Top Down vs Bottom Up

We’re talkin’ approaches to therapy and healing here, so it feels like the right time to remind us of something.

The thing about you, me and everyone else in this world is that we’re one-of-a-kind, baby. What works for me might not work for you and if you’re happy to share, I’ll be all ears and keen to hear about your experiences with these approaches. 

Let's start with what they actually are, in a nutshell.

Top Down: 

This focuses on cognition (fancy word for thinking, perceiving and reasoning) and the top areas of the brain like the frontal lobes and prefrontal cortex (the area of the brain responsible for logic and reason), and relies on language, reason and logic.

It’s concerned with how the mind interprets information, and the goal is to ‘re-wire’ the way we think to change how we feel and act. I’ve had great results with it in the past, but I’ve also been frustrated by the fact that it’s dependent on the ability to remember and apply these strategies forever (which I’ve found to be super difficult).

Examples of a top down approach include cognitive behavioural therapy (CBT), exposure therapy and psychoanalysis.

Bottom Up:

These approaches use the lower regions of the brain (the brain stem and limbic system) which are responsible for memories, learning, reflexes and the fight/flight/freeze/fawn responses. We humans absorb information from both internal and external environments and with this information, the body decides whether or not it is safe. 

This process happens automatically and first; therefore bypassing the rational prefrontal cortex, and bottom up approaches emphasise that we need to feel safe in our bodies before we can regulate our responses. These approaches use sensory information, the body and movement to access, process and integrate experiences so that we can re-pattern our responses.

For many years, this approach was the missing piece of the puzzle for me and that’s why it’s such a big focus and point of exploration for me these days.

Examples include yoga therapy, somatic therapy, dance or art therapy, and polyvagal theory (to name a few).

In a later blog, I’ll chat a bit more about my own experiences with these types of therapy in relation to my OCD but for the meantime, I’d love to hear from you. Do you have experiences or opinions on either of these approaches? Lemme know below!

I’d also like to give you a little somethin’ somethin’ as a way of thanking you for being here - a guide to 5 x body-based anxiety hacks.