Neuroscience-informed CBT

1. Introduction

Version followed: the three-phase "Waves of the ABCs" model taught from the developers' semi-structured, multiphasic treatment manual (Beeson, Field, Jones & Miller, 2017, v1.0). The manual is unpublished, so this guide rebuilds it from the published curriculum (Miller et al., 2019), the pilot study and its client handout description (Field, Beeson & Jones, 2016), the 2025 "nonhierarchical, oscillatory" update (Field et al., 2025), and the 3-session Spanish brief group protocol (NCT07822074, 2025). Where the 2025 update changes the original, both versions are named. The founding paper (Field, Beeson & Jones, 2015, "The New ABCs") is not drawn on directly [uncertain]. Its content is known here only through the developers' later papers.

Neuroscience-informed cognitive-behavior therapy (nCBT) is a semi-structured CBT developed in counselling academia in the USA, mid-2010s, by Thomas Field, Eric Beeson and Laura Jones, with Raissa Miller. It modifies Ellis's ABC model by splitting every reaction into two "waves" [source: Field, Beeson & Jones 2016; Miller et al. 2019; n-CBT About page]:

Wave 1 (A1–B1–C1), fast and bottom-up. An internal (interoceptive/somatic) or external activating event (A1) is appraised preconsciously by limbic structures (B1). This produces primary physiological, emotional and behavioural consequences through the nervous system and stress chemistry (C1), usually before the person is aware of them.
Wave 2 (A2–B2–C2), slower and top-down. Awareness of the Wave 1 activation (A2) is appraised consciously by prefrontal processes (B2). This produces secondary consequences such as shame, self-criticism or withdrawal (C2). The waves can cycle repeatedly within one event.

How change happens. Conventional CBT starts at B2 by restructuring thoughts. nCBT holds that clients first need to notice, tolerate and regulate their Wave 1 physiology, then link it to conscious appraisal. The developers' phrase is "building the brain from the bottom-up, and then connecting the bottom to the top" [source: Miller et al. 2019]. The 2025 update reframes the goal: no wave has primacy, and health is flexible oscillation between bottom-up and top-down processing. Being stuck in either mode, or relying on one response set (approach, avoid, freeze, fawn), is the clinical target [source: Field et al. 2025]. nCBT is still at NIH Stage I (intervention development) [source: Miller et al. 2019].

2. Framework

[source: Miller et al. 2019 (training curriculum); NCT07822074 protocol; Field et al. 2025; Field, Beeson & Jones 2016]

The manual has three sequential phases. The published curriculum lists the interventions in each phase. Session-by-session content for individual therapy has not been published [uncertain].

Phase 1: Attending to physiological reactions

Goals: build the therapeutic relationship; assess; produce a Waves-based conceptualisation; plan treatment. The client should start to see their problem as a Wave 1 alarm response followed by Wave 2 reactions to it.
Core content: Waves of the ABCs psychoeducation with the brain-pathway handout, a physiological self-monitoring log, and a credibility check of the rationale [source: Field, Beeson & Jones 2016].
In the pilot, most counsellors introduced nCBT early, as initial psychoeducation. A minority preferred to establish rapport and complete assessment first. Both sequences are acceptable [source: Field, Beeson & Jones 2016].

Phase 2: Build the brain from the bottom up (Wave 1 work)

Goals: help the client prevent and regulate Wave 1 activation rather than react to it, and increase interoceptive awareness and capacity [source: NCT07822074].
Named interventions: affective modelling, sensory-based coping, mindful awareness, anchoring, systematic desensitisation, bio/neurofeedback [source: Miller et al. 2019]. The 2025 update adds lifestyle work on sleep, nutrition and exercise, plus breathwork, body scanning and pulse-taking [source: Field et al. 2025].

Phase 3: Connect the bottom to the top (Wave 2 work)

Goals: tolerate activation, reappraise Wave 1 responses, and link physiology to emotion, behaviour and meaning [source: NCT07822074].
Named interventions: connecting behaviours and emotions to physiological states; self-acceptance and compassion; sensory-based exploration; imagery; reappraisal; exploring implicit schema [source: Miller et al. 2019]. Controlled exposure with interoceptive self-monitoring, and later out-of-session exposures [source: Field et al. 2025].

Session count and format

Individual counselling: no fixed number of sessions is published [uncertain]. The 2025 paper describes spending more sessions on Wave 1 capacity-building before shifting to appraisal and then out-of-session exposures [source: Field et al. 2025].
Brief group version: 3 sessions of 90 minutes, one per phase, with neuroeducational group handouts. This version was culturally adapted for Spanish-speaking adults with anxiety [source: NCT07822074].
[synthesis] A workable individual default is 1–3 sessions for Phase 1, about 3–6 for Phase 2, and the remainder for Phase 3 within a typical 12–20-session CBT course. Adjust by severity.

Within-session rhythm (2025 update)

Phases are not strictly linear. A session can move from Wave 1 work (sitting with activation), to Wave 2 meaning-making, then back to Wave 1 with the client's secondary responses, and so on [source: Field et al. 2025].

Criteria for moving between phases

The sources state no formal criteria [uncertain]. The 2016 principle is to raise awareness of physiology before restructuring thoughts, with enough repetition that skills are usable during Wave 1 [source: Field, Beeson & Jones 2016].
[synthesis] Move to Phase 2 when the client can describe their own Wave 1 to Wave 2 sequence for a recent episode and accepts the rationale.
[synthesis] Move to Phase 3 when the client can notice bodily activation early (e.g. names a body cue before escalating) and can bring arousal down in session with at least one Wave 1 skill.
[synthesis] End treatment when the client can oscillate on their own: notice, regulate, reappraise and return to the body, outside sessions as well as in them.

3. Guiding principles

[source: Field, Beeson & Jones 2016; Miller et al. 2019; Field et al. 2025, except where marked]

Body before belief. Help the client attend to the trigger and the somatic response before restructuring thoughts. In practice, do not open with thought records; open with what the body did.
Build bottom-up, then connect bottom to top. Capacity comes first, then integration. In practice, sequence regulation skills before reappraisal.
No wave has primacy (2025). Bottom-up and top-down processing matter equally; bottom-up is just faster and more frequent. In practice, cognitive work stays central, but it is no longer the only point of entry.
Oscillation is the goal (2025). Flexible movement between waves is health. Being stuck in one mode, or over-using approach, avoid, freeze or fawn, is the problem. In practice, track which mode the client gets stuck in and train the other.
Physiology is protective. Present Wave 1 reactions as the body trying to keep the client safe, not as malfunction. The developers' client wording is "my body is keeping me safe" [source: Field et al. 2025]. In practice, reframe symptoms before trying to reduce them.
Attune and accept rather than fight. The aim is to notice and tolerate activation, not to suppress or avoid it. In practice, invite the client to stay with sensations for a short time before using coping skills.
The counsellor is the regulator and container. The counsellor's own calm (stillness, a mild facial expression, slow and low-toned voice) serves as "the holding container for the client" [source: Field et al. 2025]. In practice, regulate yourself first, especially when the client escalates.
Regulate, relate, reason, reflect. This sequence is borrowed from Perry & Ablon (2019) and cited in the 2025 update. In practice, do not try to reason with a dysregulated client.
Learn through experience, not dispute. Use the client's in-session experience of regulating to challenge unhelpful beliefs, rather than relying mainly on Socratic dispute [source: Field et al. 2025]. In practice, ask "what did you just notice you could do?" more often than "where is the evidence?"
Repetition makes skills available in Wave 1. Coping skills only work in the fast wave if they have been over-practised [source: Field, Beeson & Jones 2016]. In practice, assign daily practice and rehearse in session.
Credibility and expectancy matter. Shared belief in the rationale may drive outcome as much as technique. Counsellor confidence and delivery affect how credible the model seems [source: Field, Beeson & Jones 2016]. In practice, present the model clearly and confidently, and check that the client finds it credible.
Accurate neuroscience, no neuromyths. Counsellors need enough training to avoid oversimplified or false brain claims [source: Miller et al. 2019]. In practice, present the brain-pathway model as a useful simplification, not literal anatomy.
Counsellor interoceptive awareness. Counsellors need their own interoceptive awareness to foster it in clients [source: Miller et al. 2019]. In practice, practise the body exercises yourself before teaching them.
Readiness. Clients need some insight and motivation to engage with brain education and mindfulness practice [source: Field, Beeson & Jones 2016]. In practice, simplify or postpone psychoeducation for clients who are acutely overwhelmed or cognitively limited [synthesis].
Semi-structured and flexible. The manual specifies phases and components, not a fixed script [source: Miller et al. 2019]. In practice, select interventions within each phase to fit the client.
Fidelity to essential components. The developers defined essential components and a fidelity scale that expert raters can score reliably (κ .64–.84) [source: Field et al. 2019, abstract]. The item content was not available [uncertain]. In practice, check yourself against the three phases and the Wave 1/Wave 2 work listed in Section 4.

4. Intervention inventory

Scope and sourcing: the developers' papers name each intervention below and place it in a phase. Except where marked, they publish no step-by-step procedures; those are in the unpublished manual. Every Steps list is therefore [synthesis]: standard CBT and counselling practice arranged to fit the nCBT rationale, unless a step carries a [source] tag. Every intervention named in the sources is included. Nothing has been added beyond them except the conceptualisation and practice structures that the phases require, and these are marked.

Phase 1: Attending to physiological reactions

4.1 Waves of the ABCs psychoeducation (brain-pathway handout)

Purpose: gives the client a credible neuroscience rationale so symptoms make sense as a fast protective response followed by a slower appraisal. Use early, in Phase 1. A minority of counsellors place it after rapport and assessment [source: Field, Beeson & Jones 2016].
Source content: the developers' handout (Appendix A of the 2016 paper) defines A1, B1, C1 and A2, B2, C2 in plain language beside a diagram of the two pathways: limbic area and brain stem to body for Wave 1, and up to prefrontal cortex for Wave 2. It names stress chemicals such as adrenaline, noradrenaline and cortisol [source: Field, Beeson & Jones 2016]. Do not reproduce the developers' handout; draw your own two-path diagram.
Steps [synthesis]:
1. Ask for a recent, specific episode.
2. Draw two arrows on paper: a short low arrow for Wave 1 and a longer one up to the "thinking brain" for Wave 2.
3. Fill in A1 (the trigger, internal or external), C1 (what the body and behaviour did, in the client's words), A2 (the moment they noticed), B2 (what they then told themselves) and C2 (the second wave of feeling or action, e.g. shame or withdrawal).
4. Explain that B1 is the fast, protective, mostly automatic appraisal.
5. Link the model to the plan: first we help the body (Phase 2), then we connect it to the thinking (Phase 3).
6. Give the client the diagram to keep.
Example language (illustrative): "Your body reacted before you had time to think. That's the first wave, and it's designed to protect you. Then you noticed your heart racing and told yourself something about it. That's the second wave, and that's where the shame came in."
Watch for: the client can retell their own episode using both waves; relief or curiosity rather than feeling blamed. Avoid overstated anatomy, e.g. "your amygdala is broken" [source: Miller et al. 2019 on neuromyths]. In the pilot, counsellors reported clients often visibly "getting it" at this point [source: Field, Beeson & Jones 2016].

4.2 Waves-based assessment and case conceptualisation

Purpose: maps the client's recurrent Wave 1 triggers and responses and Wave 2 appraisals so treatment can be planned. This is part of Phase 1, alongside relationship, assessment and treatment planning [source: Miller et al. 2019; NCT07822074].
Steps [synthesis]:
1. Do the usual intake and risk assessment.
2. Collect 3–5 recent episodes and map each on A1–B1–C1 / A2–B2–C2.
3. Note which response set dominates (approach, avoid, freeze, fawn) and whether the client gets stuck in Wave 1 (flooded) or Wave 2 (ruminating, over-controlling) [source for the concept: Field et al. 2025].
4. Record lifestyle factors that raise baseline reactivity (sleep, nutrition, exercise) [source for the domain: Field et al. 2025].
5. Agree goals in both waves, e.g. "notice my chest tightening earlier" and "stop calling myself weak when it happens".
6. The research team measured body awareness (MAIA; a briefer Spanish body-awareness questionnaire), anxiety and self-compassion. Track outcomes with instruments you are licensed to use [source: Miller et al. 2019; NCT07822074].
Example language (illustrative): "When this happens, where does it start: in your body, or with a thought? And what do you usually do next?"
Watch for: a conceptualisation that names both waves and a stuck point. A map that is only cognitive means you have skipped Wave 1.

4.3 Physiological self-monitoring log

Purpose: builds awareness of Wave 1 between sessions. In the pilot, clients completed a log tracking their physiological responses between sessions [source: Field, Beeson & Jones 2016].
Steps [synthesis]:
1. Make a simple log with columns for situation/trigger, first body sensations, intensity (0–10), what I did, and what I told myself afterwards.
2. Complete one entry together in session.
3. Ask for 1–2 entries a day, close to the event.
4. Review the log at the start of the next session and look for early body cues that come before escalation.
Example language (illustrative): "This week, just catch the body part first: where you felt it and how strong. The thoughts can come second."
Watch for: entries that become more specific over time (e.g. "jaw tight" rather than "stressed"), and a lag that shortens between trigger and noticing. If the client brings only thoughts, prompt them back to sensation.

4.4 Credibility and expectancy check

Purpose: checks how credible the client finds the rationale and how much improvement they expect, because shared belief in the model may drive outcome. The developers used the Credibility/Expectancy Questionnaire (Devilly & Borkovec, 2000), adapted for nCBT, after first introducing the model [source: Field, Beeson & Jones 2016; NCT07822074].
Steps [synthesis]:
1. After psychoeducation, ask how much sense the model makes and how helpful the client expects it to be. Use the published CEQ or an informal 0–10 rating.
2. If either is low, explore what doesn't fit and adjust your explanation using the client's own episodes.
Example language (illustrative): "On a 0–10 scale, how much does this way of looking at your reactions make sense to you?"
Watch for: low credibility (a cue to re-explain using the client's episodes) and overly high expectancy (a cue to set realistic pacing).

Phase 2: Building the brain from the bottom up (Wave 1)

4.5 Affective (affect) modelling by the counsellor

Purpose: co-regulates the client through the counsellor's own regulated presence. The 2025 paper describes the counsellor modelling calm with stillness, a mild facial expression and slow, low-toned soothing sounds, so that their regulation acts as a container [source: Miller et al. 2019 (named); Field et al. 2025 (described)].
Steps:
1. Notice your own arousal first.
2. Slow your breathing and speech; lower your voice; keep your posture still and open; soften your facial expression [source: Field et al. 2025].
3. Keep this up while the client is activated, rather than matching their pace.
4. Name the shift once the client settles [synthesis].
Example language (illustrative): spoken slowly and low: "Let's just slow down together for a moment... there's no rush."
Watch for: the client's breathing and speech slowing to match yours. If you are activated or rushing, deal with your own state first, e.g. in supervision.

4.6 Immediacy about the physiological state

Purpose: brings Wave 1 into awareness in the moment by naming the client's visible bodily state in session [source: Field et al. 2025].
Steps [synthesis]:
1. Ask permission to comment on what you see.
2. Describe what you see neutrally ("your hands just clenched", "you're speaking faster").
3. Ask what the client notices inside.
4. Link it to the Waves map.
Example language (illustrative): "Can I point something out? As you started talking about your manager, your shoulders came right up. What do you notice in your body right now?"
Watch for: the client starts to notice changes before you name them. Some clients feel watched or exposed, so ask permission and keep the tone curious, not interpretive.

4.7 Mindful awareness and body scanning

Purpose: builds interoceptive awareness, i.e. noticing internal body signals, so the client can detect Wave 1 early. The 2016 paper stresses repeated practice; body scanning appears in the developers' client materials [source: Field, Beeson & Jones 2016; Miller et al. 2019; Field et al. 2025].
Steps [synthesis]:
1. Start in session with 2–5 minutes.
2. Guide attention slowly from feet to head, noticing temperature, tension, movement and heartbeat without changing anything.
3. Ask the client to describe what they noticed, using sensation words.
4. Assign daily practice of a short scan and a longer one.
5. Gradually use the scan during mild activation, not only at rest.
Example language (illustrative): "Just notice your feet on the floor... now your legs... you don't need to change anything, just notice what's there."
Watch for: a richer sensation vocabulary and earlier detection of cues. Trauma survivors can find inward attention destabilising: keep eyes open, scan briefly, give the client control, and offer an external anchor (see 4.9) [synthesis].

4.8 Pulse-taking and interoceptive self-monitoring

Purpose: gives an objective anchor for noticing arousal. Clients count their pulse or use a pulse oximeter, especially during controlled exposure; pulse-taking appears in client materials [source: Field et al. 2025].
Steps:
1. Teach the client to find their wrist or neck pulse and count for 15 seconds (multiply by 4), or use a fingertip pulse oximeter [source for the method: Field et al. 2025; counting detail is synthesis].
2. Record a baseline at rest.
3. Record during and after activation (e.g. in exposure, 4.15).
4. Ask the client to estimate their pulse before checking, to train interoceptive accuracy [synthesis].
Example language (illustrative): "Before you check, guess: what do you think your heart rate is right now? Now let's see."
Watch for: guesses that get closer to measured values, and the client seeing arousal rise and fall on its own. With health anxiety or panic, monitoring can feed checking; time-limit it and fade it out [synthesis].

4.9 Anchoring

Purpose: named as a Phase 2 Wave 1 intervention [source: Miller et al. 2019]. Its exact definition in the manual was not found [uncertain]. In regulation and grounding work, anchoring usually means a stable focus of attention (breath, feet, a held object) the client returns to when activation rises. That reading is [synthesis].
Steps [synthesis]:
1. Help the client choose an anchor that feels safe (feet on floor, a textured object, breath at the belly).
2. Practise attending to it for one minute at rest.
3. During mild activation, practise noticing the activation and then returning to the anchor.
4. Pair the anchor with a short cue word.
Example language (illustrative): "Notice the activation... and now come back to your feet on the floor. That's your anchor."
Watch for: a faster return to baseline. If the client uses the anchor to avoid all activation, combine it with acceptance (4.16).

4.10 Breathwork

Purpose: down-regulates arousal after activation, as a calming step before re-engaging with interoceptive signals [source: Field et al. 2025]. No specific breathing protocol is given in the sources [uncertain].
Steps [synthesis]:
1. Teach slow breathing with a longer out-breath (e.g. in for about 4, out for about 6), at a pace that feels comfortable.
2. Practise for 2–3 minutes in session.
3. Assign brief practice several times a day so the skill is well rehearsed before it is needed.
4. Use it after exposure or immediacy work, then return to noticing sensations.
Example language (illustrative): "Let the out-breath be a little longer than the in-breath... nothing forced."
Watch for: dizziness or tingling from over-breathing; slow the pace. Panic-prone clients may treat breathing as a safety behaviour; frame it as regulation after tolerating, not as escape [synthesis].

4.11 Sensory-based coping

Purpose: gives fast, body-level ways to shift Wave 1 states that don't depend on reasoning. Listed as healthy Wave 1 coping in 2016 and as a Phase 2 intervention in 2019 [source: Field, Beeson & Jones 2016; Miller et al. 2019; Field et al. 2025].
Steps [synthesis]:
1. Explore which senses calm or alert this client: cold water, scents, textures, music, movement, pressure, taste.
2. Test 2–3 options in session and rate arousal before and after.
3. Build a portable kit and an if-then plan ("When my chest tightens at work, I will...").
Example language (illustrative): "Your body responds fast, so it helps to have tools that work just as fast. Let's find out what your senses respond to."
Watch for: measurable drops in arousal ratings. If it is used to avoid every feeling, pair it with tolerance work (4.16).

4.12 Systematic desensitisation

Purpose: retrains Wave 1 responses to feared cues by pairing graded exposure with relaxation. It supports state-dependent learning and attunement to physiological states [source: Field, Beeson & Jones 2016; Miller et al. 2019 (Phase 2)].
Steps (classic Wolpe procedure, [synthesis] as applied here):
1. Get informed consent and screen for contraindications (see safety note under 4.15).
2. Teach a relaxation response, e.g. 4.10 or progressive relaxation.
3. Build a hierarchy of 10–15 situations rated 0–100 for distress.
4. With the client relaxed, have them imagine the lowest item.
5. When distress rises, stop, relax, and repeat until the item stays low.
6. Move up the hierarchy across sessions.
7. Add body-awareness check-ins during each item.
Example language (illustrative): "Picture the first step, sitting in the car outside the office. Lift a finger if you notice any tension, and we'll pause and let your body settle."
Watch for: distress ratings falling within and across sessions for each item. Plateaus suggest the item is too large, so add intermediate steps.

4.13 Biofeedback and neurofeedback

Purpose: makes Wave 1 physiology visible so the client can learn to regulate it. Named as Phase 2 Wave 1 capacity-building [source: Field, Beeson & Jones 2016; Miller et al. 2019; Field et al. 2025]. Beeson's background is in neurofeedback [source: n-CBT About page]. No specific device protocol is given [uncertain].
Steps [synthesis]:
1. Use only the modalities you are trained and credentialled in (e.g. heart-rate variability or skin-conductance biofeedback; neurofeedback needs specific training).
2. Take a baseline.
3. Teach a target skill (slow breathing, relaxation) while the client watches the signal.
4. Practise until the client can shift the signal reliably.
5. Fade the screen so the skill generalises.
Example language (illustrative): "Watch the line on the screen as you slow your breathing... see how your body answers you?"
Watch for: a reliable self-produced shift, and transfer without the device. Without device training, substitute 4.8 [synthesis].

4.14 Lifestyle work: sleep, nutrition, exercise

Purpose: preventive Wave 1 work that lowers baseline reactivity so alarms fire less often. Added in the 2025 update [source: Field et al. 2025].
Steps [synthesis]:
1. Assess sleep timing and quality, eating regularity and physical activity, linked to the client's log.
2. Choose one small behavioural change at a time, e.g. a consistent wake time, regular meals, short walks.
3. Track its effect on next-day reactivity in the log.
4. Refer to a medical or dietetic professional when indicated.
5. Do not set calorie, weight or exercise-volume targets (house rule).
Example language (illustrative): "When you're short on sleep, your alarm system is more sensitive. Let's see if steadier sleep changes how often it goes off."
Watch for: fewer or less intense Wave 1 episodes in the log. Watch for perfectionism, or eating-disorder risk around food and exercise; screen for both.

Phase 3: Connecting the bottom to the top (Wave 2)

4.15 Controlled exposure with interoceptive monitoring

Purpose: elicits Wave 1 activation in a controlled way so the client learns to notice, tolerate and then appraise it [source: Field et al. 2025].
Source procedure: prepare the client, then elicit activation through imaginal exposure or virtual reality. The client self-monitors by counting their pulse or using a pulse oximeter. The counsellor observes and reflects the client's physiological responses to build interoceptive awareness. Then calm with breathwork and sensory coping, revisit the interoceptive signals and appraise them [source: Field et al. 2025].
Safety and consent [synthesis, standard exposure practice]:
- Get explicit informed consent: explain the purpose, the expected temporary discomfort, and the client's right to stop.
- Screen first. Defer or adapt exposure for:
  - active suicidality or recent self-harm;
  - psychosis or mania;
  - current substance intoxication or dependence;
  - severe dissociation;
  - unstable medical conditions for which arousal is risky (e.g. cardiac or respiratory conditions, pregnancy complications), pending medical clearance;
  - ongoing danger, such as current domestic violence;
  - absence of any regulation skill.
- Agree a stop signal.
- Do not begin exposure until the client has at least one Phase 2 regulation skill.
Steps [synthesis built on the source sequence]:
1. Agree the target and a 0–10 distress scale.
2. Take a baseline pulse (4.8).
3. Introduce the imaginal scene, or a VR scene if available, at a moderate level.
4. Every 1–2 minutes, ask for the pulse, the location of sensations and a rating, and reflect what you observe.
5. Encourage the client to stay with the activation (4.16) rather than escape it.
6. Use breathwork or sensory coping to settle (4.10, 4.11).
7. Re-check signals and invite appraisal: "what did your body just show you?"
8. Grade upward across sessions.
Example language (illustrative): "Your pulse went up to about 100 and now it's coming down on its own, while you stayed with it. What does that tell you?"
Watch for: activation peaking and declining, and the client staying present. Signs of dissociation (glazed eyes, losing track of your voice, numbness) mean stop the exposure and ground the client with eyes open, an external anchor and orientation to the room [synthesis].

4.16 Attunement, acceptance and tolerating activation

Purpose: helps the client notice and tolerate activation rather than avoid it, and reframe physiological responses as protective [source: Field et al. 2025; NCT07822074 (Session 3: strategies for tolerating activation)].
Steps [synthesis]:
1. When activation arises, ask the client to locate it in the body and describe it (size, temperature, movement).
2. Invite them to let it be there for a set short time, e.g. 30–90 seconds, while you co-regulate (4.5).
3. Offer the protective reframe.
4. Track the activation as it changes.
5. Extend the tolerance window gradually over sessions.
Example language: the developers' client wording "my body is keeping me safe" [source: Field et al. 2025]. Illustrative: "See if you can let that tightness be there for a few breaths. It's your body trying to protect you."
Watch for: the client's statements shifting from "I can't stand this" to "it's uncomfortable but it passes". Reduced avoidance in the log.

4.17 Connecting behaviours and emotions to physiological states

Purpose: links C1 bodily states to emotions and behaviours, so the client sees how their actions follow from their alarm states [source: Miller et al. 2019 (named)].
Steps [synthesis]:
1. Using log entries, trace body state, then emotion label, then action urge, then action.
2. Ask what the body "wanted" to do (fight, flee, freeze, appease) and what the action achieved.
3. Identify an alternative action that could follow the same body state once it has been regulated.
Example language (illustrative): "So the heat in your face came first, then anger, then you left the meeting. Your body was getting you out. What else could you do with that heat next time?"
Watch for: the client spontaneously linking a behaviour to a body state, and less self-blame for reactions.

4.18 Fostering self-acceptance and compassion

Purpose: targets harsh C2 secondary reactions such as shame and self-criticism about having Wave 1 reactions [source: Miller et al. 2019 (named); NCT07822074 (self-compassion measured as an outcome)].
Steps [synthesis]:
1. Identify the Wave 2 self-judgement (e.g. "I'm pathetic for panicking").
2. Reframe Wave 1 as protective and not chosen.
3. Invite a kinder self-statement, e.g. "what would you say to a friend whose body did this?"
4. Pair it with a soothing gesture (hand on chest) if the client is willing.
5. Practise the statement after logged episodes.
Example language (illustrative): "Your body did what it was built to do. Can you speak to yourself the way you would to someone you care about who just went through that?"
Watch for: fewer shame-driven secondary consequences. Some clients feel threatened by self-kindness; go slowly and start with "neutral" rather than "kind" [synthesis].

4.19 Sensory-based exploration

Purpose: uses sensory experience in session to explore meaning, e.g. how a sensation links to memories or appraisals. Named as a Phase 3 intervention; no procedure is given in the sources [source: Miller et al. 2019] [uncertain].
Steps [synthesis]:
1. Choose a sensation that is present now.
2. Ask the client to describe it in detail.
3. Ask what it reminds them of, when they first felt something like it, and what it seems to say.
4. Hold the sensation and the meaning side by side without forcing interpretation.
5. Connect any meaning that emerges to the Wave 2 appraisal.
Example language (illustrative): "Stay with that heaviness for a moment. If it could speak, what would it be saying?"
Watch for: new links between sensation and meaning. If memories become overwhelming, return to regulation first.

4.20 Imagery

Purpose: named as a Phase 3 intervention for connecting bottom-up and top-down processing [source: Miller et al. 2019]. Imaginal scenes are also the exposure vehicle in 4.15 [source: Field et al. 2025]. Specific imagery protocols in the manual were not found [uncertain].
Steps [synthesis]:
1. For rehearsal, have the client imagine a trigger scene, notice the Wave 1 response, apply a regulation skill in the image, then imagine responding with the new appraisal and action.
2. For soothing, build a safe or calm-place image with multisensory detail, to be used after activation.
3. Debrief body sensations after each image.
Example language (illustrative): "Picture walking into the meeting... notice what your body does... now see yourself taking that slow breath and saying what you planned."
Watch for: the client being able to stay in the image and feel the body shift. Intrusive trauma images call for trauma-specific pacing.

4.21 Reappraisal (experience-based restructuring of Wave 2)

Purpose: changes B2 appraisals of Wave 1 activation, and of the trigger. Session 3 of the group protocol is "reappraising Wave 1 responses" [source: NCT07822074]. Conventional CBT restructuring is used in Wave 2 [source: Field, Beeson & Jones 2016]. The 2025 update prefers using the client's in-session experience of regulating to challenge beliefs rather than Socratic dispute [source: Field et al. 2025].
Steps [synthesis]:
1. Straight after a regulation or exposure experience, ask what the client predicted would happen and what actually happened.
2. Identify the Wave 2 belief, e.g. "if my heart races I'll lose control".
3. Use the fresh evidence from their body to test it.
4. Write a revised appraisal in the client's own words.
5. Where needed, add standard restructuring (thought record, evidence review, alternative explanations), keeping it anchored to body data.
Example language (illustrative): "You said you'd fall apart if your heart raced. It just raced and you stayed here talking with me. What do you make of that?"
Watch for: belief ratings changing after experiences, not only after argument. Arguing with a dysregulated client goes nowhere: regulate first (Perry & Ablon sequence, cited in Field et al. 2025).

4.22 Exploring implicit schema

Purpose: surfaces implicit, often preverbal or early-learned patterns that drive fast B1 appraisals. Named as Phase 3 work; procedure not given [source: Miller et al. 2019] [uncertain].
Steps [synthesis]:
1. Look for themes across logged episodes (e.g. always activated by perceived criticism).
2. Use a body-first downward arrow: "when this sensation is strongest, what does it feel like it means about you or others?"
3. Trace the earliest memories of the same body state.
4. Name the schema in the client's words.
5. Plan corrective experiences that target the B1 trigger (exposure, relational experiences) alongside reappraisal.
Example language (illustrative): "This tight-stomach feeling seems to show up whenever someone's disappointed in you. When do you remember feeling it first?"
Watch for: recognition of the pattern without flooding. Childhood trauma material may call for trauma-focused work or referral.

4.23 Out-of-session exposures and practice

Purpose: generalises learning. After in-session capacity-building and appraisal, the counsellor assigns outside-of-session exposures [source: Field et al. 2025]. Clients also complete worksheets between sessions [source: Field, Beeson & Jones 2016].
Steps [synthesis]:
1. Agree a specific, graded real-life task.
2. Plan which Wave 1 skill the client will use and what they will notice (pulse, body cues).
3. Have them record predictions, body data and the outcome.
4. Review it next session using 4.21.
Example language (illustrative): "This week, ride two stops on the bus. Check your pulse at the start and at the end, and notice what your body does in between."
Watch for: completion rate, and avoidance disguised as "forgetting" (see Section 5).

4.24 Wave-oscillation cycle (session-level structure)

Purpose: in the 2025 version, trains flexible movement between bottom-up and top-down processing within a session [source: Field et al. 2025].
Steps:
1. Wave 1: sit with the current activation (immediacy, tolerance) [source: Field et al. 2025].
2. Wave 2: make meaning, i.e. what this emotion is and what the client tells themselves about it [source: Field et al. 2025].
3. Return to Wave 1 with the client's secondary responses, e.g. "and what happens in your body as you say that?" [source: Field et al. 2025].
4. Repeat the cycle until the client can shift modes [synthesis].
5. Close with regulation [synthesis].
Example language (illustrative): "You just called yourself weak... what's happening in your body as you hear yourself say that?"
Watch for: smoother, self-initiated shifts. The clinical signal is getting stuck in pure analysis or in pure flooding [source: Field et al. 2025].

5. Handling problems

The sources say little about clinical difficulties. Items tagged [source] come from the developers' papers; everything else is [synthesis].

The client finds the brain model unconvincing or "too sciencey" [source: Field, Beeson & Jones 2016, where credibility and expectancy, and counsellor delivery, shaped uptake]:

Check credibility (4.4).
Rebuild the model from the client's own episode rather than from anatomy.
Drop the technical terms and keep "fast body wave / slower thinking wave".
If it still doesn't land, continue with the interventions themselves; the model is a vehicle, not a requirement [synthesis].

The client wants to "just talk" and to start with relationship and assessment:

Some counsellors in the pilot preferred building rapport and doing assessment before introducing nCBT [source: Field, Beeson & Jones 2016].
Lengthen Phase 1, and bring in body observations gradually through immediacy (4.6).

Low insight or motivation, or cognitive limits [source: Field, Beeson & Jones 2016, which notes the model requires some insight and motivation]:

Simplify to two words ("body alarm" and "thinking") and use pictures.
Lean on experiential Wave 1 skills (4.5, 4.10, 4.11) and minimise abstract explanation [synthesis].

Stuck in Wave 2 (intellectualising, ruminating, analysing their own brain) [synthesis, using the 2025 stuck-mode concept]:

Interrupt the analysis gently and return to the body: "and what's happening in your chest right now?"
Use the oscillation cycle (4.24) and limit psychoeducation time.

Stuck in Wave 1 (flooding, panic, shutdown in session) [synthesis]:

Stop exploration. Co-regulate (4.5).
Orient the client: eyes open, name objects in the room, feet on the floor (4.9).
Use breathwork or sensory input (4.10, 4.11). Reason only after regulation (regulate, relate, reason, reflect; cited in Field et al. 2025).
Next time, shorten the window of activation and set smaller exposure steps.

Dissociation during body work or exposure [synthesis]:

Stop. Ground with external, eyes-open attention and orientation to the present.
Reduce how much inward focus you ask for, and use movement.
Assess for trauma-related dissociation; consider phase-oriented trauma treatment or referral.

Body focus increases anxiety (health anxiety, panic sensitivity) [synthesis]:

Frame sensations as protective signals (4.16).
Time-limit monitoring and fade out pulse checks.
Treat repeated checking or breathing "to prevent" panic as a safety behaviour to be dropped gradually.

Non-adherence to logs and practice [source: Field, Beeson & Jones 2016 (repetition needed for Wave 1 availability); remainder synthesis]:

Explore barriers and shrink the task (one entry a day; a 60-second scan).
Attach practice to an existing routine.
Do the practice in session so the client leaves with one successful repetition.
Treat non-completion as data: avoidance is itself a Wave 1 response.

Resistance to exposure [synthesis]:

Revisit consent and rationale.
Lower the step. Give the client control over pace and the stop signal.
Name the fear of the fear, which is a Wave 2 appraisal, and test it with a very small exposure.

Rupture (client feels watched, judged or "pathologised" by body comments) [synthesis]:

Acknowledge it non-defensively. Ask for permission before future immediacy.
Return control to the client, e.g. "you tell me when you notice something".
Repair explicitly: "I think I pushed too fast; that's on me."

Counsellor dysregulation or low confidence with the model [source: Field, Beeson & Jones 2016 (counsellor delivery and confidence affect effectiveness); Miller et al. 2019 (counsellor interoceptive awareness; post-training consultation helps retention)]:

Practise the body exercises yourself.
Seek consultation or supervision.
Use a fidelity self-check against the three phases [synthesis].

Risk: suicidality and self-harm [synthesis, standard practice]:

Assess risk at intake and whenever the client is more distressed, using standard structured risk assessment.
Do collaborative safety planning, including lethal-means counselling (safe storage or removal), before any exposure or intensive body work.
Postpone exposure while acute risk is present.
Wave 1 skills can go into the safety plan's coping steps.

Risk of neuromyths and overclaiming [source: Miller et al. 2019]:

Avoid telling clients their brain is "damaged" or "rewired" in literal terms.
Present the model as a useful simplification.
Keep brain explanations short and accurate.

Cultural fit [source: NCT07822074 (materials were culturally adapted, translated and piloted with community members for Spanish-speaking clients)]:

When working across language and culture, adapt metaphors, examples and handouts.
Check that body-focused framing fits the client's explanatory model [synthesis].

Device-dependent interventions unavailable [synthesis]:

Replace biofeedback with pulse counting (4.8) and the subjective log.
Replace VR with imaginal exposure (both are named in Field et al. 2025).

Sources

Sources:

Further reading (not drawn on): The New ABCs paper; the n-cbt.com Resources and Publications pages.

Books and papers cited (not drawn on unless listed above):

Field, T. A., Beeson, E. T., & Jones, L. K. (2015). The new ABCs: A practitioner's guide to neuroscience-informed cognitive-behavior therapy. Journal of Mental Health Counseling, 37(3), 206–220. doi:10.17744/mehc.37.3.02 [uncertain]
Beeson, E. T., Field, T. A., Jones, L. K., & Miller, R. M. (2017). nCBT: A semi-structured multiphasic treatment manual (v1.0). Unpublished manuscript. [not available; uncertain]
Field, T. A., Beeson, E. T., Jones, L. K., & Miller, R. (2017). Counselor allegiance and client expectancy in nCBT: A 12-month qualitative follow-up. Journal of Mental Health Counseling, 39(4), 351–365. [uncertain]
Beeson, E. T., & Field, T. A. (2017). Neurocounseling: A new section of the Journal of Mental Health Counseling. JMHC, 39, 71–83. [uncertain]
Field, T. A., Jones, L. K., & Russell-Chapin, L. A. (Eds.) (2017). Neurocounseling: Brain-based clinical approaches. American Counseling Association / Wiley. [uncertain]
Ellis, A. (1962). Reason and Emotion in Psychotherapy. Lyle Stuart.
Perry, B. D., & Ablon, J. S. (2019). Cited in Field et al. (2025) for the regulate, relate, reason, reflect sequence. [uncertain]
Devilly, G. J., & Borkovec, T. D. (2000). Psychometric properties of the Credibility/Expectancy Questionnaire. Journal of Behavior Therapy and Experimental Psychiatry, 31, 73–86. [uncertain]

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