A ‘top-down’ therapy is one that aims to create a positive change in the individual’s behavioural, 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 processes 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 an unconscious, nonverbal level and that this is manifested in various physical and bodily ways, such as :

  • body posture

  • how the person movesĀ 

  • pain and bodily sensations

Bodily reactions to emotions, events and situations In essence, then, ‘bottom-up’ approaches to the treatment of the adverse effects of trauma aim is to correct the sensorimotor dysregulation that has occurred as a result of childhood trauma. Examples of ‘bottom-up’ therapies for treating the bodily effects of trauma include :

  • sensorimotor psychotherapy

  • yoga

  • somatic experiencing

  • breathing exercises

  • EMDR

  • drama

  • singing

  • drumming

  • tapping / Emotional Freedom Technique


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