07/17/2025
❓What’s the difference between “top-down” and “bottom-up” therapy, and why does it matter? ⁉️
🧠The words “top” and “bottom” are references to particular sections of the brain and what they are responsible for.
⬇️There are therapists who follow a top-down approach, which doesn’t always achieve the desired results as well as an integrative, top-down and bottom-up therapeutic practice.
🗣️Top-down forms of psychotherapy work exactly how they sound. Top-down forms of therapy work by specifically targeting functions within the cerebral cortex. This can then change how people think, behave, and function in daily life. Common forms of top-down therapy include Brief Solution Focused Therapy and Cognitive Behavioral Therapy. These forms of therapy may be helpful for some. For others, it may not be enough.
🎧Bottom up forms of therapy target the body, then the brain stem, the limbic system, and finally the cerebral cortex. This allows for healing to take place within the body and nervous system first, which can be negatively impacted by such things as stress, chronic illness, and the many forms of trauma.
👍🏻Bottom-up forms of therapy help to re-regulate the body and nervous system first to then allow the brain to heal from the brain stem up.
😬Through these forms of therapy, you will notice how it is possible to live your life and not be in a constant state of stress, worry, or fear. 😁
😎Once this is re-established in the body and lower brain, an individual’s emotions and thoughts will begin to shift to become more adaptive and less self-critical.
🧘🏽♂️Therefore, bottom-up therapy works on understanding sensations, education on the nervous system, grounding, mindfulness, and body awareness.
👌🏻The top-down methods alone might not be enough if not taking into consideration the automatic nature of the nervous system of the individual, or in other words, a body that is hardwired to perceive danger where there is none.