Tension & Trauma Releasing

Development in conflict and disaster settings

A 2023 University of Pretoria dissertation reports that David Berceli developed TRE after years of working in countries affected by war and other disasters. He noticed that many people took a protective curled position with the front flexor muscles contracted, and he theorized that releasing this tension might lessen the body's survival response and bring stress relief. The same source describes his observation that children often tremored after a traumatic event while adults did not, and that adults he interviewed said they suppressed the tremor to avoid showing weakness.

These are the originator's observations and theories as relayed by a later author. They were not tested in the form described, and the sources reviewed do not document the fieldwork itself.

Dates and early publications

The dissertation describes Berceli, identified as a clinical social worker from the United States, presenting a newly developed technique at a conference in Cape Town in 2010 and personally training South African professionals over the following two years. By 2014, it states, South Africa had the highest concentration of trained practitioners, and 68 South African health practitioners were registered as certified when the review was written.

A 2006 paper by Berceli and Maria Napoli, however, proposed a mindfulness-based trauma prevention program for social workers that included mindfulness breathing, body scanning and trauma-releasing exercises. A technique of that name therefore appears in print before 2010, and the sources reviewed give no single agreed date for its development.

Theoretical influences

According to the dissertation, Berceli explained the technique through his own theory of the body's instinctive response to trauma, through Robert Scaer's and Peter Levine's accounts of a tremor mechanism in animals after threat, and through Stephen Porges's polyvagal theory. These frameworks are offered as explanations by TRE authors. The sources reviewed do not show that they have been tested as an account of what happens during TRE.

Names and abbreviations

Published work uses several names for the same method. Trials in multiple sclerosis use Tension and Trauma Releasing Exercises, the 2023 dissertation and the 2026 scoping review title use Trauma Releasing Exercises, a Korean pilot study uses Tension, Stress, and Trauma Releasing Exercises, and a Chinese trial protocol uses Tension and Trauma Release Exercise. A 2014 paper co-written by Berceli calls the practice self-induced unclassified therapeutic tremors. The dissertation writes the name TRE with a registered-trademark symbol, which suggests the initials are a protected mark.

Neurogenic and therapeutic tremor

The dissertation says the TRE literature calls the shaking therapeutic or neurogenic tremor. It describes the tremor as an action tremor that is activated through posture and sustained muscle contraction, widely distributed in the body, and most similar to an enhanced physiological tremor, and it contrasts this with pathological tremors that are visible, continuous and disabling. Berceli's own 2014 paper labels the tremor unclassified, meaning it does not fit a standard tremor category. The term neurogenic tremor in this context is therefore a proponents' label and not an established diagnosis.

Distinction from related approaches

TRE is a structured set of exercises that people learn and then practice themselves, and the dissertation classifies it as a relaxation technique with a somatic approach and some mindfulness elements. It draws on Levine's animal tremor theory, but the sources reviewed do not describe it as Somatic Experiencing, which is a separate therapeutic approach covered on its own page.

Bioenergetic analysis is described in a 2025 review as a form of body psychotherapy that uses grounding and postural work in trauma treatment. The sources reviewed do not document Berceli's training in bioenergetic analysis, and they do not compare the two approaches, so any lineage between them is not established here.

The exercise sequence at overview level

The dissertation describes seven stretching exercises, the first six done standing and the last lying on the floor. They aim to fatigue the large muscles of the legs and pelvis, especially the hip flexors including the psoas. The standing exercises involve tilting the feet, raising the heels, bending a knee while folded forward, a wide-legged forward bend, a pelvis-forward stretch, and a supported wall sit. In the final position the person lies with soles together and knees open, lifts the pelvis briefly, then brings the knees slightly together to invite a tremor.

The count of movements is not described identically everywhere. A 2024 trial protocol refers to a six-movement sequence followed by a tremor and release component, while MS trials describe seven exercises. Readers should treat this page as an outline and not as instructions.

The tremor phase and session format

Per the dissertation, newcomers allow the tremor for a limited time of about 15 minutes, breathe deeply and attend to body sensations. Participants are advised to stop at any point if they feel overwhelmed. The training manual, as cited, suggests three to four sessions a week in the first month and about two a week afterward. Across the 18 included studies, sessions ranged from 30 to 90 minutes, with the tremor portion typically 10 to 15 minutes.

In a Danish MS trial, participants had weekly individual sessions with an instructor and, from the second session, daily home practice of 30 to 45 minutes, with up to 15 minutes in the tremor state. A South African caregiver study used 20 hours of instruction and 30 hours of practice over 10 weeks.

Delivery and training

In 13 of the 18 studies in the dissertation, a certified TRE provider delivered the program, and in four of the remaining studies Berceli was on the research or treatment team. Psychoeducation was mentioned in half of the studies. The manual is said to allow modifications for older adults or people with disabilities who find floor work difficult. The sources reviewed identify certification by the technique's own training pathway, name no independent register or licensing body, and describe no statutory regulation.

Uses that have been studied or proposed

The dissertation describes TRE as a technique some practitioners use for stress, anxiety and related problems. Studies identified there were mostly in groups exposed to stress or trauma, with smaller numbers in people with Parkinson's disease, multiple sclerosis, epilepsy and restless legs syndrome. More recent work has looked at fatigue in multiple sclerosis, trauma symptoms in resettled refugees, and a planned trial in adolescents with emotional disorders.

Proposed mechanisms and what is untested

Proponents propose that fatiguing the hip flexors elicits a tremor that discharges built-up muscular tension and shifts the autonomic nervous system toward a calmer state. The 2024 trial protocol states plainly that the exact mechanism of action has not been established. Popular statements that the psoas stores trauma or that tremor releases it are not tested findings in any source reviewed, so this page reports them only as proponents' theory.

Scoping review

A 2023 University of Pretoria dissertation used the JBI scoping method and included 18 studies, peer reviewed and not, in English. It described six randomized trials, of which only one was peer reviewed, with the rest being dissertations or a US Army project. All quantitative studies used convenience sampling and no quality appraisal was done. The author reported possible improvements in mood, anxiety-related sleep difficulty, pain and cognitive function, and possible benefit in Parkinson's disease, multiple sclerosis and epilepsy, and called the results preliminary and tentative.

A 2026 journal version of the review, which the abstract says covers 22 studies, reports potential benefits for mood, anxiety-related sleep difficulties and cognition, with preliminary evidence in Parkinson's disease and multiple sclerosis. Only the abstract was reviewed for this page. The searches run found no meta-analysis of TRE.

Multiple sclerosis

In a nine-participant, nine-week pilot without a control group, mean Modified Fatigue Impact Scale scores fell from 43.7 to 22.0, and most self-reported symptoms improved, while a device measure of ankle spasticity did not change significantly. The authors listed small size, no control group, selection and attrition bias and an unvalidated daily measure as limits.

A later randomized trial of 28 Danish MS Society members compared eight sessions plus daily home practice with usual care. Unadjusted analyses found no significant difference in the primary fatigue outcome. After adjustment for imbalance between groups, fatigue differed (P = .03 for total score; .06 for physical subscale), and self-reported spasticity and pain were lower. The authors said further research is needed, and the control group had no active comparison.

Stress, anxiety, caregivers and refugees

A 10-week study of 21 caregivers at a children's village in South Africa, without a control group, reported 91.3 percent retention and higher scores in all five quality-of-life domains (mean 3.81 to 4.35, P less than .05). Berceli co-authored it and discloses royalties from related books. A pilot of 25 graduate students measured anxiety before and after a three-hour training and reported lower scores. The abstract describes no comparison group.

A 2024 study of resettled East African refugees in the United States used a delayed-treatment control and the Harvard Trauma Questionnaire before and after eight weeks of practice. Its abstract reports lower scores on 36 of 40 items and a significant reduction in the intervention group but not the control group. Sample sizes and risk-of-bias details were not available to this review.

Gaps and planned trials

A registered Chinese trial protocol plans to randomize 140 adolescent-and-mother pairs to TRE plus standard medication or medication alone, with follow-up at three months. It reports no results and notes no earlier study of TRE in adolescent emotional disorders. Overall, the sources describe small samples, several studies involving the originator, and no systematic review of effect sizes.

What the studies report

The MS pilot reported no explicitly stated adverse events, though two participants withdrew for health reasons that were not tied to the intervention. The caregiver study reported no negative outcomes. These statements come from small uncontrolled studies, one co-written by the originator, and silence about harms is not evidence that none occur. The dissertation did not appraise study quality, and it describes one study in which a tremor period of 45 minutes was monitored individually for adverse reactions.

Emotional, physical and trauma-informed considerations

The dissertation says self-regulation skills are taught so people can tolerate sensations and emotions without becoming overwhelmed, and that anyone may stop at any time. It limits early tremor time because of fatigue and notes that one exercise can be modified for knee or back pain. The National Center for Complementary and Integrative Health reports that relaxation techniques have occasionally produced increased anxiety, intrusive thoughts or fear of losing control, and rarely caused or worsened symptoms in people with epilepsy, certain psychiatric conditions, or a history of abuse or trauma. TRE is not named on that page, so applying it here is an inference.

Study exclusion criteria show whom researchers chose not to enroll, and they are not a contraindication list. The MS pilot excluded people with severe cognitive deficits, severe depression or heart disease, and the adolescent protocol excludes nervous system disease, schizophrenia-spectrum disorders and active self-harm behavior.

Care boundaries and training

TRE is described as a technique taught by trained providers and then practiced independently, and in the studies reviewed it was an add-on or self-care practice. It does not replace assessment or treatment for trauma-related conditions, neurological disease or severe distress. People with these conditions, with heart problems or with a history of trauma may wish to discuss any new body-based practice with their health care provider first. No independent professional register or statutory regulation for TRE providers was found in the sources reviewed.