Moving Beyond Talk Therapy: Why Trauma Therapy Requires Both Top-Down and Bottom-Up Approaches

When you’ve experienced trauma or live with chronic stress, anxiety, or nervous system dysregulation, you might know all the “right things” to do, yet still feel stuck. You may have even said to yourself, “I understand why I feel this way, so why can’t I change it?” This is where understanding top-down and bottom-up approaches to mental health therapy becomes important.

What Are Top-Down Approaches?

Top-down approaches start with the thinking and reasoning part of your brain (the neocortex). These therapies focus on understanding, insight, and developing conscious strategies to change unhelpful patterns.

• Cognitive Behavioral Therapy (CBT) – helps identify unhelpful thought patterns and practice new ways of thinking and responding.

• Narrative Therapy – reshapes the personal stories you tell about yourself, creating more empowering perspectives.

• Dialectical Behavior Therapy (DBT) – combines mindfulness, emotional regulation, distress tolerance, and interpersonal skills training to help manage intense emotions and improve relationships.

• Traditional talk therapy – verbally processing your emotions, exploring your experiences to gain insight and emotional clarity and perspective.

Top-down work can be incredibly helpful for understanding what happened, why you feel the way you do, and for building conscious coping strategies. However, because trauma and nervous system dysregulation lives in the body and often gets activated automatically and unconsciously, top down work alone usually is not enough to fully resolve many of the issues that bring people to mental health therapy. This is why it's common to hear people say things like, "I liked my therapist, and I really felt supported...but nothing really changed in my life, I'm not really sure it worked".

What Are Bottom-Up Approaches?

Bottom-up approaches focus on your body and nervous system first, helping to resolve how trauma and stress are stored physically and neurologically. These therapies target survival responses that often happen automatically—before you can think about them.

• Somatic therapies such as Somatic Experiencing - helping you sense and release stored tension and trauma patterns in the body. These therapies, such as Somatic Experiencing, guide you to tune into physical sensations, notice patterns of bracing or collapse, and gently release them so your body can experience safety again.

• EMDR (Eye Movement Desensitization and Reprocessing) – a structured approach using eye movements or bilateral stimulation to reprocess traumatic memories and reduce their emotional intensity, allowing your brain and body to respond from a place of present safety rather than past threat.

• Listening therapies such as the Safe and Sound Protocol (SSP) – using specially filtered music designed to calm the nervous system and improve emotional regulation. SSP helps people with sensory sensitivity, anxiety, trauma, or neurodivergence feel safer and more connected in their daily lives.

• Breathwork – using specific breathing techniques to support nervous system regulation and emotional release. Intentional breathwork can calm stress responses, improve emotional resilience, and reconnect you to your body’s natural rhythms.These therapies recognize that trauma isn’t only in your thoughts—it’s in your body, nervous system, and even unconscious survival patterns.

  
  

Why Bottom-Up Approaches Matter

Many people come to therapy believing, “If I can just talk about it enough, I’ll feel better.” While talking helps, it doesn’t reach the full impact of trauma because:

• Trauma lives in the nervous system as well as the mind.

• Survival responses like fight, flight, freeze, or shutdown often activate automatically.- We can’t simply “think our way out” of dysregulation.

• Safety is a body experience. Our nervous system constantly scans for safety or danger (a process called neuroception). This happens unconsciously, so we can't simply think our way into safety- our body has to experience it.

Bottom-up work gives the body a chance to feel safe again, repattern old survival responses, and reset. When combined with top-down approaches, it creates a more complete path to healing—one where both the mind and the body can process, integrate, and move forward.

Finding the Right Therapist: Moving Beyond Talk

If you’re seeking therapy for trauma, anxiety, depression, nervous system regulation, or if you live with neurodiversity (such as ADHD or Autism), it's important to look for a therapist who integrates both top-down and bottom-up approaches. Top-down work offers clarity and insight. Bottom-up work creates safety and lasting change in the nervous system. At Golden Whole Being Therapy, we specialize in moving beyond talk—helping you connect to both your mind and body so you can release old patterns, reclaim your vitality, and move forward with more ease and confidence.