Basic Treatment Principles
Body Regulation Therapy (BRT) - An Expanded Understanding
Body Regulation Therapy, BRT, is a body-oriented treatment that aims to promote the person's bodily security and motor skills, which leads to the experience of security and flexibility. It is used successfully in the treatment of people with mental illness and is a particularly effective tool in the treatment of trauma as well as generalized pain.
The therapy originates from the now well-established physiotherapeutic treatment Basic Body Awareness Therapy, BK. In line with current research and experiences, this knowledge has been further developed in order to help the person in an individualized way more distinctly to psychological stability via the body. By guiding the person to the right level of attention, their window of tolerance, patients can be treated for even severe trauma in an effective way without the risk of re-traumatization.
The exercises are chosen in the moment based on the individual's current needs, which e.g. may be to decrease or in some cases increase sympathetic activity. Often by using the influence of breathing and with the activation of skeletal muscles for stability and balance for an energy-efficient and vital movement pattern with increased ability to assert oneself. Knowledge of the connection between the brain and the body gives an inner security and feeling of strength.
The therapist-patient relationship is based on a human view that values the encounter with humility, interest and respect.
It is now predominantly physiotherapists who work within BRT. Therapists in general with solid knowledge of motor skills and with an interest in psychological treatment via the body benefit from the knowledge regardless of basic education. The main goal is to create the basis for a treatment process where understanding of the physiological processes' mutual influence on mental processes is the focus. To find clear guidelines for how the needs of the individual should be effectively recognized and thus be able to provide the right effort and treatment. A guiding star is to take part in research in the area, to evaluate, reevaluate and pass on knowledge.
Courses are given on an ongoing basis and are divided into basic training, advanced training and supervisors/certification. Furthermore, shorter themed courses are also given. See the courses tab. Interprofessional collaborations are encouraged.
Basic treatment principles
BRT uses advanced techniques such as the baroreceptor reflex, breathing training and vagus stimulation to physiologically reduce stress and increase emotional endurance. The method also includes a focus on interoception, stimulation of skeletal muscles and adaptation to the individual's tolerance window to promote mental and physical health.
Autonomous regulation
A direct route to reduced stress is to use the baroreceptor reflex. Through resistance breathing and static muscle activation, the blood pressure is increased, which the baroreceptors, our blood pressure sensors, detect and lowers the sympathetically regulated blood flow. This by reducing peripheral vascular resistance and heart rate. Correctly dosed, this can be a quick method to physiologically help the patient to calm down and be able to approach emotional endurance. This knowledge for use in clinical practice is under development, see links, and may be valuable in the initial treatment of more severe sympathetically maintained stress conditions.
Autonomic regulation and its importance in therapy is a growing field that offers important insights for professional therapists. A central part of this regulation is to understand and use the baroreceptor reflex to reduce the stress on patients. This reflex is part of the body's way of regulating blood pressure and directly affects the autonomic nervous system, particularly the sympathetic part responsible for the body's stress response.
The baroreceptors function as blood pressure sensors, located mainly in the aortic arch and carotid arteries. These sensors monitor and respond to changes in blood pressure. By deliberately increasing blood pressure via specific breathing exercises and static muscle activation, we can activate the baroreceptor reflex. This activation leads to a decrease in sympathetically regulated blood flow, by reducing peripheral vascular resistance and lowering heart rate. This process helps reduce stress and promotes a sense of calm in the patient.
To practically apply this in therapy, one can use resistance breathing, where the patient breathes against a resistance, such as breathing through a straw or covering the mouth with the hand. This creates an increased pressure in the chest and thus a temporary increase in blood pressure. At the same time, static muscle activation, such as tensing the muscles without moving them, can be used to further increase blood pressure and thereby stimulate the baroreceptors.
It is important to dose these techniques correctly. An intensity that is too high can be counterproductive and instead increase the stress level. The goal is to find a level where the patient experiences a clear relaxation and reduction of stress without feeling uncomfortable or overworked. This method may be particularly valuable in the treatment of patients with severe stress conditions who are sympathetically maintained, where traditional relaxation methods may not be as effective.
These technologies are still in development and more research is required to fully understand their potential and limitations. However, it is clear that the baroreceptor reflex offers a promising route to help patients deal with stress and anxiety in a physical way, which can complement more traditional psychotherapeutic methods. Integrating these methods into clinical practice can offer a powerful tool for therapists working with patients experiencing high levels of stress and related conditions.
Vagus influence
Breathing training that stimulates the diaphragm increases the tone of the vagus nerve and activates the parasympathetic system, leading to increased production of calming and mood-enhancing neurotransmitters. Voice use and prolonged slow exhalation also stimulate the vagus nerve and promote parasympathetic activation.
Through breathing training where the diaphragm is stimulated, tone increases in the vagus nerve, which activates the parasympathetic system. There is then an increased production of mood-enhancing and calming neurotransmitter substances such as GABA and serotonin. The vagus nerve is also stimulated by vibrations, which not least happens in connection with one's own sounding. Hence voice use, sounding, is a common component of treatment. This is preferably done in the form of monotonous and prolonged exhalation. Exhalation is parasympathetic, prolonged exhalation therefore prolongs parasympathetic activation. (Inhalation is a sympathetic activity, so in each breath the two systems shift).
One way to measure vagus activity is to measure Heart Rate Variability, HRV, which in a healthy person normally has a clear variability, but which in e.g. the exhausted and traumatized is considerably more even.
Interoception
People exposed to high stress lose the relationship with the body. Not infrequently, the ability to feel in one's body other than symptoms such as pain or shortness of breath disappears. Helping the person to get in touch with their inner body experience, interoception, the feeling of inner life, is reassuring and self-affirming. Together with the therapist, the patient is guided to a progressively increased body experience and with it increased self-compassion.
Interoception, the inner body experience, is a fundamental area of clinical practice, especially when treating people who have been exposed to high levels of stress. This ability to sense and interpret signals from one's own body is essential for emotional and physiological regulation. People who experience chronic stress or trauma can lose this critical connection to their own body's internal state, leading to a weakened ability to feel anything other than unpleasant bodily symptoms such as pain or shortness of breath.
Working with interoception in therapeutic contexts is about restoring and strengthening this connection. It involves helping patients become more aware of their internal bodily sensations, which can be anything from heartbeat and breathing to hunger or fatigue. This awareness is essential to create a sense of security and to strengthen self-esteem.
For therapists, this means guiding patients through processes and exercises that gradually increase their awareness and understanding of their own bodily signals. These exercises can vary from simple breathing exercises to more complex body scans or movement-based activities. Through these exercises, the patient gains a deeper understanding of his inner state, which is crucial for emotional processing and self-regulation.
An increased interoceptive awareness not only contributes to better physical health, but also plays a large role in the development of self-compassion. As patients begin to recognize and understand their internal body signals, they can begin to treat themselves with greater understanding and empathy. This is particularly important in the treatment of people who have experienced trauma or chronic stress, where bodily alienation is often a central issue.
In summary, interoception is an important part of therapeutic work to restore and strengthen bodily awareness and thereby promote emotional and psychological well-being. It is critical that therapists are skilled in guiding patients through interoceptive exercises, and that they understand the importance of this practice in supporting patients' holistic recovery.
Stimulation of skeletal muscles
When the patient is guided to use the deep skeletal postural muscles, the compensatory muscles will be able to relax with less muscle-related pain as a result. When the patient finds the strength and balance in this with a posture that can withstand stress, greater mental stability is also experienced.
Skeletal muscle stimulation is a central aspect of therapeutic treatment, especially when it comes to managing muscle-related pain and promoting mental stability. Skeletal muscles, often known as deep stabilizing muscles, play a critical role in the body's posture and structural integrity. These muscles are closer to the skeleton and are essential for maintaining a correct and stable body posture.
In therapeutic contexts, it is of great importance to be able to guide patients to actively use these deep muscles. Many patients often rely on the use of external, more superficial muscles - the compensatory muscles - for posture and movement. These extrinsic muscles are not designed to carry the body's main load and can therefore become overworked and cause pain.
By guiding patients to activate and strengthen the deep skeletal muscles, the extrinsic compensatory muscles can have a chance to relax and recover. This leads to a reduction in muscle-related pain. An important part of this process is helping patients develop an awareness of these muscles and how they are used in different movements and positions. This may include specific exercises, body positions and techniques to stimulate and strengthen the deep muscles.
In addition to the physical benefits, it is also important to note the psychological effect of having a strong and stable posture. As patients learn to use and rely on their deep stabilizing muscles, they may also experience an increased sense of bodily control and stability. This physical sense of stability can be translated into a sense of mental and emotional stability. A strong and stable body contributes to a strong and stable state of mind.
In conclusion, stimulation of the deep skeletal muscles is an important part of therapeutic treatment, not only for its ability to reduce muscle-related pain but also for its contribution to mental and emotional well-being. For therapists, it is crucial to be able to guide patients in the use of these muscles and integrate this knowledge into a holistic treatment plan.
The tolerance window
Dr. Dan Siegel coined the term "window of tolerance" to describe the optimal level of attention to manage emotions and make informed decisions, even under stress. The size of the window is affected by childhood attachment and environmental factors and can be reduced by negative experiences. The therapist can discover a patient's position in relation to this emotional window by observing, among other things, breathing, movement and speech. The treatment aims to help the patient recognize when he is in too high or too low a degree of arousal, find his tolerance window and gradually expand his ability to deal with emotional challenges in an adequate way.
This expression was coined by Dr. Dan Siegel with the aim of describing the most optimal level of attention in humans. Within this zone, we manage emotions adequately even when we are stressed, sad or angry. We are able to think and act with the support of our cognitive ability with considered decisions.
When we are outside our tolerance window, we have more difficulty or are even completely unable to think constructively, but act more on reflex. Negative experiences that we go through and that we lack the tools to deal with create psychological scars that reduce the window of tolerance.
Fundamental to the size of our tolerance window is the bond we had with our parents or attachment figures in childhood. It not only determines our way of facing the world, but also the base activation level of our nervous system, basically the limbic system that processes emotions.
As a therapist, you can notice when the patient is in or out of their tolerance. This is done by, among other things, analyzing breathing, movement patterns, tension level and in the patient's speech. Important in the treatment is to help the patient to his tolerance window and let the patient learn to find this himself. Under safe conditions then gradually help broaden the patient's ability to handle increasingly emotionally challenging tasks. The therapist must use his knowledge to convey safety to what the patient experiences in his body. Together they become a team that makes the patient grow.
Tensions as emotional packaging
Prolonged muscle tension is seen as unused energy from emotionally difficult experiences, leading to flight, defense or freeze reactions. When the energy is not used, it remains in the body as tension. Relaxation can bring feelings closer to consciousness, and it is important that the therapist is careful and chooses the right level of treatment. Trauma treatment requires good therapeutic intuition to avoid overwhelming the patient. The body's breathing pattern and presence indicate readiness, the goal is to work within the individual's tolerance.
Prolonged muscle tension is seen as unused energy. Emotionally difficult experiences give a signal to flee, defend oneself or, in the worst case, freeze reaction / dissociation. When the energy intended for this is not used, it stays in the body in the form of a state of tension. When the patient is helped to relax, feelings often come closer to consciousness, here it is important that the therapist proceeds carefully and chooses an appropriate dose in the treatment.
Especially in trauma treatment, the demands on the therapist's intonation ability are great. This eliminates the risk of exposing the individual to treatment they are not ready for. The body gives answers based on breathing patterns and ability to be present. The goal is always to work within the person's tolerance.
Choice of exercises
The exercises are chosen based on the person's mood and abilities at the time, but should have a goal. The therapist has the benefit of knowledge of the child's normal motor development to be able to identify immaturity in movement patterns, as in order to gain basic security and stability, these "holes in the foundation" sometimes need to be filled. Physical abilities missed as a child affect basic psychological skills even as an adult.
When it comes to choosing exercises within a therapeutic context, it is crucial to adapt them to the individual's current condition and capacity, while each exercise should have a specific goal. This requires the therapist not only to have a good understanding of the patient's current physical and mental health, but also a deep understanding of normal motor development, especially in children.
The understanding of the child's motor development is particularly important because certain motor skills or movement patterns that are not developed during childhood can lead to deficiencies in basic physical and psychological stability as an adult. If these "holes" in motor development are not addressed, they can result in persistent problems with movement control and body image, which in turn can affect psychological well-being.
In practice, this means that the therapist needs to be skilled in identifying any deficiencies or immaturities in the patient's movement patterns. This can be done through careful observation and assessment of how the patient performs various movements and activities. By identifying these deficits, the therapist can then select and adapt exercises that are not only aimed at improving the patient's current condition, but also fill in these critical gaps in their motor development.
The exercises should be designed to gradually build up the patient's motor skills while promoting a sense of security and stability. This can involve anything from basic coordination exercises to more complex tasks that require fine motor skills, balance and body awareness. It is important that the exercises are challenging enough to stimulate development, but not so difficult that they become frustrating or demoralizing for the patient.
In conclusion, when choosing exercises for therapeutic purposes, it is important to consider both the patient's current physical and psychological state as well as any gaps in their early motor development. By doing this, the therapist can create a treatment plan that not only addresses immediate problems, but also contributes to long-term improvement and stability in the patient's life.
Vitality
Daniel Stern has taken an interest in understanding vitality. A certain acceleration, eng:arousal, is necessary for us to be able to think, act, live. Thoughts and words are ultimately also preparation and completed body movements and body sensations. In the therapist-patient relationship, this can be used in a constant reading of the non-verbal expressions, which gives a deeper and more genuine understanding. This is an example of vitality.
Vitality, a concept deeply explored by Daniel Stern, is of great importance in therapeutic practice. Stern's work highlights how a certain level of arousal, or "arousal," is critical to our ability to think, act, and experience life. This concept of vitality extends beyond physical energy to encompass the dynamic interaction between body and mind.
Within the framework of vitality, thoughts and words are considered not only as mental processes but also as preparations for, or results of, bodily movements and sensations. This perspective emphasizes the inseparable connection between bodily and mental experience. Thoughts and feelings manifest not only in our mind but also in our bodies – in the form of muscle tension, breathing patterns, heart rate and other physiological responses.
For therapists, understanding vitality is critical when it comes to reading and interpreting patients' nonverbal cues. These cues, such as body language, facial expressions, tone of voice and breathing, provide a deeper and more authentic understanding of the patient's inner state. By paying attention to these non-verbal expressions, the therapist can gain a better understanding of the patient's emotional and psychological needs.
In therapeutic interaction, it is therefore important not only to listen to what the patient says, but also to be attentive to these subtle, bodily expressions of vitality. This may involve observing changes in body posture, movement patterns or breathing rhythm during the session. These observations can provide important clues to the patient's emotional state and can help the therapist tailor treatment in a more informed and sensitive way.
Integrating the understanding of vitality into therapeutic practice offers a more holistic view of patient care. It allows for a deeper connection and understanding between therapist and patient, which can be critical to the success of therapy. It therefore becomes important for therapists to continuously develop their ability to recognize and respond to these vital expressions in order to provide the most effective and emotionally resonant care.
Fascia
Fascia is a dynamic and essential part of the body, plays an active role in movement and force transmission, and is critical to physical functionality and well-being. This connective tissue, rich in nerve endings, is an important part of the body's sensory system and influences our perception of pain and other sensations, which is significant for the treatment of pain conditions and movement dysfunctions. The research surrounding fascia has led to the development of therapeutic methods such as myofascial release, which improve the function of the fascia and contribute to increased mobility, reduced pain, and a holistic view of health and well-being.
Fascia is a dynamic and essential part of the body, plays an active role in movement and force transmission and is critical to physical functionality and well-being. This connective tissue, rich in nerve endings, is an important part of the body's sensory system and influences our perception of pain and other sensations, which is significant for the treatment of pain conditions and movement dysfunctions. The research surrounding fascia has led to the development of therapeutic methods such as myofascial release, which improve the function of the fascia and contribute to increased mobility, reduced pain, and a holistic view of health and well-being.
Fascia, the extensive network of connective tissue found throughout the body, is a central topic in modern therapeutic research and practice. This connective tissue, which surrounds and supports muscles, bones, organs and the nervous system, is much more than just a passive structure. Fascia plays an active role in the body's movement and power transmission and is critical to our physical functionality and well-being.
As a professional therapist, it is important to understand the dynamic nature of fascia. Fascia is not static, but has the ability to contract and relax, which directly affects our mobility and flexibility. This ability allows the fascia to adapt and respond to the body's movements and changes in load, which is essential for efficient body movement and posture.
Fascia's wealth of nerve endings also makes it an important part of the body's sensory system. This nerve richness means that fascia is not only involved in structural support and movement, but also in how we perceive and respond to pain, pressure and other bodily sensations. This is of great importance in therapeutic contexts, especially when it comes to the treatment of pain conditions and dysfunctions in the locomotor system.
Research into fascia has greatly increased the understanding of its role in both physical health and various pain conditions. This research has led to the development of specific therapeutic methods that focus on working with the fascia. Examples of such methods are myofascial release and certain types of massage, which aim to improve the function of the fascia by dissolving tensions and blockages in this network.
By focusing on the fascia, therapists can help improve patients' overall mobility, reduce pain, and increase the body's efficiency in movement. Working with the fascia can also contribute to a deeper bodily awareness and thus promote a holistic view of health and well-being.
For therapists, it is becoming increasingly important to integrate knowledge of the fascia into their practice, and to be up-to-date on the latest research findings and treatment methods. This may involve developing specific techniques to work with the fascia, as well as understanding how this tissue interacts with other parts of the body in a complex and integrated system.
Body Regulation Therapy (BRT) represents a cutting edge in psychosomatic treatment, where the aim is to unite bodily awareness and regulation to achieve mental and physical balance. As a health care provider or professional in health-related fields, it is important to understand the core principles of BRT and its potential applications in therapeutic settings. BRT specifically targets individuals dealing with mental illness, including trauma and chronic pain conditions.