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Top-Down or Bottom-up?

Updated: Oct 8, 2022

"We need to respect our body’s reactions rather than continually trying to develop the skillset that rejects whatever our body is telling us." - Stephen Porges, Ph.D.

In our cognitive-centric world- where we highlight the brain as this amazing machine, a center of executive control of our bodies, behavior, and to a certain extent our lives- we have come to accentuate, value, and prioritize top-down mechanisms, often with an underlying belief that the Self is a piece of clay that can be shaped with our cognition and our actions are completely under our voluntary control. With this view of the brain as an amazing machine, we have created-perhaps accidentally- a dichotomy of brain-body, as if they were two distinct objects existing in space in a close relationship but easily separated into two pieces.

The truth is, our nervous system extends through our whole body and our somatic experience (body sensations that come through our senses, both coming from the outside and the inside) is intrinsically related to how we perceive the world around us. We still have an intuitive understanding of this... we know that we might get "hangry". Sometimes we don't even realize we are hungry until we realize we are getting easily irritated at the moment (then you might think, "Oh, right. I only had coffee for breakfast this morning!").

Our nervous system is not just localized in our brain/head, it extends through our whole body; nerves travel inside the spinal cord and branch off through all parts of the body. Though we might know this, sometimes we downplay the influence our body "from the neck down" has on our minds. The messages of sensory information and bodily states and needs and how they influence our brain's functions are known as bottom-up processing. However, rather than top-down (cognition or executive functions regulating our bodies) or bottom-up (sensations coming from our body regulating our minds), these systems work in a constant feedback loop, they influence each other in a reciprocal manner.

At the most basic level, they have one function: preservation, keeping you alive. Their mechanisms work as regulators. Going back to our culture's emphasis on top-down strategies, we frequently discuss how we can control or modify our behaviors, leaving aside their function as a regulation strategy. In reality, there is a lot more than just observable behaviors... Often, body sensations (even if they aren't under our awareness yet) and how our system interprets cues from our body and the environment precede behavior. Behaviors are can be seen as strategies to regulate physiological states; but this may not be entirely under our control, especially when we are disconnected from our bodily sensations and their messages.

How can therapists help?

Therapists help their clients build a resource kit that involves both types of strategies. They might use principles of interventions such as Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), or Dialectical Behavioral Therapy (DBT), top-down strategies that might include reframing your thoughts, identifying your personal values, and cognitive dissonance (inconsistent thoughts, beliefs, or attitudes) that help you change your thinking, attitudes, perceptions, and eventually influencing your choices and behaviors. They'd also build bottom-up resources, and interventions such as Eye Movement Desensitization and Reprocessing (EMDR), Accelerated Resolution Therapy (ART), and Somatic Experiencing Therapy, build upon these resources. Breathwork, as well as other tools and exercises, help you increase awareness and observation of your physiological shifts when presented with daily challenges (changes in breathing pattern, heart rhythm, or gut feelings) using different strategies to use your body for regulation (breathing exercises, eye movements, tapping, touch, sound, and others).

In trauma contexts...

When speaking about trauma treatment, this becomes particularly important. When you learn to recognize your body's reactions as adaptive strategies that kept you safe and minimized danger and pain the best it knew how to at the moment, your sense of self-compassion grows. Those reactions may have been 'stuck' in the body, but now you have the knowledge and strategies to help them complete their cycle and help you find new strategies that are adaptive to your present context (in contrast with reacting in light of past events).

Additionally, trauma doesn't reside only in explicit memory (conscious, intentional recollection of factual information, previous experiences, and concepts). Traumatic memories are largely encoded in our implicit memory (not readily accessible to our awareness), with strong emotional associations and directly link to our physiology. Viewing our behaviors through this lens helps us foster self-compassion. Developing and expanding our regulation resources empowers us and gives us an opportunity to build a better relationship with ourselves and others.

Drawing of a brain titled "Brain-Based Approaches to Help Clients After Trauma".
Image credit: The National Institute for the Clinical Application of Behavioral Medicine (NICABM)


Porges, S. W. (2017). The pocket guide to polyvagal theory: The transformative power of feeling safe.

Ashwell, Ken W. S. & Restak, Richard M. (2012). The brain book: development, function, disorder, health. South Yarra, Vic: Palgrave Macmillan

Thaina Cordero is a Certified Sexologist and Care Coordinator at Cypress Wellness Center. She has an MS in Educational Psychology, is a trauma-informed yoga teacher, and doctoral student of Clinical Sexology at Modern Sex Therapy Institute. She has completed Levels 1 and 2 of Clinical Foundations in Gottman Method Couples Therapy. She helps individuals and couples explore their sexual expression, needs, fantasies, preferences, curiosities, and difficulties as they create more pleasurable, satisfying, and fulfilling sex life and relationships. Click here to request an appointment.

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