When we work with trauma from a top-down perspective, we start with the brain—specifically the neocortex, the part responsible for thinking, meaning-making, and language.
Cognitive Behavioural Therapy (CBT), recommended by the American Psychiatric Association to treat PTSD, helps us reframe traumatic stories and shift how we think and behave. As our thoughts change, our emotional brain (limbic system) and survival brain (brainstem) begin to settle.
But here’s the catch: trauma isn’t just in the mind—it lives in the body.
In cases of repeated or developmental trauma, the thinking brain often goes “offline.” The body reacts before the mind can process. That’s why healing is most powerful when we combine top-down approaches like CBT with bottom-up therapies that work directly with body sensations, movement, and nervous system regulation.
As Ogden, Pain & Fisher write, when top-down management is thoughtfully balanced with bottom-up processing, “the complex effects of trauma are more likely to respond to treatment.”
If you’re navigating trauma, make sure you’re getting support that honours both your mind and your body. You deserve holistic healing.Take care,
Love, Jen
