A Bottom-Up Approach to Trauma

In therapy there are two approaches to trauma. Both refer to the order of areas of the brain being addressed in the therapy. The first is top-down, and the second is bottom-up. When our brains grow in utero the brain stem grows first (reptilian brain, that contains our threat response), the next part is the Limbic system (the feeling brain), the last part to grow is the neocortex, the thinking brain.


When we work top-down, we are beginning the therapeutic process by engaging the neocortex, which controls thinking, language, personality and decision making.

The American Psychiatric Association (APA) recommends the use of Cognitive Behavioural Therapy (CBT) for treating PTSD. This is a top-down approach. CBT is a process that helps you to change your thoughts and replace them with more positive thoughts and behaviours.

The issue with this approach is that trauma de-activates the thinking parts of the brain, so it is very difficult to use this method when you are ‘triggered’. You are in fight or flight.


Here we start working with the brain stem, which governs automatic functions such as breathing and sleeping. This approach starts with the BODY. It recognises that trauma is stored in the body and the body needs to be engaged in the healing process, along with the mind.

I use Gendlin’s ‘Focusing’ as the primary method to work bottom-up with trauma. It allows the body to speak to us in a very safe way. We are with the feeling AND also safely in the present. There is a dual awareness of current safety and past lack of safety without feeling unsafe now.

As we connect with the body, the body becomes a safe place again. We start to inhabit our body in a new way and there is more energy for life again.


Van der Kolk (2014). The Body Keeps the Score.  London, UK: Random House.