November 2026

Rethinking Mechanisms of Change in CBT: A Historical Review Through Predictive Processing and Embodied Cognition

November 10, 2026November 10, 2026 NeuroAffective-CBT® Journal

Dr Kristina Ivings and Daniel Mirea (10 November 2026)
| The NeuroAffective-CBT® Journal |

Abstract

This historical review draws on predictive processing and 4E cognition to reconsider how change occurs in cognitive behavioural therapies. It proposes that bodily regulation, imagery and behavioural practice may help clients revise threat expectations and expand what they feel able to do. NeuroAffective-CBT® serves as an example of how these methods can be integrated with cognitive reflection. The review also briefly considers the use of imaginal rehearsal in Hypno-CBT®. Further research could test which components contribute to change and whether gains carry into everyday life.

Keywords: Cognitive behavioural therapy, mechanisms of change, predictive processing, 4E cognition, embodiment, integrative psychotherapy

Introduction

Cognitive Behavioural Therapy (CBT) is the most extensively researched form of psychotherapy (Hofmann et al., 2012), and Dialectical Behaviour Therapy (DBT) is among the best-supported treatments for borderline personality disorder (Storebø et al., 2020). The models used to explain how these therapies work, to therapists and to clients, have not kept pace with contemporary neuroscience.

Psychoeducation in CBT and DBT commonly draws on simplified neuroanatomical stories and evolutionary models of emotion and behaviour. Compassion-Focused Therapy teaches a distinction between an “old brain” of evolved emotions and motives and a “new brain” of thought and imagination (Gilbert, 2009, 2010), echoing MacLean’s (1990) triune model. Widely used CBT-informed self-help presents anxiety as the product of an amygdala pathway that the cortex must work around or retrain (Pittman & Karle, 2015). DBT’s skills materials teach that primary emotions such as fear, anger, disgust and shame are innate and evolved, each serving a survival function (Linehan, 2015). Dual-system models also appear in theoretical accounts of CT: Clark and Beck (2010) proposed that anxiety and depression involve heightened bottom-up, amygdala-driven processing combined with weakened top-down, prefrontal reflective control. The dual-process theorists themselves are more cautious. Kahneman (2011) describes System 1 and System 2 as useful fictional characters rather than brain systems, and Evans and Stanovich (2013) prefer to speak of Type 1 and Type 2 processes. The clinical version hardens these metaphors into anatomy and casts the amygdala as a fear centre, a view that LeDoux (2015), whose earlier research helped establish the amygdala’s role in threat detection, now argues against.

Contemporary affective neuroscience describes cortical and subcortical regions as densely interconnected and jointly involved in both emotion and cognition (Pessoa, 2013; Barrett, 2020). Predictive processing retains a hierarchy of top-down and bottom-up signalling, but it is a single integrated hierarchy, not a contest between separate emotional and rational systems.

Our concern is not with the efficacy of CBT and DBT but with the models offered to explain it. Therapists and clients are asked to accept inaccurate accounts of their own biology, and the mismatch may obscure which components of treatment are effective. We suggest it may also have slowed the development of approaches that work with, rather than in spite of, the brain’s predictive and embodied organisation.

This paper draws on predictive processing and 4E cognition to set out a contemporary account of mind and brain, then uses it to re-read the history of psychotherapy: its Stoic antecedents, early somatic and behavioural methods, Beckian Cognitive Therapy (CT), metacognitive therapy, the third-wave approaches and DBT.

This review considers whether some interventions may work through processes that their original theories gave less attention to. Early behavioural approaches, including Salter’s (1949) conditioned reflex therapy and Wolpe’s (1958) systematic desensitisation, made action and bodily experience central to therapeutic learning. Beckian cognitive therapy (CT) retained behavioural methods and used some of them to test and revise beliefs. Later approaches, including Meichenbaum’s (1985) Stress Inoculation Training (SIT), continued to emphasise rehearsal and the graded application of coping skills. We use predictive processing and 4E cognition to explore how bodily regulation, rehearsal and action may contribute to therapeutic change. We close by considering how these methods can be integrated with cognitive reflection and how future research might test the proposed mechanisms.

Neuroscientific Foundations

Predictive Processing and Allostasis

A useful starting question is what a brain is for. Barrett (2017) argues that its core task is regulating the body rather than thinking: anticipating the needs of the organism and meeting them before they arise, a process she describes as running a budget for the body. The view draws on Sterling’s (2012) account of allostasis, the predictive regulation of physiological variables such as glucose, oxygen, water and salt. It is not universally accepted as the brain’s primary function, but it supplies the framing adopted here.

Predictive processing describes how this regulation might be achieved. The brain is modelled as a generative system that continually predicts its inputs and revises those predictions in light of prediction error, the mismatch between what was expected and what arrives (Friston, 2010; Clark, 2013). Predictions prepare the cardiovascular, metabolic and muscular systems in advance of anticipated demand, so prediction serves allostasis rather than operating separately from it.

Peters et al. (2017) argue that sustained uncertainty is metabolically costly, because a system that cannot resolve its predictions must remain mobilised. We propose that some of what clients describe as chronic worry, ambient threat and the urge to ruminate reflects this state of unresolved prediction error and sustained autonomic arousal. On this view, deliberate, linguistic thought is one form of the brain’s predictive activity, serving the regulation of the body and the guidance of action, rather than the brain’s defining function.

Precision weighting determines how much influence a signal has. The brain estimates the reliability of its predictions and of incoming sensory evidence and weights each accordingly (Friston, 2010; Clark, 2013). Precision weighting operates throughout the hierarchy, across exteroceptive, proprioceptive and interoceptive signals. Applied to interoception, the brain’s inference about the internal state of the body, it shapes how bodily states are felt and interpreted (Seth, 2013).

Where a prediction carries high precision, conflicting evidence can be discounted. In the rubber hand illusion, synchronous stroking of a visible rubber hand and the participant’s hidden hand leads participants to feel the touch as located on the rubber hand and to experience it as their own (Botvinick & Cohen, 1998). The sense of ownership is associated with activity in premotor cortex (Ehrsson et al., 2004), and threatening the rubber hand produces skin conductance responses (Armel & Ramachandran, 2003). Visual evidence given high precision reshapes the felt location of the body. Clinically, the analogy suggests that a high-precision prediction of threat could lead the brain to discount interoceptive and environmental evidence of safety, which would help explain why reassurance and contrary evidence often fail to reduce distress.

4E Cognition

4E cognition holds that the mind is not a program running inside an isolated skull. Mind is:

Embodied: shaped by visceral, gut–brain and autonomic states.
Embedded: functioning within a physical, socioeconomic and cultural niche.
Enacted: brought forth through sensorimotor activity and engagement with the environment.
Extended: offloading cognitive work onto external tools, technologies and spaces.

The 4E paradigm emerged as a philosophical and phenomenological critique of computer-metaphor cognitive science, with roots in the work of Varela, Thompson and Rosch (1991). Predictive processing grew out of computational neuroscience, formalised through models of Bayesian inference and the free-energy principle (Friston, 2010).

Clark (2016) argues that the two frameworks are compatible: predictive processing offers a candidate mechanism for embodied and enacted cognition, because the brain minimises prediction error partly by acting on the body and the world. The compatibility is debated, and radical enactivists reject the representational reading of predictive processing (Hutto & Myin, 2013). The argument here requires only the weaker claim that the brain’s predictions serve an organism that is embodied, embedded and acting in the world.

Affordances and Self-Efficacy

Gibson (1979) introduced the concept of affordances: the possibilities for action an environment offers an organism, given the fit between the organism’s capacities and the properties of its surroundings. Rietveld and Kiverstein (2014) extend this into a landscape of affordances, the field of possibilities open to an organism within a given practice and situation. A chair affords sitting; a phone affords contact with others.

We propose that the state of the body budget shapes which affordances are salient. When resources are ample, the landscape is rich with invitations to approach, connect and explore. When the budget is depleted, or the system is held in high-precision threat prediction, invitations to reward recede while obstacles and threats gain salience. A flight of stairs becomes a barrier and a social encounter becomes a threat.

This proposal offers a mechanistic reading of two earlier ideas. Salter (1949) argued that psychological health depends on excitation predominating over inhibition, illustrated by the image of a dog bounding into a room to see what it offers. Bandura (1977) argued that efficacy expectations, a person’s belief that they can carry out the behaviour an outcome requires, govern whether they initiate and persist in coping. In predictive processing terms, self-efficacy can be modelled as the precision the brain assigns to predictions of its own capacity to act and cope. High self-efficacy would make approach-related affordances salient before any action is taken, whereas low self-efficacy would act as a confident prediction of failure that narrows the perceived field in advance.

Emotions as Constructed

The view that emotions are discrete, biologically fixed responses is often traced to Darwin (1872), who argued that emotional expressions are innate and shared across cultures and species. Darwin did not present most expressions as adaptations; he explained many as “serviceable associated habits”, vestiges of actions that had once been useful. The later basic-emotion tradition recast emotions as evolved programmes, each with a characteristic expression and physiology (Ekman, 1992).

The idea acquired an anatomical home in MacLean’s limbic system, which he developed from 1949 and later incorporated into the triune brain model, summarised in his 1990 book (MacLean, 1990). The triune model presents the limbic system as an older emotional brain lying beneath a rational neocortex.

DBT’s skills curriculum draws on the basic-emotion tradition. It teaches that emotions have evolutionary functions and unfold through a sequence of prompting events, interpretations, biological changes, action urges and expressions (Linehan, 2015). Because the sequence includes interpretation, the model is not purely reflexive, but it presents a set of primary emotions as universal, biologically prepared responses, and this is the model taught to DBT therapists and clients.

Barrett’s (2017) theory of constructed emotion offers an alternative. On this account, emotions are categories the brain constructs in the moment by applying learned concepts to core affect, rather than circuits waiting to be triggered. Core affect is a continuous blend of valence (pleasant or unpleasant) and arousal, often represented as a circumplex (Russell, 2003; Barrett, 2006). An emotion such as fear or anger arises when the brain categorises a change in core affect, in context, using culturally learned concepts. Basic-emotion theorists dispute this account (Ekman, 1992), but it is consistent with the predictive framework above and carries different clinical implications: if emotions are constructed predictions, they can be changed through the body, the situation and the concepts available to the client.

A Historical Re-Reading of the Clinical Lineage

This section does not claim that earlier clinicians held predictive processing views. It asks how far each approach’s effective components can be explained by the framework above, and how closely its stated theory matches those components.

Stoic Antecedents

Epictetus held that people are disturbed not by events but by their judgements about them (Enchiridion 5) and advised wanting events to happen as they do rather than as one wishes (Enchiridion 8) (Epictetus, 2014). In predictive processing terms, a rigid judgement about how events should unfold resembles a high-precision prediction that reality repeatedly violates. Beck and Ellis both acknowledged Stoicism as an antecedent of their approaches, but they adopted its emphasis on judgement more readily than its emphasis on acceptance.

Somatic and First-Wave Behavioural Approaches

Early somatic approaches targeted the body directly. Jacobson’s (1938) progressive relaxation and Benson’s (1975) relaxation response aimed to lower muscular tension and sympathetic arousal. These methods change the interoceptive evidence available to the brain, and we hypothesise that they reduce the precision assigned to threat predictions without requiring verbal engagement.

First-wave behaviour therapy focused on environmental contingencies, conditioning and overt behaviour (Skinner, 1953; Salter, 1949; Wolpe, 1958). It did not exclude internal experience. Wolpe’s systematic desensitisation paired deep muscle relaxation with imagined scenes from a graded hierarchy, and Wolpe used hypnosis to deepen relaxation (Wolpe, 1958). Systematic desensitisation is an early demonstration that embodied imagery, practised in a regulated bodily state, can change fear responses.

Salter (1949) argued that anxiety reflects an excess of inhibition and prescribed excitatory exercises: spontaneous, expressive action, including voicing feelings and acting on impulse. His approach was clinically influential but was never tested in controlled trials. Salter had earlier written on hypnosis (Salter, 1944), and his emphasis on action, expression and expanded behavioural capacity anticipates the enactive view later developed in 4E cognition. Read through this lens, uninhibited action exposes the person to real-world prediction errors whose evidence is likely to update the generative model more effectively than abstract verbal reflection.

Self-Efficacy and Stress Inoculation Training

Two later developments kept action and rehearsal central. Bandura’s (1977) self-efficacy theory identified performance accomplishments as the most powerful source of efficacy expectations, ahead of vicarious experience, verbal persuasion and physiological states, and proposed that desensitisation and exposure work partly by raising self-efficacy. SIT combined conceptual preparation with skills acquisition and rehearsal, including imaginal and in vivo rehearsal of coping, followed by graded application (Meichenbaum, 1985). SIT includes cognitive restructuring and self-instruction, but its rehearsal and application phases embody the principle that coping is learned through practice.

Neither was rejected by CBT. Self-efficacy is widely used within CBT, and SIT remains in use, particularly for stress and trauma. Our claim is narrower: in Beckian theory, efficacy and rehearsal are not the mechanism of change; belief change is.

The Cognitive Revolution

Beck (1976) and Ellis (1962) placed thought content at the centre of the clinical model. Beck’s CT identified negative automatic thoughts, underlying assumptions and core beliefs, organised in schemas, as the primary targets of treatment. Ellis targeted irrational beliefs, worked through his ABC (later ABCDE) framework in Rational Emotive Behaviour Therapy.

Beck’s later work broadened the model. His theory of modes integrates cognitive, affective, motivational, behavioural and physiological systems (Beck, 1996), the generic cognitive model extends this account across disorders (Beck & Haigh, 2014), and Clark and Beck (2010) linked the model to neurobiological findings. In clinical practice, however, CT remains centred on content: identifying “thinking errors”, examining the evidence for and against thoughts, and constructing more rational alternatives through thought records and Socratic questioning.

CT retained behavioural methods, including activity scheduling, graded tasks, exposure and behavioural experiments, but changed their rationale. Behavioural experiments are framed as tests of explicit predictions, with success measured by the degree of belief change, so that action serves as evidence in a cognitive argument. The approach rests on an implicitly Cartesian assumption that the problem lies in the accuracy of mental representations and that the remedy is better representations.

Metacognitive Therapy

Wells’ Self-Regulatory Executive Function (S-REF) model (Wells & Matthews, 1994) is the clearest precedent for the process-over-content position taken here. It locates the maintenance of disorder in the Cognitive Attentional Syndrome (CAS), the pattern of perseverative worry and rumination, threat monitoring and counterproductive coping driven by positive and negative beliefs about thinking, rather than in thought content. Metacognitive Therapy (MCT) accordingly does not dispute content. It modifies these beliefs and trains non-engagement with thoughts through detached mindfulness and the Attention Training Technique (ATT; Wells, 2009). ATT involves focusing on and switching attention between multiple external sounds; Wells stresses that it is not distraction but training in flexible, executive control of attention, which also disconfirms beliefs that attention and worry are uncontrollable.

Predictive processing allows this account to be restated. Metacognitive beliefs can be read as high-level priors governing the precision assigned to internally generated content, so that believing worry to be necessary or uncontrollable keeps precision on threat simulations. ATT can be read as practice in reallocating precision away from such content. The frameworks differ in what they treat as the substrate of change. S-REF is framed in information-processing terms of levels, stored plans and executive control, whereas a predictive and 4E account treats the same phenomena as properties of a single embodied hierarchy regulating the body budget.

MCT therefore converges with the present argument at the clinical level while offering a different account of how change occurs. Hypno-CBT® uses hypnosis to rehearse coping responses in imagination (Davis, 2016). Whether using hypnosis to help clients disengage from thoughts, followed by imaginal rehearsal, offers benefits beyond detached mindfulness remains an open question.

Third-Wave Approaches and DBT

Mindfulness-Based Cognitive Therapy (MBCT) and Acceptance and Commitment Therapy (ACT) also moved from content to process. MBCT trains clients to relate to thoughts as passing mental events rather than facts (Segal et al., 2002). ACT targets the function of thoughts through defusion, acceptance and contact with the present moment, and is grounded in functional contextualism and relational frame theory (Hayes et al., 2006). ACT explicitly rejects mechanistic information-processing models, and its contextual, action-oriented stance is arguably closer to the enactive view taken here than any other variant of CBT. Its limitation, from the present perspective, is that it deliberately works at the level of functional analysis rather than mechanism, so it does not offer an account of how these processes relate to prediction and the regulation of the body.

DBT combines behavioural science with Zen-informed acceptance and mindfulness practice (Linehan, 1993). Its distress tolerance skills include TIPP: changing body Temperature (for example, cold water on the face to trigger the dive reflex), Intense exercise, Paced breathing and Paired muscle relaxation (Linehan, 2015). These skills act directly on autonomic arousal. We hypothesise that a strong, immediate change in bodily input forces rapid updating of interoceptive predictions and draws precision away from internally generated threat content. DBT’s mindfulness skills ask clients to observe and describe internal experience without judgement, echoing contemplative traditions that aim to quieten the mind rather than argue with it. DBT thus restored much of what CT had marginalised, but its explanatory framework remains the basic-emotion model described above, together with the states-of-mind metaphor of emotion mind, reasonable mind and wise mind.

Recent Integrative Models

Daniel Mirea’s NeuroAffective-CBT® (NA-CBT), developed for difficulties involving shame, self-disgust and low self-esteem, combines cognitive-behavioural methods with affective neuroscience and embodied regulation (Mirea, 2018). Its six-module structure places physiological stabilisation early in treatment. The Tiredness, Exercise and Diet (TED) framework addresses sleep and fatigue, physical activity and nutrition as foundations for emotional regulation (Mirea, 2025). The Pendulum Effect formulation describes how clients may oscillate between overcompensation, avoidance and capitulation in response to a shared affective threat. More recent work uses embodied rehearsal, mental imagery and values-guided behavioural experiments to develop what Mirea calls the Integrated-Self (Mirea, 2026).

This emphasis on embodied and experiential learning is evident in NeuroAffective Narrative Reconsolidation (NNR), the fourth of the six NA-CBT modules. The method can be interpreted through the lens of 4E cognition, as illustrated by its use in clinical supervision (Mirea & People, 2026). It brings bodily sensations and emotional responses into the retelling of a significant experience (embodied) and situates that experience within the person’s relationships and circumstances (embedded). First-person role-play, imagery and rehearsal allow alternative responses to be explored through action (enacted). The supervisor’s prompts and the structure of the exercise can also serve as external supports for organising and revisiting the account (extended).

Mirea reports learning directly from Donald Meichenbaum and identifies Stress Inoculation Training as an influence on NA-CBT’s use of coping-skills rehearsal and graded practice. The NeuroAffective-CBT® Journal publishes Mirea’s conceptual and clinical papers alongside case studies and reviews by other clinicians. The case studies illustrate how clinicians have applied the framework in practice. Mirea presents NA-CBT as a clinical formulation framework, and its effectiveness as a treatment protocol remains to be established.

Clinical Implications

If the brain is a predictive system whose core task is allostasis, distress is better understood as a problem of prediction and precision than as a problem of inaccurate belief. When rigid top-down expectations repeatedly meet contrary evidence, the system remains mobilised, and the client experiences worry, ambient threat and the drive to ruminate.

Predictive processing also suggests why CT’s focus on content may be limited. Thoughts are simulations generated by a predictive system, and their influence depends on the precision (the confidence or salience) the system assigns to them. Sustained analytical engagement with distressing content is itself a precision-raising act: attending to a thought, interrogating it and treating it as a problem to be solved signals that it matters. The client may exchange irrational rumination for rational rumination without leaving the loop. A related difficulty is familiar to cognitive therapists: clients often report knowing an alternative thought to be true without feeling it to be true, a pattern described as rational-emotional dissociation (Stott, 2007). Where behavioural experiments succeed, predictive processing would locate the change in the precision updating produced by acting, not in the verbal re-rating that follows, which suggests they may work despite their stated rationale rather than because of it.

This does not mean that only overt action can produce change. Imagined action engages much of the neural machinery used to plan and perform it (Jeannerod, 2001), so vivid, embodied rehearsal is closer to offline action than to verbal reflection, and Wolpe’s imaginal hierarchies show its clinical value. The relevant distinction is between abstract, evaluative thinking about experience and embodied simulation of it. Bandura (1977) nonetheless ranks performance accomplishments above other sources of efficacy, so simulation is best treated as preparation for enactive mastery rather than a replacement for it.

Through the lens of affordances, anxiety and depression can be understood partly as the perception of an impoverished, threatening field of possibilities, not only as misinterpretation. The aim of therapy then shifts from changing what a client thinks about the world toward expanding what they perceive themselves able to do in it, by raising self-efficacy and the salience of approach-related affordances.

The same framework explains why contemplative traditions aim to quieten the mind rather than dispute its content. Laukkonen and Slagter (2021) propose that meditation progressively reduces the precision and influence of high-level predictions. Epictetus’s advice to want events to happen as they do points in the same direction, since relaxing demands on reality reduces the prediction error those demands generate. We hypothesise that resting in non-evaluative awareness lowers the precision of top-down expectations about how things should be, reducing prediction error, autonomic arousal and metabolic cost.

A clinical model built on this account would be enactive and embodied. It would use somatic regulation to restore the body budget, embodied simulation to raise self-efficacy, and real-world action to confirm it, opening the client’s landscape to possibilities for safety, agency and action not previously perceived.

The Efficacy Question

Johnsen and Friborg (2015) reported that the effects of CBT for depression declined across trials published since 1977. The finding is contested: a re-analysis by Ljótsson et al. (2017) argued that the decline was not robust. The data cover depression only, and because they begin after CT was established, they cannot show that the shift from behaviour therapy to CT reduced efficacy. We cite the finding as a reason for concern rather than as evidence for the present thesis.

More direct evidence comes from studies separating CT’s components. In a component analysis, behavioural activation alone produced outcomes comparable to full CT for depression (Jacobson et al., 1996), and in a later trial behavioural activation performed comparably to antidepressant medication and better than CT among more severely depressed clients (Dimidjian et al., 2006). Longmore and Worrell (2007) reviewed the evidence and questioned whether challenging thoughts is necessary for CBT’s effects. The evidence is not uniform, and Lorenzo-Luaces et al. (2015) review findings that cognitive change can mediate symptom change in CT. Taken together, these findings are consistent with the view that much of CBT’s effectiveness derives from its behavioural and experiential components, and that CT may be effective despite, rather than because of, its stated rationale.

Conclusion

Across its history, psychotherapy has developed somatic, behavioural, experiential and process-focused interventions whose effects can be understood in more than one way. Predictive processing and 4E cognition offer complementary perspectives on how bodily regulation, expectations, action and context may shape therapeutic learning. From this perspective, some of the benefits of CBT and DBT may arise from changes in what people feel able to do as well as from changes in how they interpret their experiences.

Cognitive reflection can help people identify what they expect to happen, while bodily regulation, imagery and rehearsal can help them prepare to try a different response. Acting in everyday settings gives them an opportunity to learn from what happens. NeuroAffective-CBT® offers one example of how embodied narrative work and values-guided behavioural experiments might connect new understandings with action in daily life (Mirea, 2026; Mirea & People, 2026).

Further research could examine what these components contribute, for whom and under what conditions. Comparing an established intervention with and without imaginal rehearsal could test whether rehearsal improves coping in situations clients previously avoided. Tracking bodily arousal, threat expectations and perceived coping ability during therapy could help clarify whether changes in these processes precede improvements in everyday functioning. Follow-up could show whether those improvements persist.

Taken together, these ideas make the case for a new wave of integrative cognitive behavioural therapies rooted in embodied learning, informed by contemporary neuroscience and guided by research into how change occurs in therapy and carries into everyday life.

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Declaration of interests

Dr Kristina Ivings (HCPC, BPS) is Head of the Hypno-CBT® Research Unit. Daniel Mirea is the founder of NeuroAffective-CBT® and has authored and co-authored publications on the model that are cited in this review. These professional interests are relevant to the selection and interpretation of material on Hypno-CBT® and NeuroAffective-CBT®. The review discusses both approaches as examples of recent integrative developments. The proposed mechanisms of change are presented as hypotheses for empirical investigation.

Authorship and attribution

This selective historical review and conceptual analysis draws on published research and publicly available clinical and training resources. The authors distinguish the claims made in the cited sources from their own interpretation of earlier therapies through predictive processing and 4E cognition.

Data availability

No original participant data were collected or analysed for this review. The sources are listed in the references.

Ethics and confidentiality

The article draws on publicly available sources and contains no original participant data or identifiable clinical material.

NeuroAffective Narrative Reconsolidation (NNR) in Clinical Supervision: A Case Illustration of Male Relationship Loss and Grief

November 3, 2026November 3, 2026 NeuroAffective-CBT® Journal

Daniel Mirea and Chris People (3 November 2026)
| The NeuroAffective-CBT® Journal |

Abstract

This article explores the application of NeuroAffective Narrative Reconsolidation (NNR) in clinical supervision through a case illustration involving a man experiencing relationship loss and grief. Drawing on a recorded supervisory role-play and subsequent descriptive feedback from the treating therapist, it examines how embodied experience, emotional regulation, cognitive updating and personal meaning can inform therapeutic formulation and intervention. NNR is a memory-processing approach developed within NeuroAffective-CBT® that seeks to integrate emotional experience, autobiographical meaning and personal values within the development of what Mirea (2026) conceptualises as the values-based Integrated-Self. The nine-stage NNR framework organises the discussion of experiential learning, exploring connections between bodily distress, self-beliefs, identity and values following separation. Particular attention is given to rumination, digital monitoring of a former partner and the persistence of emotional distress alongside behavioural progress. Empathic mentalisation, psychologically adapted method acting, guided imagery and collaborative enquiry are considered as methods for exploring a possible patient perspective and rehearsing therapeutic responses. Proposed behavioural experiments, rehearsal and follow-up illustrate how learning might extend into everyday action. The clinical material is descriptive and does not establish treatment effectiveness or neurobiological memory reconsolidation. NNR-informed supervision is presented as a structured, flexible framework for experiential learning that warrants further clinical evaluation.

Keywords: NeuroAffective-CBT; NeuroAffective Narrative Reconsolidation; clinical supervision; relationship loss; grief; experiential learning; imaginal rehearsal; cognitive updating.

Ed’s story…

Ed had never travelled abroad before. Now, following the painful end of his relationship, he had taken himself to Prague, alone. It was a significant step for someone learning to build a life beyond the partnership he still missed. There was movement, initiative and a willingness to enter unfamiliar territory. By any reasonable measure, this was progress.

Yet a quiet evening could still bring him back to the relationship he had lost.

Ed’s therapist, Adrian, brought his story to clinical supervision. He described a familiar therapeutic puzzle: his patient was doing more, taking chances and becoming less restricted by avoidance, but when the activity stopped, rumination and online checking could return. These episodes were less frequent than before, although they remained painful.

During our discussion, a Saturday evening provided the starting point for an experiential role-play. The scene was familiar: being alone at home, checking a former partner’s Spotify activity and reading meaning into her choice of music. What might she be feeling? Did a particular song mean something? Could a playlist offer a small window into a life from which he now felt excluded?

Adrian stepped into his patient’s role, drawing on what he knew of Ed while also imagining some of the responses. The exercise allowed us to explore a possible experience of loneliness, longing and the fear that another relationship might never feel as meaningful.

How could the man who travelled to Prague still feel so caught in the past?

Perhaps we need to begin by allowing both experiences to belong to the same person. Ed’s progress was real. So was his grief. The question was how the confidence and possibility available to him in one setting might become more accessible in another, especially when there was little to do and nobody else around.

This is where Ed’s story invites us to look more closely: at what happens when the world becomes quiet, the body registers the absence, and the mind begins telling us what that absence means.

What do we lose when a relationship ends?

Both authors have recently encountered more men seeking help with relationship loss in their own practices. This observation has prompted our interest, although it cannot establish a wider trend. Ed’s story provides a starting point for exploring how grief, bodily experience and personal meaning may interact after separation, and how NeuroAffective-CBT might help us formulate possible ways forward.

Losing a relationship can mean losing everyday companionship, familiar routines and an anticipated future. Even the small details matter: someone to tell about the day, shared plans for a weekend, the expectation of being remembered. The former partner remains alive, but access to the relationship has changed. Online traces may keep that person visible while leaving their feelings and intentions unknown.

There can also be uncertainty about who we are outside the partnership. Slotter, Gardner and Finkel (2010) associated reduced self-concept clarity after breakup with distress. For someone in Ed’s circumstances, a useful question might therefore be: which parts of life still feel available, and which seem to have disappeared with the relationship? We cannot answer that from his travel achievement alone.

Here, grief describes an experience of loss rather than a diagnosis. Relationship breakdown alone does not establish PTSD or prolonged grief disorder. Assessment must attend separately to depression, anxiety, substance use and any qualifying traumatic experiences.

Do men experience relationship loss differently?

The question deserves attention without expecting every man to supply the same answer. Leopold’s (2018) longitudinal research found greater short-term vulnerability among men on some wellbeing measures following divorce, while women experienced more persistent economic disadvantage. Many medium-term outcomes were similar. The consequences depend partly on what is measured and when.

Men’s responses to support are also more varied than familiar stereotypes suggest. Oliffe et al. (2022) described several routes to help following relationship breakdown, including existing relationships, new connections and professional care. Entwistle et al. (2021) found men openly expressing heartache in an online relationship-help setting. These findings encourage curiosity about how someone is already seeking help.

A man may believe that needing company makes him weak, that rejection exposes failure, or that he should have recovered by now. Another may view seeking therapy as an expression of responsibility. Research on masculine norms and help-seeking supports exploring these meanings rather than assigning them in advance (Seidler et al., 2016).

Average differences in romantic attachment have been reported, but they do not explain an individual’s grief (Del Giudice, 2011). Nor does testosterone offer a simple explanation: its association with aggression is weak and cannot determine a clinical formulation (Geniole et al., 2020). With Ed, the starting point remains his relationships, learning and circumstances. Attachment-related longing, rumination and avoidance are not exclusive to men.

Who initiated the separation also matters, although initiators can grieve and noninitiators can feel relief (Brüning, 2022). Parenthood, housing, finances, age, sexuality and cultural expectations may change both the loss and the support available. These are questions to ask, not details to add to Ed’s biography. A formulation should make room for practical difficulties alongside emotional meanings.

When checking promises connection

The Spotify scene offers a useful way into this difficulty. A song becomes a clue, the clue invites an interpretation, and the interpretation may become a conclusion about oneself. Perhaps she is happy without me. Perhaps I mattered less than I thought. Perhaps I will always be alone. These are possible meanings to investigate, rather than established statements from Ed.

Checking can promise proximity or certainty without providing either. Marshall (2012) associated monitoring a former partner on Facebook with greater breakup distress and longing. The study cannot establish which causes which, but it supports examining what checking does within a particular evening.

What was happening before the phone was picked up? What did the person hope to find? Did checking bring relief, deepen sadness or start another search? A playlist cannot reliably tell us what a former partner feels. Continuing to interpret it may nevertheless seem easier than facing the uncertainty it leaves behind.

Digital contact can also offer friendship and useful support. Burke and Kraut (2016) found that associations with wellbeing depended on the kind of communication and the strength of the relationship. For someone like Ed, the question is whether online activity provides reciprocal connection or repeatedly returns attention to an unavailable partnership.

Nor is more discussion always helpful. Sbarra et al. (2013) found poorer outcomes from expressive writing among some separated adults already strongly engaged in rumination or searching for meaning. This was not a study of NNR, but it reminds us to ask whether revisiting a story produces learning or simply keeps the person inside it.

The Pendulum-effect: what are we trying to protect?

The NA-CBT Pendulum-effect formulation describes how overcompensation, avoidance and capitulation may sustain negative affect and associated beliefs (Mirea, 2019). Applied here as a working hypothesis, it invites us to examine the protective purpose of a response and its longer-term consequences.

Understanding what we are protecting ourselves from begins with finding words for the experience. As Mirea (2019) explains, painful affect can become entangled with the language used to describe it. “I feel like a fool” or “I feel like a loser” sounds like an account of an emotion, yet it also carries a judgement about the whole person. Beneath that judgement there may be sadness, shame, loneliness or disappointment. The judgement can add another layer of suffering: something painful has happened, and now the person condemns themselves for how they feel.

Language offers different ways of describing these experiences. The Portuguese word saudade, for instance, conveys longing for someone or something absent. English can communicate this through words such as longing, yearning and missing, although each brings a slightly different emphasis. The clinical task is to help the person find language that captures their experience without turning it into a verdict on their worth.

For Ed, this would mean exploring whether “I miss her” had become entangled with a conclusion such as “I am unlovable”. One describes the pain of an absent relationship; the other extends that pain into a judgement about identity and future possibilities. We would need to ask Ed which words fitted, rather than assume the meaning for him.

Someone may stay relentlessly busy to keep loneliness away, try to become so successful or desirable that rejection seems impossible, or surrender to the conclusion that they are unlovable. These positions can alternate. The person who appears highly active may still feel vulnerable when the activity ends.

We should be careful with Ed’s trip, however. Travelling alone may express curiosity, courage and agency. Its value survives the return of sadness. To understand whether activity sometimes becomes avoidance, we would need to ask whether he can also choose to rest and what he fears might happen then.

Shame and guilt require similar care. Responsibility for a particular action may call for acknowledgement, learning or appropriate repair. The belief that one is permanently defective creates a different difficulty. Continued suffering does not necessarily repair harm, and accountability does not require repeated contact with someone who has requested distance.

Self-compassion may help someone remain honest without adding humiliation. Sbarra, Smith and Mehl (2012) associated observer-rated self-compassion with less intrusive separation-related distress over time. This does not establish an intervention effect, but it supports asking how a person responds to their own pain. Does a difficult evening become another occasion for self-attack?

Before experiential work: safety and support

Behavioural progress tells us something valuable about functioning. It cannot, by itself, tell us whether someone feels safe when alone. Wilson et al. (2025) identified associations between relationship breakdown and men’s suicidality. Such findings justify direct enquiry without predicting an individual’s risk from marital status or gender.

Assessment should explore suicidal thoughts, intent, previous attempts, access to means, hopelessness, substance use and sleep, alongside reasons for living and available support. Where self-harm is present, NICE (2022) recommends needs-based psychosocial assessment and collaborative safety planning. Urgent concerns require an appropriate clinical response.

Nothing in the material establishes that Ed was suicidal. The point is that travelling, working or socialising should not replace asking how the person is coping during their hardest hours. Experiential work belongs within that wider understanding of care.

Returning to the difficult evening

Adrian’s question led us towards NeuroAffective Narrative Reconsolidation, or NNR (Mirea, 2026). Could attending to bodily experience and personal meaning help connect an achievement such as Prague with the moments when capability feels distant?

Relaxation may make distress more manageable. Resource imagery may bring a felt sense of strength or connection. The next task is to discover whether these experiences change the meaning attached to the original situation. Feeling better while imagining Prague does not establish that being alone at home now feels different.

Adrian’s enactment could be understood as a psychologically adapted form of method acting, involving what Mirea (2022) describes as empathic mentalisation: temporarily entering a possible patient perspective through imagination, first-person language and embodied responses. This offers a way of exploring another person’s experience while recognising that our understanding remains partial and open to correction. During supervision, it can help the therapist develop questions and possibilities to explore with the patient.

In treatment, asking “Is this how it feels for you?” gives the patient an opportunity to recognise, refine or reject the therapist’s understanding. Such exchanges may help the patient feel heard and understood, while making the therapeutic interaction more predictable: the therapist checks their understanding, and the patient’s response guides what happens next. Ed would remain the authority on whether an image, sensation or interpretation fitted his experience.

Authenticity matters here. A person must be free to report sadness, uncertainty, resistance or little response at all. Posture, expression and breathing can enter the enquiry, alongside the words used to describe the experience. The value of the exercise lies in whether it supports an understanding that the person recognises as their own and can carry into everyday life.

Siegel and Bryson’s (2011) phrase “name it to tame it” captures the value of putting emotional experience into words. Within NA-CBT, this enquiry also explores what those words mean to the person and how they connect with bodily sensations and self-beliefs. The nine stages below show how these distinctions inform experiential work in supervision.

Exploring the nine NNR stages

The nine stages below explain the use of NNR in clinical supervision through Adrian’s role-play and the follow-up information he provided about Ed. As Adrian was already familiar with NNR, the exercise took the form of a focused, realistic rehearsal rather than a full presentation of each stage.

Adrian had brought to supervision a recurring clinical difficulty in his work with men experiencing relationship loss, introducing Ed as a particular example. Patients could understand their difficulties logically, engage in cognitive reappraisal, examine evidence for and against their beliefs and practise coping skills, yet remain troubled by a sense of loss experienced bodily and existentially. The roadblock concerned how to connect intellectual understanding with what continued to feel emotionally true.

Adrian was therefore invited to participate in a role-play. Role-play is an established method in cognitive behavioural supervision for exploring case conceptualisation, therapeutic strategies and the therapeutic relationship, with opportunities for modelling, rehearsal and feedback (Prasko et al., 2023). This form of experiential learning was familiar to Adrian through NA-CBT training, where empathic mentalisation, psychologically adapted method acting and imagery techniques are introduced early. Having checked that he felt comfortable proceeding, he was invited to close his eyes and temporarily embody Ed’s perspective: to imagine what Ed might see, hear, think and feel during the difficult evening.

Adrian drew on his knowledge of Ed while also imagining some responses. His sensations and distress ratings therefore describe his experience in role. According to Adrian’s subsequent account, Ed initially described feeling “like a fool” and “alone”, before identifying sadness through enquiry. Adrian also reported that Ed’s recognition that “life goes on” opened the way to further identity work. These observations provided points of correspondence with the supervisory exploration, while Ed’s own account remained the basis for confirming or revising the formulation.

The stages organise the explanation retrospectively within a structured but flexible framework; they may overlap or be revisited according to the person’s response. Suggested questions illustrate how the work can be developed and are not all verbatim exchanges from the sessions.

1. Narrative activation

We began with the Saturday evening, when being alone led to checking the former partner’s online activity and searching for meaning in what appeared there. In role, Adrian described loneliness, missing the former partner and fearing that another relationship would never compare.

This episode provided a relevant starting point for the exercise. With Ed, the enquiry begins with his own account: “Take me to the moment when the evening became difficult, perhaps even unbearable. What happened, and what did it mean to you?” Exploring a specific episode helps identify the triggering situation, factors that increase vulnerability, and affective modulators: what intensifies or eases the emotional experience. It also clarifies the emotional response and personal meaning, giving the process a focus without requiring the whole relationship to be retold.

In the sequence explored during supervision, boredom while alone preceded the checking. The former partner’s online activity then provided material for interpretations that intensified distress. Distinguishing the initial context, the checking behaviour and the meaning attached to what appeared online helps identify where the negative arousal was triggered and what sustained it.

2. Hot memory selection

The NeuroAffective Narrative Reconsolidation protocol includes an important stage labelled “hot memory selection”, particularly relevant when a distressing memory or flashback activates a strong emotional response. A “hot memory” refers here to an emotionally charged moment associated with high negative arousal, such as recalling the instant of an assault or being told that an emergency operation is necessary.

Relationship loss and grief can involve a different kind of stress, without necessarily involving the traumatic exposure associated with PTSD. Some losses occur in traumatic circumstances, such as a fatal car accident or violence; others involve the painful ending of a relationship. The dominant emotion may shift with the context, while associated cognitions carry recurring themes of loneliness, inadequacy and permanent changes to the self and future prospects. Someone may move from “I am capable and have something to offer” towards “I am not good enough” or “Nobody will want me again”. These meanings are not gender-specific and can significantly alter the autobiographical narrative: how the person understands their past, who they have become and what remains possible.

In Ed’s case, the starting point was a recent episode of checking his former partner’s online activity. The task is to identify the moment and associated meaning carrying the greatest emotional charge. This involves experiential revisiting of the episode alongside Socratic enquiry: “What did you notice? What went through your mind at that point? What did that seem to say about you or your future?” Here, the focus is on how a present-day situation activates painful affect and self-beliefs.

Such enquiry explores the bridge the person constructs between past, present and future: “Who I was, who I am and who I will become.” For example, “I felt valued in that relationship” may become “Without her, I am worthless”, followed by “I will always be alone”. The ending becomes connected to a wider account of identity, extending its meaning beyond the immediate loss.

NNR allows flexibility here. “Which part of that moment hurts most?” would help Ed choose the focus. Seeing an online update, imagining his former partner enjoying life without him, or concluding “I will never feel as alive as I did with her” could each carry a different emotional meaning. These are possibilities to explore with Ed, allowing him to identify what fits.

The enquiry distinguishes what he saw, what he imagined and what he concluded about himself. An online indication that his former partner was enjoying an evening, for example, would provide limited information about her life; “She never cared about me” or “I am worthless” would add interpretations requiring separate examination.

An earlier memory might become relevant if Ed made that connection. Feeling excluded in the present might, for instance, remind him of an earlier experience of abandonment or emotional deprivation. Such a connection could warrant a separate processing session, while keeping the current episode sufficiently focused. A childhood origin should not be supplied simply because relationship loss can activate attachment concerns.

The focus at this stage therefore remains on selecting the emotionally charged moment and identifying its associated cognitions and personal meanings. These provide a focus to revisit in stages five and six, when perspectives are broadened and cognitions updated. “Being alone tonight proves that I will always be unwanted”, for example, becomes a specific meaning to explore alongside the bodily distress.

3. Somatic tracking

In role, Adrian described sadness felt around his chest or heart and tension in his hands. The bodily experience appeared to “travel”, shifting in location and intensity, with the greatest distress eventually felt around the head. He rated distress at approximately eight out of ten.

These observations informed subsequent enquiry with Ed, whose emotional experience was initially less clearly differentiated. Expressions such as “I feel like a fool” and “I feel alone” became starting points for exploring the associated self-judgements and sense of isolation. Through this enquiry, Ed identified sadness, echoing the emotion Adrian had described during the supervisory role-play.

Once the emotion has been identified, bodily enquiry can follow: “Where exactly do you feel the sadness in your body? What else do you notice there? Does it stay in one place, or does it shift as we explore it?” What initially feels overwhelming and difficult to express may become more understandable as the person identifies particular bodily sensations, areas of muscular tension and changes in intensity. A confusing emotional experience acquires a more recognisable bodily form, with specific sensations that can be attended to and potentially eased.

The indirect therapeutic message at this stage is that the experience can be approached, understood and potentially influenced. This prepares the ground for distress modulation, before returning to the selected moment to explore its emotional intensity and associated meaning.

Throughout this process, sensation, emotion and interpretation are explored together. Tightness, sadness and the belief that one will always be alone are related experiences, but they are not interchangeable. Uncertainty or an absence of sensation is equally acceptable.

4. Distress modulation

Distress modulation focuses on the physiological expression of the emotional experience identified earlier: muscular tension, changes in breathing, pressure, restlessness or other bodily sensations. What initially feels overwhelming and difficult to explain can become more approachable when the person recognises particular responses that may be influenced. “My whole life feels unbearable” may coexist with something more immediate and specific: “My jaw is clenched, my forehead is tense, and I am holding my breath.”

Within NNR, this creates an opportunity to experience some influence over distress. The emotional episode retains its personal meaning, while aspects of its bodily expression may begin to ease, sometimes within minutes. The indirect therapeutic message is important: “This experience can change, and I can participate in that change.”

The therapist can draw on comfortable abdominal breathing, progressive muscle relaxation, grounding and individually meaningful imagery. Imagery-based cognitive therapy and Hypno-CBT provide resources for developing these methods, including guided imagery, therapeutic suggestion and rehearsal of coping responses (Hackmann, Bennett-Levy and Holmes, 2011; Robertson, 2013).

Davis (2023) distinguishes the relaxation of muscular tension from emotional and autonomic relaxation, while exploring their relevance to psychological flexibility. This distinction is useful within NNR: easing tension in the jaw or forehead provides a concrete starting point for exploring whether the wider emotional experience also changes.

In supervision, the therapist can experience the guidance directly and reflect on its effects. With his eyes closed, Adrian was guided through breathing and relaxation around the forehead, face and jaw, attending to the areas where tension had become most noticeable. During the supervisory role-play, Adrian reported a reduction in subjective distress from approximately eight to four out of ten following the breathing and relaxation exercise. His familiarity with imagery and hypnotic relaxation is relevant to understanding this response; the pace and usefulness of the same methods with Ed would require individual exploration.

Guidance remains concrete and exploratory: “As you breathe out comfortably, can you allow a little less effort around your forehead? What happens if you loosen your jaw? What changes, if anything?” Progressive muscle relaxation can help distinguish tension from release, while gentle relaxation without deliberate tensing may be more suitable where discomfort or injury is present.

Metaphors can make this process easier to understand and embody. An emotional wave, for example, invites the person to notice changes in intensity: “Where is the wave now? Is it building, holding or beginning to settle? Can you remain supported while it moves through?” Surfing the wave conveys the possibility of responding to emotion without needing to force it away. The therapist checks whether the metaphor fits; the person need not experience a smooth or predictable decline in distress.

Closing the eyes may help some people reduce external distraction and engage more fully with imagery and bodily experience. It remains an invitation. For someone whose traumatic experiences involved darkness, enforced eye closure or an inability to see what was happening, closing the eyes may increase threat. Imagery can also be explored with eyes open, a softened gaze or attention moving between the image and the room.

Dissociation requires particular attention. Becoming quiet or still does not necessarily indicate relaxation. The therapist checks whether the person remains present and connected: “Can you still hear me clearly? Are you aware of the room? Do you feel more settled, or further away?” If disconnection, panic or excessive bodily monitoring increases, inward attention can be reduced and grounding introduced, for example by looking around the room, naming visible objects or noticing contact with the chair and floor. The exercise can be adapted or stopped.

The aim is sufficient regulation to continue exploring the selected moment and its meaning. Complete calm, closed eyes or a particular distress score need not become conditions for participation. A reduction in tension opens the way to ask whether the original cognition still feels equally convincing when the moment is revisited.

5. Perspective shifting

Once the selected moment can be approached with tolerable distress, attention returns to the situation and the meanings identified earlier. Perspective shifting broadens the field of enquiry: what else becomes visible when the person is less absorbed in the most painful interpretation?

In clinical supervision, embodied or in-character role-plays allow the therapist to explore this shift experientially. Adrian can temporarily inhabit the lonely Saturday evening, then consider the same scene from an observer position or through the eyes of someone who understands the pain without sharing the self-condemnation. While remaining in character, he might be asked: “As you look at yourself sitting there, what do you notice? What might someone who knows and cares about you understand about that moment?” This maintains an experiential connection with the episode while opening space for another perspective.

The online checking provides a focus: “What did her online activity actually show you? What did you imagine was happening? What remained unknown? When you saw what she was listening to on Spotify, what did those song choices mean to you then? As you revisit that moment from a calmer position, what else can you see or understand?” A song choice or an online update may reveal little about the former partner’s current emotional life yet become the foundation for a much larger narrative: “She is happy, I meant nothing, and I have been left behind.” Separating observation from interpretation makes that narrative available for examination.

The former partner may be doing well, and Ed may genuinely feel lonely. A broader perspective allows both possibilities while acknowledging the limits of the available information. Neither observation determines his worth or settles his future. The therapist practises remaining alongside the pain while opening its meaning to enquiry.

The aim is to loosen the rigid bridge connecting a painful recent past, a negatively defined present self and a future that appears already decided. “She left me, therefore I am unlovable, and I will always be alone” becomes a sequence of meanings to explore. What happened remains part of the person’s story without having to define who they are now or dictate what happens next.

6. Cognitive updating

Cognitive updating returns directly to the cognition attached to the emotionally charged moment. Having broadened the perspective, the therapist explores whether new information changes what the experience means. In clinical supervision, this involves practising how to return from relaxation or resource imagery to the original belief: “As you revisit that evening now, does ‘I cannot connect with anyone again’ still feel as convincing? What, if anything, has changed?”

With Ed, the enquiry centres on the conclusion identified earlier: “When you checked her online activity, what did that moment seem to prove? Does it still carry the same meaning now?” The Prague trip provides relevant information about his ability to act independently and enter unfamiliar situations. Its significance for connection, confidence or future possibilities needs to emerge from his own account.

The aim is to develop an update that Ed finds credible. “I will definitely find someone better” would make a promise that therapy cannot provide. A more grounded understanding might be: “I miss this relationship, but being alone tonight does not decide my whole future.” Alternatively, he might recognise: “The relationship ended; that does not mean everything I offered within it has disappeared.”

The selected evening is then revisited with this understanding: “As you picture yourself checking her online activity now, what feels different? What still hurts? How convincing does the original conclusion feel?” Attention returns to bodily sensations alongside language and meaning. Sadness may remain but feel less consuming, while the conclusion becomes less absolute and a different response becomes possible.

According to Adrian’s follow-up account, Ed’s recognition that “life goes on” provided sufficient movement to proceed towards identity reframing. The significance of this phrase lies in what it meant to Ed. Enquiry can clarify that meaning: “When you say life goes on, what now feels possible that seemed unavailable before?”

The focus remains on whether the developing understanding addresses the original pain. If “I am worthless” still feels entirely true, a calmer body or an enjoyable image alone would leave an important part of the work unfinished. That response invites further exploration of what remains convincing about the belief and what the proposed update has yet to address.

7. Identity reframing

Identity reframing explores how the experience has changed the person’s account of who they are. Following cognitive updating, the enquiry moves from “What does this moment mean?” towards “What does this now allow me to recognise about myself?” Ed’s recognition that “life goes on” provides an opening: who is the person who can carry this loss while continuing to live?

Relationship loss can create an autobiographical division between “the person I was when I felt valued” and “the person I am now that the relationship has ended”. Identity reframing explores whether qualities associated with the earlier self remain available, alongside capacities discovered since the separation.

The Prague trip provides a concrete example. During the role-play, Adrian developed the image of an adventurer, describing strength, excitement and smiling. In supervision, this allows the therapist to experience how a resource can become embodied through posture, expression and felt readiness, then explore how it relates to the painful self-view.

With Ed, the enquiry would follow his own language: “What did taking that trip reveal about you? Which qualities helped you go? Are those qualities still yours when you feel sad?” Curiosity may provide a starting point, even if determination or confidence feels less accessible. A willingness to take a chance while uncertain can itself become meaningful. The “adventurer” image offers a possibility to test, while Ed’s response determines whether it fits.

This returns to the autobiographical bridge between past, present and future. “I used to be capable, but now I am broken” might become “I am going through a painful loss, and I have already shown that I can do unfamiliar things.” Capability and vulnerability can belong to the same person; a difficult evening need not erase the qualities expressed in Prague.

The emerging understanding also needs an experiential dimension: “As you remember being in Prague, what do you notice in your posture, expression or readiness to act? As you picture the difficult evening again, can you still recognise those qualities in yourself?” Such questions help the therapist explore whether the broader sense of self remains accessible when grief returns.

“I am hurting, and I can still take part in life” acknowledges the loss while allowing identity and future possibilities to extend beyond it.

8. Values and meaning integration

Personal values give the developing understanding a direction. Following identity reframing, the enquiry moves from “What can I recognise about myself?” towards “What matters to me, and how do I want to live?” For Ed, recognising that life continues opens questions about what he wishes to carry forward, reconnect with or develop.

In clinical supervision, this stage helps the therapist explore the personal meaning of a resource before translating it into action. Prague might represent curiosity, freedom, companionship or something else entirely. “What made that trip worthwhile for you? What mattered about taking yourself there?” invites the person to identify the qualities that made the experience significant.

The same enquiry can explore what Ed wishes to retain from the relationship and what he now wants to develop. Care may remain important without requiring continued monitoring of his former partner. Independence may include choosing to ask for support. Self-respect might involve acknowledging regret while allowing himself to move beyond repeated self-punishment.

Personal values also provide a basis for questioning rigid rules expressed through “I must always…”, “I have to…” or “If… then…”. “I value loyalty”, for example, could become entangled with “If I stop suffering, it means I never really loved her.” Distinguishing the value from the rule opens alternative ways of expressing what matters. In supervision, the therapist can practise this enquiry: “What would loyalty mean now that the relationship has ended? Could you honour what mattered while also allowing yourself to live?” The patient’s response guides whether this understanding fits.

Personal values then enter a recognisable situation: “How would you like to treat yourself and others during the next difficult evening? What would care, curiosity or self-respect look like in that moment?” A chosen response might involve speaking more kindly to himself, contacting a friend, exploring an unfamiliar activity or allowing himself to rest.

The experiential dimension remains important: “How does that response feel as you imagine it? Does it express something you care about, or feel like another demand?” This helps the therapist explore whether the proposed action carries personal meaning. Sadness can remain present while values give the next step a direction.

9. Future orientation and relapse planning

Future orientation carries the updated meaning and personal values into situations where distress may return. In clinical supervision, this provides an opportunity to rehearse how the therapist helps a patient draw on the work when faced with familiar triggers.

The Saturday evening offers a recognisable scene: “You are home, there is little planned, and you notice the urge to check. What goes through your mind? What do you notice in your body? With the understanding you have developed, how would you like to respond?” Adrian can explore these questions in character, then reflect with the supervisor on what made the guidance useful, difficult or emotionally credible.

The rehearsal brings together the original trigger, the updated cognition and a response connected to personal values. “Being alone means nobody wants me” might become recognisable as a familiar conclusion open to examination. Ed could practise acknowledging sadness, recalling his capacity for initiative and choosing whether to rest, contact someone or continue an activity. Posture, breathing and felt readiness can be explored alongside what he imagines saying and doing. During the demonstration, a physical gesture was paired with the resource image as a possible cue for recalling the associated sense of capability. Its usefulness with Ed would need to be explored collaboratively: “When you use that gesture, what comes back to you? Does it help you remember something useful about yourself?”

Rehearsal also includes difficulty: “What if the sadness stays? What if you check before noticing the urge? What if the friend you contact is unavailable?” These questions allow realistic alternatives to be developed. A response such as “I checked because this is painful. I can understand what happened and choose my next step” makes room for learning without turning a setback into another judgement about identity.

Relapse planning therefore includes recognising vulnerable situations, practising responses and identifying support when distress becomes harder to manage. The aim is greater flexibility when the familiar pattern returns.

Bringing Prague home: follow-up, behavioural experiments and feedback

Follow-up and feedback extend stage nine beyond the session and inform the NNR process as a whole. Behavioural experiments provide opportunities to test updated meanings in everyday situations, while subsequent review helps the patient, therapist and supervisor identify what has changed, what remains difficult and which stages may need revisiting.

Prague provides a meaningful experience to draw upon; an ordinary evening at home offers a setting in which to explore its relevance. A small collaborative experiment could involve a manageable period without monitoring the former partner. Beforehand, Ed would identify his prediction: “If I do not check, the loneliness will become unbearable.” Afterwards, the enquiry would explore what happened: “How did the urge change? What happened to the sadness? What helped you respond? What did you learn about your ability to remain with the experience?”

The experiment also needs to address the purpose of checking. If Ed seeks companionship, putting the phone away may leave that need untouched. The plan could therefore include opportunities for reciprocal contact, while distinguishing necessary communication from monitoring for reassurance and respecting the former partner’s autonomy.

The patient’s feedback then becomes material for further supervision. Did the updated meaning remain convincing during the evening? Was the resource image accessible? Did the planned response fit the need? If “I can still connect” felt credible in the room but disappeared when Ed was alone, the therapist and supervisor could explore what made the difference and whether cognitive updating, identity reframing or rehearsal needed further attention.

Progress might include shorter periods absorbed in rumination, greater willingness to ask for company or more freedom to rest without interpreting sadness as failure. Review also attends to difficulties arising from the intervention: imagery that encourages rumination, pressure to feel confident or bodily enquiry that increases monitoring. These observations help refine the formulation and the guidance offered.

What can we conclude?

This case illustration explores how NeuroAffective Narrative Reconsolidation (NNR) can be used in clinical supervision, with particular attention to male relationship loss and grief. The authors’ clinical observations of an apparent increase in men seeking therapeutic support following relationship breakdown provided an additional motivation for exploring this clinical presentation. Imaginal role-play gives the therapist an opportunity to experience the guidance, explore a possible patient perspective and rehearse questions before adapting the work collaboratively with the patient. Adrian’s subsequent account of his work with Ed adds clinical context, while remaining descriptive rather than establishing treatment effectiveness.

The nine stages organise this learning. Narrative activation identifies a relevant episode; hot memory selection locates its most emotionally charged moment and meaning; somatic tracking explores its bodily expression. Distress modulation supports tolerable engagement, while perspective shifting and cognitive updating examine the interpretations sustaining distress. Identity reframing places the experience within a broader account of the self, values and meaning integration gives that understanding direction, and future orientation and relapse planning carry it into rehearsal, everyday action and subsequent review. These tasks can overlap and be revisited according to the person’s response.

The focus throughout is process-based change: what helps this person learn, attend differently, regulate distress, develop new meaning and act with greater choice? NNR draws on methods with empirical support in related therapeutic contexts. A systematic review supports the use of progressive muscle relaxation for stress, anxiety and depression in adults (Muhammad Khir et al., 2024), while a randomised trial examined imagery rescripting as a treatment for adults with childhood trauma-related PTSD (Boterhoven de Haan et al., 2020). Imagery rescripting is distinct from the resource imagery and imaginal rehearsal illustrated here. These findings inform the rationale for related methods; they do not establish that every component contributes equally or validate NNR as a complete intervention for relationship loss.

Within this framework, attention training and focused enquiry help the person recognise where attention becomes captured and practise redirecting it. Body scanning and relaxation make aspects of physiological distress more recognisable and potentially manageable. Imaginal rehearsal provides opportunities to practise coping responses, while more precise language helps distinguish sensations, emotions and self-judgements. New learning develops as these experiences are connected with revised meanings and tested through action.

For Ed, exploring “I feel like a fool” helped distinguish sadness from the judgement attached to it. A conclusion such as “Being alone means I will always be unwanted” then becomes available for separate enquiry. The practical question is whether this understanding helps him respond differently during a difficult evening: acknowledging the feeling, seeking reciprocal contact, resting or choosing an activity without needing to prove that he has recovered.

Putting the learning into practice is integral to the work. Follow-up explores what happened, which coping skills were useful and which conclusions remained credible outside the session. The patient’s feedback informs further therapy and supervision: refining the formulation, adapting the guidance and revisiting stages where needed. Change is explored through repeated cycles of experience, reflection, action and feedback.

An immediate shift in distress, imagery or narrative does not demonstrate neurobiological memory reconsolidation (Elsey, Van Ast and Kindt, 2018). Further evaluation should examine acceptability, unwanted effects and sustained change, alongside the contribution of the different therapeutic processes.

Ed’s story leaves us with a useful question: how can someone recognise their growing capacity while remaining honest about what they have lost?

The man who travelled to Prague and the man who struggled on a quiet evening belong to the same life. Bringing Prague home means making the qualities expressed on that journey more accessible when grief returns. The relationship mattered. Its ending hurts. There may still be people to meet, places to discover and choices to make, including the choice to rest. Recovery can leave room for all of these experiences.

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A note on sources

This article draws on selected literature concerning relationship loss, men’s adjustment, help-seeking, rumination, digital monitoring and related therapeutic methods. It is a narrative discussion rather than a systematic review. The clinical material comprises an unpublished recorded supervision session (Mirea, n.d.) and descriptive follow-up information supplied by the treating therapist. Reports about Ed, Adrian’s experience during role-play and illustrative therapeutic questions are distinguished throughout. No direct patient-treatment recording was analysed, and the follow-up account does not constitute a formal evaluation of treatment outcomes.

About the authors

Daniel Mirea is the founder of NeuroAffective-CBT®, a senior accredited CBT therapist, clinical supervisor and university lecturer with almost 40 years’ professional experience.

Chris People is an accredited Hypno-CBT therapist and trainer and a certified NeuroAffective-CBT practitioner undertaking further training in psychotherapy.

Declaration of interests

Daniel Mirea is the founder of NeuroAffective-CBT® and originated the Pendulum-effect formulation and NNR approach discussed in this article. Chris People is a certified NeuroAffective-CBT practitioner and an accredited Hypno-CBT therapist. These professional and intellectual interests inform the authors’ practitioner perspectives.

Confidentiality and data

This article draws on a recorded clinical supervision session and subsequent descriptive follow-up information provided by the treating therapist. Pseudonyms have been used, and identifying details have been omitted or modified where appropriate to protect confidentiality. The patient’s reported experiences are distinguished from the therapist’s responses during supervisory role-play and from proposed clinical interventions. Follow-up information is descriptive, and no formal patient outcome measures were collected. The confidential recording and transcript are not reproduced in full and are retained securely.