aligns with established findings in affective neuroscience, attachment theory, and bottom-up trauma processing. Clinical studies and practitioner reports indicate particular effectiveness for complex trauma presentations, including early attachment trauma and dissociation, where traditional exposure-based or cognitive approaches may be poorly tolerated.

Importantly, DBR is not a symptom-management technique. It is based on the premise - shared by other evidence-based somatic trauma therapies - that the brain has an inherent capacity to resolve traumatic memory when it is accessed in the right way.

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What DBR may help with

DBR may be helpful where symptoms are rooted in unresolved threat or attachment disruption, including:

• Post-traumatic stress (single-incident or complex)

• Dissociative presentations (including depersonalisation, derealisation, and DID)

• Early attachment trauma and developmental trauma

• Anxiety disorders driven by threat sensitivity

• Eating and body-image difficulties linked to control, shame, or survival strategies

• Trauma responses following sexual abuse or assault

The focus is not the diagnostic label, but whether there is an underlying experience at the origin of the distress.

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Intended outcomes

DBR aims to reduce trauma-related symptoms by allowing the nervous system to complete interrupted defensive and orienting sequences. Clients commonly report:

• Dramatically reduced reactivity and hypervigilance

• Less dissociation and shutdown

• Increased emotional clarity and self-compassion

• Shifts in deeply held beliefs about self, others, and safety

• A greater sense of agency, embodiment, and choice

The goal is not to relive trauma, but to integrate it - so life is no longer organised around protection from the past.

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How DBR differs from traditional therapies

Unlike purely cognitive or talk-based therapies, DBR does not rely on insight, reframing, or willpower to control symptoms. Unlike exposure-based approaches, it does not require repeated immersion in distressing memories to achieve change.

DBR is precise, non-overwhelming, and bottom-up. By working at the level of the brainstem - before emotion and meaning cascade - it often allows processing to occur more efficiently and with less destabilisation, particularly for clients who dissociate or become flooded in therapy.

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DBR and EMDR: how they differ

Both Deep Brain Reorienting (DBR) and Eye Movement Desensitisation and Reprocessing (EMDR) are evidence-based trauma therapies that aim to resolve traumatic memory rather than manage symptoms. They share a bottom-up orientation and an understanding that trauma is stored in the nervous system. However, they work at different levels of the trauma response.

EMDR primarily targets traumatic memories once emotional and physiological activation is already present. It uses bilateral stimulation to support processing of the memory network, including associated images, emotions, beliefs, and body sensations. For many people, EMDR is highly effective - particularly when memories are clear, contained, and can be accessed without overwhelming the system.

DBR works earlier in the trauma sequence. Instead of beginning with emotion, cognition, or imagery, DBR focuses on the brain’s first orienting and shock responses - before the full emotional and defensive cascade occurs. By anchoring processing in the subtle orienting tension generated by the midbrain, DBR often allows traumatic experience to be accessed without triggering flooding, dissociation, or shutdown.

This difference makes DBR particularly well suited for:

• clients who dissociate or become overwhelmed during EMDR or exposure-based work

• early attachment trauma where memories are vague, pre-verbal, or relational rather than event-based

• complex trauma presentations where threat and attachment injury are intertwined

In practice, DBR and EMDR are not mutually exclusive. Many clinicians use both, selecting the approach that best matches the client’s nervous system, history, and current capacity. At The HK Psychology Practice®, the guiding principle is not allegiance to a single method, but clinical judgment: choosing the approach that allows trauma to be processed safely, effectively, and with the least unnecessary distress.

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A note on fit

DBR is not a universal solution and does not work for everyone. It requires careful pacing, specialised training, and a strong therapeutic relationship. When appropriately applied, however, it offers a powerful option for clients who have not found relief through more conventional approaches.