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Mental Health Considerations

TRE can be a valuable complement to mental health treatment. However, certain conditions benefit from working with both a TRE provider and a mental health professional to ensure the practice is approached safely.

TRE Is Not Crisis Intervention

TRE is not appropriate for acute mental health crises. If you are in crisis, contact mental health services, a crisis line, or go to your nearest emergency department. TRE is a practice for building regulation over time, not for managing acute emergencies.

Post-Traumatic Stress Disorder (PTSD)​

Situation: You have been diagnosed with PTSD or have significant trauma history.

Approach:

  • TRE can be very helpful for PTSD symptoms when practised appropriately
  • Work with a trauma-informed certified TRE provider, especially when beginning
  • Start with very short tremoring sessions (5 minutes or less)
  • Build strong self-regulation skills before working with more intense material
  • Practise grounding techniques thoroughly
  • Consider combining TRE with trauma therapy (EMDR, Somatic Experiencing, etc.)
  • Never force yourself to "work through" traumatic memories during TRE
  • The goal is nervous system regulation, not re-traumatisation

Why this matters: PTSD involves a highly sensitised nervous system. TRE can help gradually desensitise, but requires pacing and professional guidance to avoid overwhelm.

Complex Trauma or Developmental Trauma​

Situation: You have a history of childhood abuse, neglect, or chronic traumatisation.

Approach:

  • Absolutely learn TRE with a certified provider who understands complex trauma
  • Expect to go much slower than others
  • Your nervous system may have limited experience of safety: build that gradually
  • Strong emphasis on self-regulation and pacing
  • May need 1–2 minute tremoring sessions initially
  • Work with a trauma therapist alongside TRE practice
  • Focus on building resources and capacity before processing
  • Consider titration: work with small amounts of activation at a time

Why this matters: Complex trauma often involves structural nervous system patterns developed early in life. These require patient, careful work with appropriate support.

Dissociative Disorders​

Situation: You have dissociative identity disorder (DID), depersonalisation, derealisation, or other dissociative conditions.

Approach:

  • TRE can trigger dissociation, so proceed carefully
  • Work with both a certified TRE provider and a dissociation-specialist therapist
  • Develop strong grounding skills before practising TRE
  • Keep eyes open during practice if closing them triggers dissociation
  • Very short sessions with frequent grounding breaks
  • Have a grounding plan for if dissociation occurs
  • Practise in presence of a trusted person or provider initially

See also: Dissociation

Why this matters: Dissociation is a nervous system strategy to escape overwhelming experience. TRE's intensity can trigger this strategy, so extra safety measures are needed.

Depression and Suicidal Ideation​

Situation: You are experiencing significant depression or having suicidal thoughts.

Approach:

  • If actively suicidal, seek immediate mental health support before considering TRE
  • If in treatment for depression, inform your therapist/psychiatrist you want to try TRE
  • TRE can be helpful for depression but may temporarily intensify emotions
  • Start gently with support available
  • Notice if TRE helps or makes things worse for you
  • Some people find TRE lifts their mood; others find it brings up difficult feelings
  • Work with a certified TRE provider who understands depression
  • Maintain your other mental health treatments alongside TRE

Why this matters: Depression often involves nervous system shut-down. TRE can help re-activate, but the process may bring up difficult material that needs appropriate support.

Psychosis or Severe Mental Illness​

Situation: You have schizophrenia, bipolar disorder, or other conditions involving psychosis.

Approach:

  • Do not practise TRE during acute psychotic episodes or manic states
  • When stable, TRE can be practised with appropriate support
  • Work with a certified TRE provider who can coordinate with your psychiatrist
  • Ensure your medication regimen is stable
  • Very gentle, brief sessions
  • Strong emphasis on grounding and present-moment awareness
  • Watch for any signs of destabilisation
  • Have your treatment team's support

Why this matters: Conditions involving psychosis require careful nervous system work. TRE's capacity to bring up non-ordinary experiences needs to be approached with clinical support.

Eating Disorders​

Situation: You have anorexia, bulimia, binge eating disorder, or other eating disorders.

Approach:

  • The body-focus of TRE can be challenging but also potentially healing
  • Work with an eating disorder specialist therapist who knows about TRE
  • Also work with a certified TRE provider
  • Pay attention to body image issues that may arise
  • Use TRE as part of developing healthy embodiment, not body control
  • If practice triggers restriction, bingeing, or purging, pause and discuss with your treatment team
  • May need to establish some recovery stability before beginning TRE

Why this matters: Eating disorders often involve complicated relationships with embodiment. TRE can help healing but needs careful guidance.

Borderline Personality Disorder​

Situation: You have BPD or traits of emotional dysregulation.

Approach:

  • TRE can be beneficial but requires strong self-regulation skills
  • Work with a certified TRE provider, especially initially
  • Build self-regulation capacity gradually
  • May need skills training (DBT or similar) before or alongside TRE
  • Watch for emotional flooding: use techniques to slow/stop as needed
  • Have support available during and after practice
  • Shorter sessions are better until you know your response patterns

Why this matters: BPD involves challenges with emotional regulation. TRE activates emotions, so solid regulation skills are important for safe practice.

Mental Health and TRE Providers

Certified TRE providers are not therapists (unless they also hold mental health credentials). If you have significant mental health concerns, work with both a TRE provider and a mental health professional. They can collaborate to support your healing journey. Many therapists are now becoming familiar with TRE and can work alongside your practice.

Finding Professional Support​

If you need mental health support beyond TRE, consider:

For trauma:

  • EMDR therapists
  • Somatic Experiencing practitioners
  • Sensorimotor Psychotherapy therapists
  • Trauma-focused CBT providers
  • IFS (Internal Family Systems) therapists

For general mental health:

  • Licensed counsellors or psychotherapists
  • Clinical psychologists
  • Psychiatrists (for medication evaluation)

For body-based issues:

  • Physiotherapists
  • Osteopaths
  • Craniosacral therapists
  • Massage therapists trained in trauma-informed approaches

Integration of TRE with other professional support often yields the best results. See also Finding Support for more guidance.