DBR is a brain-based psychotherapy. During a traumatic or overwhelming event, the brain activates a sequence of responses, including orienting towards or away from something, subconscious shock, emotions and defenses. Because this sequence occurs too quickly to consciously process what’s happening, it can get stuck in the nervous system. Later, when reminded in some way of the original event, the brain replays the same sequence of orienting, shock, emotions and defenses (what we call “getting triggered”). In DBR, we access the sequence and let it replay much more slowly so that you can witness and process it. This allows the sequence to be released so that it doesn’t keep replaying, and our emotional, defensive and behavioral responses in previously triggering situations can start to change.

DBR is potentially helpful for anyone who has a history of trauma (including “big T” and “little t” traumas, complex trauma, preverbal trauma, attachment wounds, unmet needs, etc.) or other types of overwhelming or adverse experiences. If you’ve had good results with other therapies, DBR may help you achieve additional progress, deeper change and further resolution. If other therapies have not been working well, DBR may be more effective or more tolerable or may help you start to make better progress in your other therapy.

DBR can have a number of potential benefits. These are some examples of changes I have seen happen for clients using DBR therapy. DBR therapy may help you:Become more grounded and present,Feel less reactive and less frequently triggered,Develop an increased capacity to tolerate intense or uncomfortable feelings and sensations,Reduce tendencies to avoid, numb, minimize, intellectualize, ruminate, lash out or dissociate,Accept reality more and engage less in magical thinking,Tolerate ambiguity and complexity better and engage less in binary thinking,Become less rigid, more flexible and better able to problem solve,Take other people’s words and behaviors less personally,Feel less overly responsible for others,Decrease tendencies to fawn, submit or people please,Improve your ability to self-advocate, say no and set boundaries,Find it easier to prioritize self-care and make healthy choices, and/orFeel less conflicted about connecting with others or reaching out for support.

In a DBR session, the therapist helps you identify a recent trigger (or sometimes a memory) to process and then leads you in an exercise to help you access a very grounded state before processing. Then the therapist helps you access the sequence and supports you in letting it unfold slowly so that it can be processed and released. The processing is experienced primarily as physical sensations, which vary by person and from session to session. Examples include muscles tensing or relaxing, pressure, a sense of something moving through or out of the body, heat or cold, nausea, auditory or visual effects, feeling heavy headed, lightheaded or sleepy, and many other things. There may or may not be involuntary movement (ex., the head bracing back or turning, an eye twitching, an arm shaking, the shoulders or hips twisting, a leg turning, etc.). Since you are so grounded, these experiences are easier to tolerate than they would normally be and typically clear up by the end of the session. (There are also strategies to use if something does feel like too much for you.) DBR theorizes that these sensations are the shock, emotions and defenses moving through the body and that letting this happen slowly, with grounded presence, clears out the stuck sequence so that you don’t keep getting retriggered.

In DBR, we work in deeper parts of the brain than in other trauma therapies. You therefore do not need to focus on trauma images or memories, figure out which memories are connected to present symptoms, identify or challenge core beliefs or work with parts of self because these things exist in higher levels of the brain. If they do come up, we acknowledge them briefly and then refocus on the processing that’s happening in the body. The unique grounding exercises used in DBR also help you to be able to sit with emotions, sensations and defensive responses that might otherwise be too intense or overwhelming to tolerate. These aspects of DBR often make it easier for clients to do than other types of trauma therapies. DBR can also seem more subtle than other therapies. We don’t try to intellectually understand what’s going on during the session because that would take you into higher levels of the brain and disrupt the processing in the deeper parts. As a result, the connections between the thing we choose to process, the processing that occurs in the session and the changes you experience subsequently in your life are not always as obvious as they might be in other therapies. This may be a little difficult at first if you’re someone who likes to cognitively make sense of what’s happening. However, clients usually seem to have less of a need to intellectually understand this over time because they feel good about their progress.

You don’t necessarily have to know or remember that you’ve experienced a trauma for DBR to be helpful. Stressful or overwhelming events may have been experienced as traumatic by your brain and nervous system even if you wouldn’t call them traumas. If you find yourself getting triggered, anxious, depressed, angry, overwhelmed, etc., or if you find yourself struggling to either connect with or set boundaries with others, DBR may be helpful. See also the question above “How might DBR help me?” for more information.

Yes, DBR can be done virtually. In fact, the first clinical trial of DBR's effectiveness was completed during the COVID-19 pandemic, and all of the DBR therapy sessions in that study were held virtually. DBR seems to work just as well in person or virtually for most clients. There are some clients for whom virtual therapy may not be appropriate in general, but that is true whether using DBR or another type of therapy.

I offer DBR both as a primary therapy and as an adjunctive therapy. DBR can be a good adjunctive therapy for several reasons. We do not need to take an in-depth history, which can be helpful if you want to try another modality without spending a lot of time rehashing your history again with a new therapist. Also, since most of the session is spent in somatic (body focused) processing, we only talk a little bit about your history and current life. This can help to minimize problems that sometimes occur in adjunctive therapy (for example, feeling like you’re getting “mixed messages” if you talk about the same thing with two different therapists). Finally, you may find that doing adjunctive DBR therapy can lead to greater progress and better outcomes in the other type of therapy you’re doing with your primary therapist.