What's the Difference Between "Top Down" and "Bottom Up" Approaches to Trauma Therapy?

The two most prevalent forms of psychotherapy for trauma are "top down" and "bottom up" psychotherapy.  The focus of this article will be to distinguish between these two types of psychotherapy and how each approach works with trauma therapy.

What the Difference Between "Top Down" and "Bottom Up" Approaches to Trauma Therapy?

The Top-Down Psychotherapy Approach in Trauma Therapy

Top down psychotherapy is a form of psychotherapy that is most used in the US.  With top down therapy, the basic premise is that if you change how you think, you will change how you feel. 

In top down psychotherapy, like cognitive behavioral therapy (CBT), the psychotherapist helps you to see the distortions in your thinking and change your behavior.

What's the Difference Between "Top Down" and "Bottom Up" Approaches to Trauma Therapy?

Top down psychotherapy focuses on the neocortex part of the brain, which is the part of the brain in charge of executive functioning.

One of the advantages of CBT is that it is easy to teach new psychotherapists.  It's not as complex as many of the experiential bottom-up approaches to therapy.

In my professional experience as a trauma therapist for more than 20 years, top down psychotherapy can work well for people under certain circumstances.  For instance, people who have phobias and who go for CBT often have good overcomes.

However, with regard to trauma therapy, I have found that many people don't overcome their traumatic experiences with CBT.  One important reason for this is that trauma therapy needs to focus on the limbic system in the brain where the trauma is stored--not on the neocortex, which is the focus of CBT.

I have found that when you focus on the neocortex in trauma therapy, the therapist can help the client to develop insight into their problems, but the trauma, which resides in the limbic system remains unresolved.

So, with CBT, the client has insight into the trauma, but nothing changes on an emotional level.  The client continues to be symptomatic for trauma.  In addition, the client is often confused as to why he isn't feeling better if he now has insight into his problem because he doesn't understand that insight isn't enough.

The Bottom-Up Psychotherapy Approach in Trauma Therapy

In the bottom-up psychotherapy approach in trauma therapy, there is more of a recognition of the importance of mind-body connection in resolving traumatic experiences (see my article: Mind-Body Oriented Psychotherapy).

What's the Difference Between "Top Down" and "Bottom Up" Approaches to Trauma Therapy?

Bottom-up psychotherapy is also known as experiential psychotherapy (see my article: Why Experiential Psychotherapy is More Effective to Overcome Trauma Than Talk Therapy Alone).

The bottom-up psychotherapy approach focuses on the limbic system of the brain where traumatic experiences are stored and where symptoms get triggered (see my articles: Coping With Emotional Trauma: Becoming Aware of Your Triggers).

Various forms of bottom-up psychotherapy approaches, which are experiential forms of therapy, deal with psychological trauma in different ways, and these include:

Somatic Experiencing focuses on the body discharging trauma-related energy through the body.  So, for instance, if someone is holding onto the trauma in the form of tension in her shoulders, the therapist might help the client to discharge this energy from the shoulders.  This usually happens in subtle ways (see my article: The Body Offers a Window Into the Unconscious Mind).

In EMDR Therapy (Eye Movement Desensitization and Reprocessing), there is a desensitization to the traumatic experience and a reconsolidation of the traumatic memories.  EMDR therapy posits that everyone is capable of adaptively processing information, including traumatic memories.   EMDR facilitates this processing (see my articles: How EMDR Therapy Works: EMDR and the Brain and Experiential Therapy, Like EMDR Therapy, Helps to Achieve Emotional Breakthroughs).

Clinical Hypnosis, also known as hypnotherapy, posits that all hypnosis is self hypnosis (see my article: All Hypnosis is Self Hypnosis).  The psychotherapist who is a hypnotherapist facilitates the process of helping the client to achieve a relaxing state in order to make the connection between the mind and the body to change traumatic experiences.  This always the client's unconscious experiences to become conscious (see my article: Clinical Hypnosis: Bridge Back to Heal Emotional Wounds).

Conclusion

Over the years, I have used both top-down and bottom-up psychotherapy approaches to help clients to overcome traumatic experiences.

My experience has been that bottom-up psychotherapy approaches are more effective in helping client to overcome trauma than top-down approaches.

 I also want to emphasize that even when I use a bottom up approach to therapy, depending upon the needs of the client, I usually at least some top down form of therapy.

Getting Help in Therapy

The effect of traumatic memories often gets worse over time without psychological help (see my article: The Benefits of Psychotherapy).

If you have been struggling with unresolved trauma, you could benefit from working with a psychotherapist who uses a bottom-up approach to trauma therapy (see my article: How to Choose a Psychotherapist).

About Me

I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

I work with individual adults and couples, and I have helped many clients to overcome their traumatic experiences.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.