How We Can Work Top-Down with The Brain to Heal Trauma

The American Psychiatric Association (APA) recommends the use of psychotherapy in the form of Cognitive Behavioural Therapy (CBT) to treat PTSD (APA, 2010). CBT is a process that helps you to change your thoughts and replace them with more positive thoughts and behaviours. With trauma, the aim is to change the narrative of the trauma and create a more organised felt sense of the self in the body.

CBT is a top-down approach. It starts with the neocortex, where we can process thoughts and rationalise. Once we have shifted our thinking and gained insights, changes take place in the mammalian brain around our emotional responses, and finally the reptilian brain becomes calmer.

In my experience this is most effective when combined with a bottom-up approach. When there is repeated trauma the neocortex is off circuit. The body responds before we have had a chance to process what has happened. The trauma is held in the body and working with the mind alone does not produce a holistic healing.

I have found a need to work primarily from the BOTTOM-UP, using bits of top-down as we go to integrate the experiences. Modalities which do this well are EMDR and the Sensorimotor Approach.

Ogden, Pain & Fisher (2006) believe that when “somatically informed top-down management of symptom(s) is thoughtfully balanced with bottom-up processing of trauma-related sensations, arousal, movement, and emotions the complex effects of trauma are more likely to respond to treatment” (p.17).

Take good care my friends and make sure you get help if you know you are experiencing the aftereffects of trauma.


Ogden, P., Pain C., & Fisher, J. (2006). A sensorimotor approach to the treatment of trauma and dissociation. Psychiatric Clinics of North America, 29, 263-279