A randomized controlled trial of Deep Brain Reorienting: a neuroscientifically guided treatment for post-traumatic stress disorder

Abstract

Background: Advanced neuroscientific insights surrounding post-traumatic stress disorder (PTSD) and its associated symptomatology should beget psychotherapeutic treatments that integrate these insights into practice. Deep Brain Reorienting (DBR) is a neuroscientifically-guided psychotherapeutic intervention that targets the brainstem-level neurophysiological sequence that transpired during a traumatic event. Given that contemporary treatments have non-response rates of up to 50% and high drop-out rates of >18%, DBR is investigated as a putative candidate for effective treatment of some individuals with PTSD. Objective: To conduct an interim evaluation of the effectiveness of an eight-session clinical trial of videoconference-based DBR versus waitlist (WL) control for individuals with PTSD. Method: Fifty-four individuals with PTSD were randomly assigned to DBR ( N = 29) or WL ( N = 25). At baseline, post-treatment, and three-month follow-up, participants’ PTSD symptom severity was assessed using the Clinician Administered PTSD Scale (CAPS-5). This is an interim analysis of a clinical trial registered with the U. S. National Institute of Health (NCT04317820). Results: Significant between-group differences in CAPS-total and all subscale scores (re-experiencing, avoidance, negative alterations in cognitions/mood, alterations in arousal/reactivity) were found at post-treatment (CAPS-total: Cohen’s d = 1.17) and 3-month-follow-up (3MFU) (CAPS-total: Cohen’s d = 1.18). Significant decreases in CAPS-total and all subscale scores were observed within the DBR group pre – to post-treatment (36.6% CAPS-total reduction) and pre-treatment to 3MFU (48.6% CAPS-total reduction), whereas no significant decreases occurred in the WL group. After DBR, 48.3% at post-treatment and 52.0% at 3MFU no longer met PTSD criteria. Attrition was minimal with one participant not completing treatment; eight participants were lost to 3MFU. Conclusions: These findings provide emerging evidence for the effectiveness of DBR as a well-tolerated treatment that is based on theoretical advances highlighting alterations to subcortical mechanisms in PTSD and associated symptomatology. Additional research utilizing larger sample sizes, neuroimaging data, and comparisons or adjacencies with other psychotherapeutic approaches is warranted. Trial registration: .

Survival, Attachment, and Healing: An Evolutionary Lens on Interventions for Trauma-Related Dissociation

“… 103 Other examples include somatic trauma psychotherapies (eg, Somatic Experiencing and Sensorimotor Psychotherapy), Deep Brain Reorienting, and Multi-Modal Motion-Assisted Memory Desensitization and Reconsolidation (3MDR). 5 , 18 , 150 EMDR combines top-down activation of the PFC and attentional control with direct effects on the brainstem to engage sensory integration. 18 Somatic psychotherapies similarly engage attentional control, emotion regulation, and mindful experiencing of somatosensory states.…”

“…Deep Brain Reorienting focuses on subcortical orienting, shock, and PAG-based affective responses associated with traumatic memories, without discussing traumatic content. 150 Finally, 3MDR includes treadmill walking, somatosensory processing, and an eye movement task within a virtual reality exposure environment. 5 All emphasize co-regulation and safety of the therapeutic context, to titrate experience.…”

A conceptual framework for a neurophysiological basis of art therapy for PTSD

“…It is likely that our searches failed to identify studies wherein neurophysiological, or biomarker keywords or terms were not included. Other psychotherapies with emerging evidence such as Brief Eclectic Psychotherapies, psychodynamic therapies, Deep Brain Reorienting ( Kearney et al, 2023 ), and other creative arts therapies like music and dance therapy, have not been underscored in this paper for comparison. Also, while narrative synthesis allowed the inclusion of heterogeneous evidence for the conceptual mapping, it is susceptible to selective reporting ( Campbell et al, 2019 ).…”

The Stress Phenotyping Framework: A multidisciplinary biobehavioral approach for assessing and therapeutically targeting maladaptive stress physiology

“…Bottom up approaches that help to regulate the body’s physiologic stress response include interventions such as heart rate variability biofeedback (e.g., HeartMath) ( Fournié et al, 2021 ; Lehrer et al, 2020 ), yoga ( Kearney & Lanius, 2022 ), and somatic sensory-based psychotherapies ( Kearney & Lanius, 2022 ) such as Somatic experiencing, Sensorimotor Psychotherapy, and Sensory Motor Arousal Regulation therapy (SMART). In addition, breathing practices such as prolonged expiratory or coherent breathing can activate parasympathetic function, which, over time, helps to increase self-regulatory capacity of the ANS ( Balban et al, 2023 ; Kearney et al, 2023 ; Komori, 2018 ).…”

“…Heart rate variability biofeedback (e.g., HeartMath) ( Fournié et al, 2021 ; Lehrer et al, 2020 ), yoga ( Kearney & Lanius, 2022 ), somatic psychotherapies ( Kearney & Lanius, 2022 ) (e.g., Somatic Experiencing, Sensorimotor Psychotherapy, Sensory Motor Arousal Regulation Therapy [SMART]), prolonged expiratory breathing ( Balban et al, 2023 ; Kearney et al, 2023 ; Komori, 2018 )…”