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Repairing The Traumatized Brain: The Staircase Metaphor

Over the centuries various metaphors have been used to help explain the brain and its functioning. These metaphors have tended to reflect the most advanced technology that had been created at the time such as springs and levers, steam engines, and, most recently, computers.

Another recent way of describing the brain was by splitting it into 3 parts (the triune brain) and labeling them the reptilian brain, the mammalian brain, and the homo sapiens brain representing the brain stem, the limbic system, and the neocortex respectively.

A very similar analogy but instead of using the terms the reptilian, mammalian homo sapiens brain to describe the brainstem, limbic system, and neocortex use the terms stair step 1, stair-step 2, and stair-step 3, respectively. This staircase metaphor is particularly applicable to the brain when we are trying to decide on whether the therapy we choose to deal with our trauma reflects a bottom-up approach or a top-down approach. 

A top-down approach focuses on the higher parts of the brain (stair-step 3) whilst a bottom-up approach strat with the lower part of the brain (stair-step 1).

Because top-down therapy focuses on stair step 3 and the higher parts of the brain, including the neocortex and frontal cortex, therapy tends to involve talking, cognitions (thoughts), and emotional awareness. And, because bottom-up therapy focuses on stair step 3, it focuses on the base of the brain (the brain stem) which is involved in reflexes, memory, learning, and automatic survival responses. Stair step 2 represents the limbic system (a region of the brain involved in behavioral and emotional responses, particularly those directly related to our survival such as eating, sex, the fight/flight response, and nurturing our young.

In the case of severely traumatized individuals, it has been argued that it is best to start therapy with a bottom-up approach because, if the brain has experienced severe and protracted trauma, the prefrontal cortex significantly shuts down thus impairing our ability to think. This means the prefrontal cortex is unable to override the overactive brain stem, to which trauma energy has been diverted, leaving us in a state of severe tension, agitation, fear, and hypervigilance. So bottom processing aims to relieve the bodily/biological symptoms of trauma starting on stair step1 so that the staircase may be ascended to reach stair step 3 once it is possible for us to think clearly again. To read more about bottom-up therapy, click here.