‘Top-Down’ And ‘Bottom-Up’ Approaches To Dealing With Effects Of Childhood Trauma.


A ‘top-down’ therapy is one that aims to create a positive change in the individual’s behavioral, emotional and somatic symptoms in a ‘top-down’ direction (i.e. by beneficially ALTERING THE INDIVIDUAL’S THOUGHT PROCESSES). Techniques for doing this include cognitive restructuring and increasing the traumatized individual’s insight into his or her condition, amongst many others.

Whilst ‘top-down’ therapies are necessary, and can be very effective, there is now a growing realization, when treating the traumatized individual, the addition of ‘bottom-up’ therapeutic techniques may be of paramount importance in relation to treating the bodily adverse effects of trauma such as sensorimotor symptoms and autonomic dysregulation.


Unlike ‘top-down’ therapies, which concentrate on an individual’s thinking processess to treat the effects of trauma, ‘bottom-up’ therapies concentrate upon BODILY EXPERIENCES as an initial route through which to treat the effects of trauma by ameliorating dysfunctional trauma-related, chronic and automatic bodily responses. This approach is taken because it is theorized that our nervous systems and muscles store distressing images and memories on a unconscious, nonverbal level and that this is manifested in various physical and bodily ways, such as :

  • body posture

In essence, then, ‘bottom-up’ approaches to the treatment of the adverse effects trauma aim is to correct the sensorimotor dysregulation that has occurred as a result of childhood trauma. (In relation to this, you may also wish to read my previously published article entitled : OFTEN AGGRESSIVE? HAS YOUR SENSORIMOTOR SYSTEM BEEN PRIMED BY CHILDHOOD TRAUMA TO DEAL WITH THREAT?’)

Examples of ‘bottom-up’ therapies for treating the bodily effects of trauma include :

  • sensorimotor psychotherapy
  • drama
  • singing
  • drumming

David Hosier BSc Hons; MSc; PGDE(FAHE).

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About David Hosier BSc Hons; MSc; PGDE(FAHE)

Psychologist, researcher and educationalist.

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