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Top down and Bottom up Approaches in therapy

Top-down networks integrated into the prefrontal cortex include those related to inhibiting and directing automatic responses, including emotional responses, to environmental stimuli. by Jane Leu Rekas


"Top-Down processing is our most highly developed way of processing information: using cognition (thinking), which takes place in the prefrontal cortex of the brain. In top-down processing, the prefrontal cortex uses current and past information to interpret a situation and direct the body on what to do next. The brain uses logic, planning, and problem-solving to make conscious decisions about what to do next, how to interpret something."

"In bottom-up processing, the input of sensory information is coming in from the external environment. Our sensory receptors in turn let the brain know whether we are safe. These processes occur without us even being conscious of them. In other words, the prefrontal cortex is not involved. Bottom-up psychotherapy methods use the wisdom of the body’s sensations and movements to access the trauma that is held in our fascia or connective tissue. We do not have to have conscious memory of traumatic experiences to process and heal trauma using bottom-up therapy approaches." source

Listen to Therapy Chat Podcast Episode 294 for more of the conversation with Robyn Brickel, MA, LMFT about top-down and bottom-up trauma therapy approaches.

In Episode 299 of Therapy Chat Podcast, two previous interviews with trauma therapist Lisa Ferentz, LCSW-C were put together in a replay episode in which Lisa and host Laura Reagan, LCSW-C talk about how trauma is held in the body and why bottom-up therapy methods are helpful. Listen here.

Bessel van der Kolk’s book, The Body Keeps The Score: Brain, Mind, and Body In The Healing Of Trauma

Mayo Clinic article on CBT:


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