DBR Background

There are well-researched trauma psychotherapies which offer hope of full recovery as they are not dependent on top-down management of symptoms. These transformational approaches rely on the human brain having an inherent ability to find healing from emotional trauma when the memory of the initiating event is approached in a specific way.

However, it can often be difficult to get to the core of an adverse experience to liberate this healing flow. Sometimes it is difficult because returning to the event is emotionally overwhelming and there is a protective tendency to turn attention away from the memory as soon as possible. Sometimes there is a more evident dissociation from the present-day experience through numbing, blanking out, shutting down, or switching into a self-state like that which occurred at the time of the original trauma. Sometimes there has been a shock – before the emotions became intense – which replays so fast that it is easily missed during treatment. More commonly it is because the original experience that was so disturbing has been covered in layers of thoughts and feelings and distressing re-experiencing. It may also have been compounded by relational problems which themselves were precipitated by the continuing distress.

DBR Clinical Applications

It is well-recognised that traumatic experiences can lead to the development of the full syndrome of post-traumatic stress disorder (PTSD) with its characteristic intrusive features, such as flashbacks and nightmares, and attempts to avoid triggers to further distress.

In more complex forms of PTSD there may be more derealisation and depersonalisation, consistent with the brain’s attempts to avoid being overwhelmed by shock and horror, and by intense affects of fear, rage, grief, or shame. The more dissociative forms of PTSD occur when there has been early life attachment disruption preceding other traumatic experience. Dissociative disorders may arise from early life separation experiences experienced as painful and unresolved even when there has been no later abuse. The pain of aloneness may be an internal driver of defensive and affective responses and may thus contribute to difficulties in regulating emotions. Any such difficulty may lead to efforts to control distress through substance abuse, eating disorders, or self-harm – or it may be expressed through troublesome anxiety or mood disturbance. It is not so much the clinical presentation which is important for DBR – but whether there is an underlying event or experience at the origin of the distress.