Speech therapy, physio and burp retraining (BERP)
Quick summary
- A speech therapy routine called BERP (Behavioural Eructation Retraining Protocol, "eructation" means burping) teaches body positions that help a burp out.
- In a small US study, 6 of 7 people (opens in a new tab) got lasting relief. But they also had Botox. It was tested alongside Botox, not instead of it.
- In the UK, speech and language therapists mostly see people with swallowing problems. Few will know R-CPD, so take the research with you.
What is BERP?
BERP was made by a voice team at Yale in the US. A speech and language therapist teaches you a position with the following features: laryngeal lowering, jaw protrusion, head turn and tuck, and torso anchoring (opens in a new tab). In plain words:
- Lower your voice box, as if you're about to yawn.
- Push your jaw forward a little.
- Turn your head and tuck your chin.
- Hold your body steady ("torso anchoring"), for example sitting firmly with your back supported.
Each step is taught in isolation, followed by the integration of the steps into a coordinated movement (opens in a new tab). So you learn one move at a time, then put them together.
Did BERP work?
In the study, 7 people had R-CPD that Botox hadn't fully fixed, or that came back. After an average of 3.7 BERP sessions, 6 patients achieved durable relief (opens in a new tab), although 2 of them also had more Botox. Six of the seven could burp using the position during their initial appointments (opens in a new tab). Some called themselves "a burping machine" (opens in a new tab).
The authors call it a promising adjunct (opens in a new tab). That means an extra help alongside Botox, not a replacement. It's a small study, and it hasn't been tested in people who never had Botox.
Can you learn to burp with a coach?
A 2026 review mentions a man who learned to burp himself 15 years ago and has since personally coached 30 individuals (opens in a new tab), with "consistently positive results". He teaches a low growl, timed with a push from the tummy. That's a story the review authors were told, not a study. See relaxing into the burp.
There's another reason to think the throat can learn. In Dr Bastian's first study, after Botox the majority seem to have "retrained" the ability to belch (opens in a new tab) for the long term.
How do I find a speech therapist or physio in the UK?
- On the NHS: ask your GP. Speech and language therapists mainly help people with swallowing problems, and the NHS says your GP may refer you to a speech and language therapist or a dietitian (opens in a new tab) for swallowing trouble.
- Privately: the Association of Speech and Language Therapists in Independent Practice has a find a therapist search (opens in a new tab).
- Physio: the NHS says you can get physiotherapy for free on the NHS, but there may be a long waiting list (opens in a new tab). A physio can help with neck and back exercises, and posture.
- Check they're registered. Speech and language therapists and physiotherapists in the UK must be on the HCPC register (opens in a new tab).
- Take the research. Print the BERP study (opens in a new tab) and our one-page explainer to help them understand R-CPD.
What do people with R-CPD say?
“I taught myself to burp through all the incredible information on this sub that merged into a routine of stretching, strengthening my neck muscles, singing lessons, breathing exercises”
“I focused on the torso anchoring as the most useful way to get small burps and then they've kept getting larger and easier from there”
“at least in my experience, with practise, I've been able to skip most of the steps and just have to lower my larynx.”
Patient reports. Short quotes, linked to the original post. We leave out usernames.
Frequently asked questions
Can a speech therapist help with R-CPD?
Possibly. In a small US study, a speech therapy routine called BERP helped 6 of 7 people (opens in a new tab) burp, alongside Botox. Not many UK therapists know about R-CPD yet.
What is BERP for R-CPD?
BERP stands for Behavioural Eructation Retraining Protocol. It teaches laryngeal lowering, jaw protrusion, head turn and tuck, and torso anchoring (opens in a new tab), which are positions that help a burp out.
Is BERP instead of Botox?
No. In the study it was used as an adjunct (opens in a new tab) for people Botox hadn't fully helped. Nobody has tested it on its own yet.
Sources
- Keltz et al. 2025, Laryngoscope (opens in a new tab)
- Lehmann and Kahrilas 2026, narrative review (free full text) (opens in a new tab)
- Bastian and Smithson 2019, OTO Open (free full text) (opens in a new tab)
- NHS: Swallowing problems (dysphagia) (opens in a new tab)
- NHS: Physiotherapy (opens in a new tab)
- ASLTIP: Find an independent speech and language therapist (opens in a new tab)
- HCPC: Check the register (opens in a new tab)
Other things people try
- Shaker exercise (head lift)Lie flat and lift your head to look at your toes. The exercise people mention most.23 of 120 people mention it
- Relaxing into the burpNotice the gurgle, relax your throat and let it come up. Don't force it.78 of 120 people mention it
- Side neck sit upsLie on your side and lift your head towards the ceiling. Often done with the Shaker.12 of 120 people mention it
- Throat massage and pressureGentle massage around the voice box. Never hitting or squeezing your neck.21 of 120 people mention it
- Back, chest, yoga and postureGym work, yoga, physio for the back, and sitting up straight.23 of 120 people mention it
- Fizzy drinks and positionsLying on your left side, chin tucks, head turns, and practising with a fizzy drink.47 of 120 people mention it
- Swallowing airA few people gulp air to practise. It can make bloating worse, so read the warnings.25 of 120 people mention it
- Diet: less gasLow FODMAP, fewer fizzy drinks, eating slowly. Can ease symptoms while you try other things.7 of 120 people mention it
- HypnosisThe only non-Botox, non-surgery case in the medical papers so far.Backed by one published case
- Speech therapy and physio (BERP)A therapist teaches you positions to let a burp out. Tested in a small study.7 of 120 people mention it
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