A predictive processing framework for body-oriented trauma intervention: a hypothesis illustrated by Body Connect Therapy

This paper proposes a theoretical framework for understanding body-oriented trauma intervention by integrating predictive processing theory with candidate subcortical threat-processing pathways. Body-oriented interventions have gained increasing recognition in trauma treatment, yet the theoretical mechanisms underlying their effects remain underspecified. Within predictive processing, trauma is conceptualized as rigid, maladaptive predictions-particularly at the bodily level-that resist updating despite contradictory evidence. We identify the superior colliculus (SC) and its connections to the periaqueductal gray (PAG) and amygdala as candidate neural substrates for rapid, subcortical threat detection that may become dysregulated in trauma. The framework proposes four mechanisms through which body-oriented interventions may facilitate therapeutic change: (1) interoceptive attention increasing precision-weighting of bodily signals; (2) somatic safety experiences generating prediction errors that update threat models; (3) eye movement interventions potentially modulating SC-mediated defensive responses; and (4) "letting go" practices reducing excessive prior precision on threat predictions. Using Body Connect Therapy (BCT) as an illustrative case, we demonstrate how specific techniques may engage these theoretical mechanisms, while emphasizing that proposed mechanism-technique mappings remain hypothetical. The framework generates specific, testable predictions regarding interoceptive precision changes, SC pathway modulation, directional eye movement effects, and differential mechanism engagement across techniques. We discuss implications for understanding existing approaches, address alternative mechanisms for eye movement effects, and distinguish between common factors and technique-specific components. This theoretical integration aims to advance mechanistic understanding of body-oriented trauma intervention and guide future empirical research.