Tension and Trauma Releasing Exercises (TRE)

1. Introduction

Version followed: David Berceli's standard seven-exercise TRE sequence (TRE for All / TRE Global): five standing preparatory exercises, a wall sit, and a supine tremor position. The exercise detail comes from the account by certified provider Andreas Herold (2015) and the TRE protocol in the US Army-funded trial (Kent, 2018), where the trainers were taught by Berceli from approved manuals. Berceli's own books (Trauma Releasing Exercises, 2005; The Revolutionary Trauma Release Process, 2008; Shake It Off Naturally, 2015) are not drawn on. Where the two opened accounts differ, the difference is noted. [uncertain: the manual wording and any revisions after 2015 may differ]

TRE (Tension and Trauma Releasing Exercises, also written Tension, Stress and Trauma Releasing Exercises) is a structured self-help exercise method. David Berceli, a bioenergetics-trained trauma educator with a PhD in social work from Arizona State University, developed it in the early 2000s. He described it as growing out of his relief work in conflict regions, including Lebanon and Sudan, and from Alexander Lowen's bioenergetic analysis. [source: Wikipedia; TRE brochure] It is not a psychotherapy with phases. It is a short, fixed exercise routine that clients learn from a provider and then practise on their own. A psychotherapist can use it as an adjunct to therapy. One public health-insurer guide states plainly that it does not replace psychotherapy. [source: DAK]

Core idea of change, in the method's own terms: Berceli holds that repeated stress and trauma leave deep, chronic muscular contraction, especially in the iliopsoas, calves, quadriceps, adductors, diaphragm, neck and jaw. In his account, defensive fight, flight and freeze responses that could not be completed stay stored in procedural memory as this tension. [source: Herold 2015; TRE brochure] The exercises are meant to "painlessly increase the tension on the muscles" [source: TRE brochure] by gently tiring the legs and hips. This brings on an involuntary shaking that he calls neurogenic tremor. Berceli treats this tremor as an innate mechanism for discharging tension and restoring nervous-system regulation. The neurobiological claims (lower amygdala activity, serotonin and GABA changes, alpha waves) are Berceli's hypotheses, reported second-hand. They are not established physiology. [source: Herold 2015; Wikipedia] [uncertain]

2. Framework

TRE has no treatment phases in the psychotherapy sense. The structure is (a) one session format, the exercise routine, and (b) a learning course that moves from guided to independent practice. [source: Herold 2015; Kent 2018]

Within each session (both opened accounts agree):

Phase I, preparatory exercises (about 15–25 min) [uncertain: timing inferred from the 60-min sessions in Kent 2018]. Goal: stretch and mildly tire the feet, calves, thighs, adductors, hip flexors and front of the body, in a fixed order that works upward from the feet. Fatigue is pitched at about 7 on a 1–10 effort or strain scale, never pushed to pain. [source: Herold 2015; Kent 2018; Fiol 2025]
Wall sit (about 5 min, plus 3–4 min hanging forward). In Herold's version this is the first tremor exercise; Kent groups it with the preparatory work. [source: Herold 2015; Kent 2018]
Phase II, supine tremor phase (15–30 min, or as long as the client is comfortable). Goal: let tremor emerge in the legs, pelvis and lower back and run without effort. The client can stop it at any time by stretching the legs out flat. [source: Kent 2018; Herold 2015]
Rest and integration. Lie quietly. Then talk it through with the provider or group, or write brief notes when practising alone. [source: Herold 2015]

Course formats in the sources:

Kent 2018 (veterans with PTSD in VA care): 8 group sessions of 60 min, twice weekly for 4 weeks, about 10 people per group, two trainers, home-practice diaries. [source: Kent 2018]
Fiol 2025 (multiple sclerosis research sample): 24–25 sessions of 60 min, 3 per week (two in person, one online), each opening and closing with about 10 min of sharing. Led by certified TRE instructors with a body-mind therapist and a neurologist. [source: Fiol 2025]
TRE workshops: participants practise twice daily during the workshop, with one-to-one attention to individualise the exercises. [source: TRE brochure]
Individual teaching with a practitioner, or self-teaching at home. [source: Herold 2015]

Home-practice progression:

First home session without adverse reaction → practise every second day.
Later → every three days or twice weekly. Herold notes that practising much less often may let tension build up again.
Berceli is reported as saying daily practice does no harm. [source: Herold 2015, citing Berceli]

Criteria for moving on:

From screening to first session: medical clearance where needed, and no exclusion conditions (see 4.1). [source: Kent 2018; Glickman]
From guided to independent home practice: the client can do the sequence safely. They can also notice early overload signs (breath holding, bracing, rising nervousness) and stop or ground themselves on their own. [source: Herold 2015] Several guided sessions are advised before practising alone. [source: DAK]
Increasing tremor time: only after a session with no adverse after-effects. [source: Herold 2015] Starting with short tremor periods and adding time gradually is [synthesis].
In psychotherapy: stabilisation and window-of-tolerance skills should come before tremor work. Trauma memories that surface go into the main therapy, not into longer tremoring. [synthesis]

3. Guiding principles

[source: Herold 2015 unless marked]

Self-regulation comes first. Without enough self-regulation, the sensations, emotions and thoughts that arise during tremor cannot be held. In practice: teach stopping and grounding before teaching the tremor.
Stay inside the window of tolerance. Aim for neither hyperarousal (too strong) nor hypoarousal (numbing). In practice: track the client's arousal every few minutes and adjust.
Going too fast or too long can re-trigger freeze or dissociation. In practice: keep early sessions short; shorter is safer when in doubt.
The client is always in control of the tremor. It stops when the legs are stretched out flat or the feet slide down. [source: Kent 2018; Herold 2015] In practice: rehearse stopping before the first tremor.
Let the tremor happen; never force it. It should feel pleasant or freeing, not threatening. [source: DAK] In practice: no coaching to shake harder; no tremor is not a failure.
Fatigue, not pain. Preparatory exercises go to about 7/10 strain. Burning or mild aching is expected, and intensity may be eased. [source: Herold 2015] In practice: the client sets the intensity, and sharp pain means stop.
Individualise and omit. Positions are adapted or dropped when needed, for example head-down positions after concussion. Workshops give one-to-one attention. [source: Herold 2015; TRE brochure] In practice: no exercise is compulsory.
Screen the body and mind before starting. [source: Kent 2018; Glickman; DAK] In practice: take a medical and psychiatric history and get clearance where needed (4.1).
Integrate after tremoring. Rest, then talk it through or journal. In practice: always leave time after tremoring; never end a session straight from the tremor.
Aim for self-help. The long-term goal is independent home practice. [source: Herold 2015; TRE brochure] In practice: teach the sequence so the client can do it without you.
An adjunct, not a replacement. TRE does not replace psychotherapy [source: DAK], and it is not a treatment for physical disease. Studies in multiple sclerosis or restless legs are research, not indications. [source: Wikipedia; Fiol 2025] [synthesis] In practice: keep the main treatment plan in place.
Hold the theory as the method's own. "Stored trauma" and "discharge" are Berceli's explanatory model. [source: Wikipedia; Herold 2015] In practice: present tremor to clients as a natural body response that many find calming, not as a proven mechanism. [synthesis]
No touch. The sources describe TRE as self-administered, with no hands-on work. [source: Herold 2015; Kent 2018] In practice: if you ever give any physical help (for example steadying balance), follow the consent steps in 4.1. [synthesis]

4. Intervention inventory

The seven exercises below follow the order in Herold (2015). Kent (2018) describes the same building blocks in summary form: standing on the balls of the feet, knee bends, forward bends, hamstring stretches held for several breaths, a wall position, then the supine tremor. Kent's list also mentions a forward bend with one leg raised, which Herold does not describe. [uncertain: exact manual wording, repetition counts and timings may differ in Berceli's own books] Sections 4.1 and 4.9–4.12 cover the procedures around the sequence. Training: TRE is taught by certified providers (TRE for All / TRE Global certification). In Kent's trial, Berceli trained the trainers. Clinicians should complete TRE provider training and practise the sequence themselves before teaching it. [source: Kent 2018; TRE research page] They should also check that adding a movement method fits their licence, jurisdiction and insurance. [synthesis]

4.1 Screening, orientation and consent (before the first sequence)

Purpose / when: Before anyone does TRE. This rules out medical and psychiatric conditions where induced fatigue, head-down positions or uncontrolled arousal are unsafe, and makes sure the client knows they are in control.
Contraindications and cautions in the sources:
- Do not do TRE in pregnancy, with physical injuries (fractures, strains, sprains), or after recent surgery that has not fully healed or is still under medical care. [source: Glickman, certified TRE provider; DAK says pregnancy only after medical advice]
- Use caution with high or low blood pressure; heart conditions, including past heart surgery, pacemaker or arrhythmia; and blood-sugar problems, especially on medication. Go slowly with chronic fatigue or fibromyalgia. [source: Glickman] Cardiovascular problems that limit exercise capacity call for caution. [source: DAK]
- Neurological conditions with an unexplained tremor need medical review first. [source: DAK]
- Psychiatric conditions (bipolar disorder, dissociative disorders, severe depression, borderline personality disorder, psychosis, schizophrenia), especially if medicated: practise only with close self-regulation, preferably with a certified provider. [source: Glickman]
- Excluded in the Kent trial: suicidality needing more than outpatient care (screened with the C-SSRS), active alcohol or substance dependence, active psychosis, severe or acute illness, conditions that rule out exercise, and paralysis. Kent also requested medical clearance and used a fitness screen. [source: Kent 2018]
- Head-down positions are omitted after concussion. [source: Herold 2015]
- Added [synthesis]: epilepsy or seizure history (get neurologist advice; an involuntary-movement protocol can confuse seizure observation); severe dissociation or recent trauma without stabilisation; active self-harm; joint hypermobility, osteoporosis or a falls risk (standing balance work); glaucoma or retinal problems (head-down forward bend).
Steps:
1. Take a medical history covering the list above. Ask for physician clearance where any caution applies. [source: Kent 2018; Glickman]
2. Take a psychiatric and risk history using your usual standard risk assessment. [source: Kent 2018 used the C-SSRS] [synthesis: apply local suicide-risk protocol]
3. Explain the sequence, what tremor feels like, and that it is involuntary but can always be stopped. Present Berceli's theory as his model, not as fact. [synthesis]
4. Agree a stop signal and rehearse stopping: legs out flat, or feet sliding down (see 4.9). [source: Kent 2018; Herold 2015; rehearsal is synthesis]
5. Get informed consent, including the option to skip any exercise. [synthesis]
Touch: None of the sources describes touch in TRE. If you offer any physical help (steadying balance, placing a cushion under the knees), first explain what you would do and why. Ask permission. Offer a no-touch alternative (a wall, a chair back, a rolled blanket). Agree a stop signal, and check in during and after. This needs training and supervision. [synthesis]
Example language (illustrative): "These exercises tire your legs a little, and afterwards, lying down, many people feel a shaking start by itself. You're in charge the whole time: stretch your legs out flat and it settles. Let's practise that now, before we start."
Watch for: Hesitancy about losing control, a medical history the client has not disclosed, and current crisis. If any of these appear, postpone. [synthesis]

4.2 Exercise 1: Feet and ankles (rolling onto the foot edges)

Purpose / when: The opening exercise. It loads and stretches the feet and ankles, at the start of every sequence. [source: Herold 2015]
Steps:
1. Stand with feet about hip-width apart and both feet pointing forward [synthesis: stance width].
2. Roll both feet the same direction, so one foot rests on its outer edge and the other on its inner edge. Hold about 30 s.
3. Roll to the other side and hold about 30 s.
4. Alternate, about 5 times each side.
5. Come back onto both feet and shake the legs out loosely. [source: Herold 2015]
Example language (illustrative): "Let both feet roll to the right so you're on the edges of your feet. Breathe, and notice your ankles. Now roll to the left."
Watch for: Ankle pain or instability (stop, or do it seated with less weight) [synthesis]. Breath holding. Mild warmth or fatigue in the ankles is the intended effect.

4.3 Exercise 2: Calves (single-leg heel raises)

Purpose / when: Tire the calf muscles. Second in the sequence. [source: Herold 2015; Kent 2018: "standing on the balls of the feet"]
Steps:
1. Put your weight on one foot. The other foot stays lightly on the floor for balance; a hand on a wall is allowed.
2. Raise the heel of the standing foot as high as possible, then lower it.
3. Repeat until the strain reaches about 7 on a 1–10 scale. Burning, tension or mild aching in the calf is expected, and the client may ease off slightly.
4. Stand on both legs and shake out the worked leg.
5. Repeat on the other leg. [source: Herold 2015]
Example language (illustrative): "Keep lifting the heel at your own pace. When it feels like about a 7 out of 10, stop, stand on both feet and shake that leg out."
Watch for: Cramping (stop and stretch the calf); clients pushing past 7, which is a self-regulation teaching point. A light quiver in the calf afterwards is common and fine. [synthesis]

4.4 Exercise 3: Single-leg knee bends

Purpose / when: Tire the quadriceps and the standing leg. Third in the sequence. [source: Herold 2015; Kent 2018: "knee bends"]
Steps:
1. Stand on one leg and hold the other foot behind you with the same-side hand, as Herold describes. A hand on a wall for balance is [synthesis].
2. Bend the standing knee as low as comfortable, keeping the heel on the floor, then straighten.
3. Repeat until strain reaches about 7/10, then shake the leg out.
4. Change legs. [source: Herold 2015; shake-out and side change follow the pattern of exercise 2, inferred: uncertain]
Example language (illustrative): "Bend and straighten slowly, heel down. You set the depth. Stop at about a 7."
Watch for: Knee pain (make the bend shallower, or stop); losing balance (use the wall). If the client cannot balance, a supported two-leg version is [synthesis].

4.5 Exercise 4: Wide-leg forward bend with breaths

Purpose / when: Stretch the adductors and hamstrings. Fourth in the sequence. Leave it out after concussion and when head-down positions are unsafe. [source: Herold 2015; Kent 2018: forward bends and hamstring stretches held for several breaths]
Steps:
1. Stand with legs wide until you feel tension in the inner thighs.
2. Bend forward, letting the hands go towards the floor. Take 3 deep breaths.
3. Walk the hands over to one foot: 3 breaths. Walk them to the other foot: 3 breaths.
4. Come back to the middle, reach the hands back between the legs: 3 breaths.
5. Roll up slowly to standing. [source: Herold 2015]
Example language (illustrative): "Let your head and arms hang. Three slow breaths here... now walk your hands to your right foot."
Watch for: Dizziness on coming up. Rise slowly, head last, and pause standing before the next exercise. Back pain: bend the knees. [synthesis]

4.6 Exercise 5: Pelvic arch with turning and gaze

Purpose / when: Open the front of the body (hip flexors and front thighs) and rotate the spine. Fifth in the sequence. [source: Herold 2015]
Steps:
1. Make fists and place them on the lower back, just above the pelvis.
2. Push the pelvis gently forward to make a mild back arch, stretching the front of the thighs.
3. Turn gently from the hips, mouth slightly open, and look back towards one corner of the room.
4. Turn to the other side and look into the opposite corner.
5. Return to upright. [source: Herold 2015; number of turns not given: uncertain]
Example language (illustrative): "Fists on your lower back, let your hips ease forward, a gentle arch only. Turn slowly and look into the corner behind you. Let your jaw soften."
Watch for: Lower-back pain (make the arch smaller); neck strain (turn less); dizziness. [synthesis]

4.7 Exercise 6: Wall sit, then hanging forward

Purpose / when: Tire the quadriceps until a tremor starts in the legs. Sixth in the sequence. Herold calls it the first tremor exercise. Kent describes upper-leg fatigue in weight-bearing positions, followed by several minutes of quivering with slow, deep breaths. [source: Herold 2015; Kent 2018]
Steps:
1. Lean your back against a wall and slide down as if sitting on an invisible chair. DAK describes the knees at about 90° over the feet. [source: Herold 2015; DAK]
2. Breathe calmly. When burning or pain starts in the thighs, slide about 5 cm higher up the wall.
3. Keep going for about 5 min in total, moving up the wall as needed, until a tremor appears in the legs. The tremor may grow as the burning fades.
4. Push away from the wall, stand with knees soft, and let the upper body hang forward for about 3–4 min. Let any leg tremor continue.
5. Roll up slowly. [source: Herold 2015]
Example language (illustrative): "When the burning gets strong, slide up a little; you don't need to prove anything. If your legs start to shake, that's the response we're inviting. Let it be there."
Watch for: Knee pain (sit less deep, or stop); breath holding or jaw clenching, which Herold names as early overload signs. In Herold's account, a tremor taking over as the burning fades shows the exercise is working. Dizziness when rolling up after hanging forward. [source: Herold 2015; dizziness note is synthesis] Leave out the forward hang after concussion. [source: Herold 2015, by analogy with exercise 4: inferred]

4.8 Exercise 7: Supine tremor phase (butterfly and pelvic lift, then knee adjustments)

Purpose / when: The core of TRE: letting tremor emerge and continue in the legs, pelvis and lower back. Always after the preparatory exercises. [source: Herold 2015; Kent 2018]
Starting position: Lie on the back, preferably on a mat, with knees bent and open and the soles of the feet together (butterfly). [source: Herold 2015; Kent 2018]
Steps:
1. In butterfly, lift the pelvis a little off the floor and hold about 1 min.
2. Lower the pelvis and rest about 1 min, knees relaxed and falling apart.
3. Bring the knees about 5 cm closer together. Stay and notice whether tremor starts. If not, move them another few centimetres, finding the position where tremor begins. [source: Herold 2015]
4. Then put the soles of the feet flat on the floor, knees slightly apart, and let the tremor continue. It may spread into the pelvis and lower back, and sometimes into other muscle groups. [source: Herold 2015; Kent 2018]
5. Let the involuntary shaking run without adding effort, breathing slowly. Duration: 15–30 min, or as long as the client is comfortable (Kent's trial). [source: Kent 2018] For beginners and trauma clients, start much shorter, such as a few minutes, and lengthen gradually. [synthesis]
6. To finish, slide the feet down until the legs lie flat. The client may roll onto one side before getting up. [source: Herold 2015]
Example language (illustrative): "Let your knees come together just a little... and wait. If a shaking starts, you don't need to do anything. If it gets more than you want, stretch your legs out and it will settle."
Watch for: Signs it is working: a rhythmic tremor that feels neutral or pleasant, easier breathing, softening afterwards. Overload signs: breath holding, bracing, nervousness, unpleasant images or thoughts. Signs of shutting down: numbness, going blank, seeming far away. When these appear, stop and ground (4.9). [source: Herold 2015] Clients with arthritis or hip problems may need cushions under the knees. [synthesis]

4.9 Modulating, pausing and stopping the tremor (self-regulation skill)

Purpose / when: Teach this before the first tremor and use it whenever arousal moves towards the edge of the window of tolerance. In TRE this is the main safety tool. [source: Herold 2015; Kent 2018]
Steps:
1. Stop: stretch both legs out flat on the floor, or let the feet slide down. The tremor settles. [source: Kent 2018; Herold 2015]
2. Resume (if wanted): soles flat again, knees slightly apart. [source: Herold 2015]
3. Adjust intensity: change how far apart the knees are, a few centimetres at a time, to make the tremor stronger or softer. [source: Herold 2015 describes knee position as what brings on the tremor; using it to turn intensity down is synthesis]
4. Ground: feel the back and feet against the floor, open the eyes, look around the room, breathe slowly, rest. [source: Herold 2015 mentions grounding; the specific grounding steps are synthesis]
5. If unpleasant thoughts, images or sensations arise, stop. [source: Herold 2015]
Example language (illustrative): "Let's pause: slide your feet down. Feel the floor under your back. Look around and name three things you can see. We'll decide together whether to go on."
Watch for: The client can stop on their own without being prompted. That is the readiness marker for home practice. [source: Herold 2015] If the tremor does not settle after the legs are stretched out, see section 5.

4.10 Rest and integration

Purpose / when: After every tremor phase. Lets arousal settle and links the experience to the client's self-understanding. [source: Herold 2015]
Steps:
1. Legs out flat, resting quietly for a few minutes. The length is not given in the sources. [uncertain]
2. Roll to the side and sit up slowly.
3. Talk it through with the therapist or group, or, when alone, write brief notes. [source: Herold 2015]
4. In psychotherapy, take emotionally charged material into the regular therapy process rather than exploring it further through the body. [synthesis]
Example language (illustrative): "What did you notice during the shaking, and what do you notice now? Anything you want to bring into our next session?"
Watch for: Lingering activation or spaciness. Do not let the client drive or leave until they are oriented. [synthesis]

4.11 Home practice and practice diary

Purpose / when: Once the client has learned the sequence and stopping. Home practice is the long-term aim of TRE. [source: Herold 2015; TRE brochure]
Steps:
1. Agree the frequency: after a first trouble-free home session, every second day; later every three days or twice a week. [source: Herold 2015]
2. Agree a tremor-time limit and a safe, private space. [source: DAK suggests a quiet, undisturbed room; the time limit is synthesis]
3. Keep a diary: whether the client planned to practise, whether they did, and whether tremor occurred, as in Kent's trial. Add notes on after-effects. [source: Kent 2018; Herold 2015]
4. Review the diary at the next session. [synthesis]
Example language (illustrative): "This week, every other day, the full sequence with no more than ten minutes of tremor, then rest. Jot down how you felt that evening and the next morning." (The ten-minute figure is illustrative.)
Watch for: After-effects the next day (sleep, mood, soreness). If these appear, shorten or space out practice. Practising compulsively to "release" more is also a warning sign. [synthesis]

4.12 Group delivery format

Purpose / when: Teaching TRE in groups, as in workshops and both trials. [source: Kent 2018; Fiol 2025; TRE brochure]
Steps:
1. Groups of about 10, with two leaders where possible. [source: Kent 2018]
2. Open with about 10 min of sharing. Run the sequence. Close with about 10 min of sharing, within a 60-min session. [source: Fiol 2025]
3. Teach self-regulation of physical symptoms (tiredness, cramps) and emotional experiences (fear, irritability) as part of the session. [source: Fiol 2025]
4. Give individual attention so each person's exercises are adapted to them. [source: TRE brochure]
5. Mats spaced apart, permission to keep eyes open, and a leader free to step aside with anyone overwhelmed. [synthesis]
Watch for: People copying others' tremor intensity or comparing. Normalise any degree of tremor, including none. [synthesis]

Note on popular variants

A German health-insurer guide lists exercises that do not appear in Herold's or Kent's account of Berceli's sequence: heel shifting from foot to foot, pelvic circles, and lying knee rocking from side to side. [source: DAK] These may come from other neurogenic-tremor teachers. They are not presented here as TRE. [uncertain]

5. Handling problems

The sources say little about problems. Herold names overload, freeze or dissociation from going too fast, and the need to stop and ground. Kent gives the stop method, and Fiol mentions self-regulating cramps, tiredness, fear and irritability. Everything else below is [synthesis] unless tagged.

Overwhelm or hyperarousal during tremor (fast breathing, panic, intrusive images). Stop: legs out flat, eyes open, orient to the room, slow the exhale, rest. [source: Herold 2015; Kent 2018 for stopping; orienting steps are synthesis] At the next attempt, use a shorter tremor period, a wider knee position and more preparation with stabilisation skills. If intrusions recur, pause TRE and work on stabilisation in the main therapy first. [synthesis]
Shutdown, numbing or dissociation (hypoarousal, going blank, a frozen look, losing track of time). Herold warns that going too fast or too long can re-trigger freeze or dissociation. [source: Herold 2015] Stop the tremor. Ask the client to open their eyes, sit up, press the feet into the floor, name things in the room and move the hands. Resume only once they are clearly present. Be cautious about TRE with dissociative disorders, and do it only with close guidance. [source: Glickman; grounding steps are synthesis]
No tremor appears. Normalise this: tremor is not forced. [source: DAK] Check for bracing and breath holding. Try small knee-width adjustments of a few centimetres. [source: Herold 2015] Repeat the wall sit for longer, within comfort, before lying down. [synthesis] Do not instruct voluntary shaking as a substitute. That is not part of the opened TRE descriptions. [synthesis]
Tremor does not settle after the legs are stretched out. Roll to the side and sit up. Put the feet on the floor, place the hands on the thighs, breathe slowly and orient. Usually it fades within minutes. If it persists or comes with weakness, visual or speech problems, get medical review. DAK names these features as reasons for medical evaluation of tremor. [source: DAK; settling steps are synthesis]
Pain, cramps, burning beyond 7/10. Burning is expected, but the client may ease off. [source: Herold 2015] Sharp or joint pain means stop that exercise, shorten it or skip it. Cramp means stretch the muscle and rest. [synthesis] Injury or recent surgery rules TRE out. [source: Glickman]
Dizziness or light-headedness after the forward bend or hanging forward. Come up slowly, sit down, and drop the head-down positions if it recurs. [synthesis] Leave them out entirely after concussion. [source: Herold 2015]
Strong emotion (crying, anger, fear) during or after. Fiol includes fear and irritability among the experiences participants learn to self-regulate. [source: Fiol 2025] Allow it within tolerance, without encouraging catharsis. Stop if it escalates, and process it in the integration talk or the next therapy session. [synthesis]
Suicidal thoughts or acute distress emerging. Stop TRE. Carry out a standard risk assessment and safety planning under your service's protocol. Resume only once the client is stable. Kent excluded people whose suicidality needed more than outpatient care. [source: Kent 2018; response is synthesis]
Delayed after-effects (poor sleep, irritability, low mood or soreness the next day). Space sessions further apart and shorten the tremor time. Increase dose only after a trouble-free session. [source: Herold 2015 for progressing after no adverse reaction; the rest is synthesis]
Non-adherence to home practice. Review the diary without judgement. [source: Kent 2018 diary] Shrink the task, for example tremor only on two set days. Link it to an existing routine. Check whether the client avoids practice because it felt unpleasant, and if so, adjust the dose rather than urging compliance. Herold notes that infrequent practice may let tension return. [source: Herold 2015; rest synthesis]
Over-practice or compulsive "releasing". Long daily tremor sessions chasing catharsis, or using TRE to avoid feelings or therapy topics. Agree an upper limit and explore what the practice is doing for the client. [synthesis]
Fear of losing control, or reluctance to lie down. Rehearse stopping several times before any tremor. Let the client keep their eyes open, take a position near the door, or lie at an angle against cushions. Fully supine positions can feel exposed after assault. [synthesis]
Scepticism ("this is just fatigue"). Agree that tiring the muscles is how the tremor is brought on. Offer TRE as an experiment and judge it by the client's own experience. Do not argue for Berceli's theory. [synthesis]
Over-interpreting the tremor ("my trauma is coming out", spiritual meanings). Treat these as the client's meanings to explore. Do not confirm that particular memories are being released; that is a hypothesis, not fact. [source: Wikipedia, on the theory's unproven status; response is synthesis]
Group problems (comparing, contagion of distress, shame about shaking). Normalise variation. Give a quiet exit option, and let a co-leader attend to anyone who is distressed. [synthesis]
Ruptures (feeling pushed, unsafe or abandoned during the tremor). Name and own any pacing error. Return choice to the client about the next session's dose and format. Repair before resuming. [synthesis]
Medical tremor or neurological conditions. An unexplained or pre-existing tremor needs medical clarification before starting. [source: DAK] For multiple sclerosis or Parkinson's disease, TRE has been studied only in research settings. Do not offer it as a treatment for those conditions; work alongside the treating physician. [source: Fiol 2025; Wikipedia; response is synthesis]
Pregnancy discovered after starting. Stop. The provider health list rules out TRE in pregnancy. [source: Glickman; DAK advises medical consultation]

Sources

Sources:

Further reading (not drawn on) [uncertain]:

Berceli, D. (2005). Trauma Releasing Exercises (TRE): A Revolutionary New Method for Stress/Trauma Recovery. BookSurge.
Berceli, D. (2008). The Revolutionary Trauma Release Process: Transcend Your Toughest Times. Namaste Publishing.
Berceli, D. (2015). Shake It Off Naturally: Reduce Stress, Anxiety, and Tension with TRE. CreateSpace.
Berceli, D. (2009). Evaluating the effects of stress reduction exercises employing mild tremors: A pilot study (PhD dissertation). Arizona State University.
Berceli, D., Salmon, M., Bonifas, R., & Ndefo, N. (2014). Effects of self-induced unclassified therapeutic tremors on quality of life among non-professional caregivers: A pilot study. Global Advances in Health and Medicine, 3(5), 45–48.

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