A Comprehensive Guide to Bottom Up Treatment: Healing Trauma from the Roots

The prevalence of trauma, anxiety, and depression has led to breakthroughs in psychotherapy and counselling. One such approach that has gained significant traction is the “bottom up treatment.” This cutting-edge therapy is transforming how we approach mental health, particularly with trauma recovery.

At Inquire Talk, we understand the importance of mental health and wellbeing. Our passionate therapists are dedicated to providing online counselling, therapy and psychotherapy to individuals seeking support and assistance.

Understanding Trauma

The term ‘trauma’ encompasses experiences that overwhelm an individual’s ability to cope, leaving them feeling helpless, horrified, or profoundly threatened. Trauma could stem from a single event, such as a natural disaster, or from ongoing stressors like abuse or neglect. When trauma occurs, it impacts not just the mind but also the body, creating a lasting imprint that can manifest as mental, emotional, and physical symptoms.

The Neuroscience of Trauma

Trauma impacts the brain in complex ways. It activates the brain’s alarm system, sending it into a state of high alert, leading to the classic ‘fight, flight, or freeze’ responses. Neuroscientific research reveals that trauma affects the brain’s structure and function, particularly in areas responsible for emotion regulation, memory, and perception. This neurobiological impact underscores the need for therapeutic approaches that address both the brain and body.

Top Down vs Bottom Up Treatment: A Comparison

Traditionally, psychotherapy has employed a “top-down” approach, focusing on cognitive processes. Cognitive Behavioural Therapy (CBT), for instance, emphasizes changing maladaptive thought patterns to alter feelings and behaviours.

However, top-down methods often fall short when dealing with trauma. This is because trauma responses are automatic and originate in the lower regions of the brain, beyond cognitive control. Simply put, you can’t “think” your way out of trauma.

This is where “bottom up treatment” comes in. Bottom up therapy engages the body’s sensory experiences to regulate emotions and address trauma at its roots. This approach recognizes that feelings and body sensations often precede conscious thoughts, especially in the context of trauma.

A Closer Look at Bottom Up Treatment

The foundation of bottom up therapy lies in its focus on the body’s innate wisdom. This therapy uses sensory awareness and body-based techniques to access and heal trauma stored within the body, bypassing the cognitive processes that often struggle to articulate traumatic experiences.

The bottom up treatment approach starts by stabilizing the individual’s environment and helping them regulate their sensory experiences. This stability and regulation are achieved through patterned, repetitive activities that reorganize the brain’s functioning, soothing the fear response and promoting a sense of safety.

The Significance of Bottom Up Treatment for Trauma

Bottom up treatment is especially effective for individuals who have experienced early or complex trauma. These individuals often have a dysregulated nervous system, with their bodies locked into a constant state of ‘fight, flight, or freeze.’ This dysregulation impedes their ability to form secure attachments, manage their emotions, and engage in thoughtful reflection and learning.

By addressing trauma from a body-based perspective, bottom up treatment can help individuals move out of survival mode and into a state of security and connection. This shift allows for healthier relationships, emotional regulation, and improved cognitive functioning.

The Neuro-Sequential Model of Therapeutics

A significant model in bottom up treatment is the Neuro-Sequential Model of Therapeutics (NMT), developed by psychiatrist Bruce Perry. NMT is a phased, flexible approach that organizes therapeutic techniques in the order that the brain develops and heals. This model is grounded in the understanding that the brain develops from the bottom up, starting with the brainstem (responsible for survival responses), then the limbic system (regulating emotions and behaviour), and finally the cortical brain (responsible for thinking, planning, and learning).

A Comprehensive Guide to Bottom Up Treatment

Stages of Brain Development and their Therapeutic Implications

1. Motor and Sensory Input (Brain Stem/Mid Brain) The first stage focuses on regulating the brain stem, the most primitive part of the brain responsible for survival responses like fight, flight, or freeze. This regulation is achieved through patterned, repetitive activities like dance, drumming, or sensory-based interventions.
2. Attachment, Emotions, and Behaviour (Limbic Brain) Next, therapy focuses on the limbic system, which governs emotions and behaviour. Secure attachments are fostered, and emotional responses are managed.
3. Thinking, Planning, Inhibiting & Learning (Cortical Brain) Finally, the focus shifts to the cortical brain, where cognitive functions like thinking and learning take place. This stage involves more traditional talk therapy, offering opportunities for reflection, understanding, and insight.

Modalities of Bottom Up Therapy

Several therapeutic methods align with the bottom up treatment approach. These include:

1. Somatic Experiencing: This therapy focuses on the body’s sensations to resolve trauma symptoms.
2. Eye Movement Desensitization and Reprocessing (EMDR): EMDR uses bilateral stimulation to access and heal trauma.
3. Internal Family Systems Therapy: This therapy promotes healing by accessing and addressing the individual’s inner parts.
4. Expressive Arts Therapy: This therapy uses various art forms to facilitate trauma healing.
5. Sensorimotor Psychotherapy: This body-oriented approach integrates sensorimotor processing with cognitive and emotional processing in the treatment of trauma.

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Supporting Individuals with Developmental Trauma

Individuals with developmental trauma—prolonged, repeated trauma occurring in childhood—can significantly benefit from bottom up treatment. These individuals often struggle with insecure attachment, emotional dysregulation, and cognitive difficulties. Bottom up treatment addresses these issues in a gentle, invitational manner, allowing the individual to process their trauma in a safe, controlled environment.

What to Expect in Bottom Up Treatment

The first phase of bottom up treatment focuses on creating a safe, stable environment for the individual. This phase involves teaching the individual about the biology of trauma responses and practicing emotion regulation skills based on biological cues.

Once the individual feels secure, therapy transitions to addressing the traumatic memories stored in the body. This stage is approached with care to avoid retraumatizing the individual. The goal is to help the individual understand that the danger they are responding to is in the past and that they are safe in the present.

Through this process, bottom up treatment empowers individuals to reclaim their bodies, regulate their emotions, and redefine their narratives, paving the way for a healthier, more resilient future.

Conclusion: An Integrated Approach to Trauma Treatment

In sum, bottom up treatment is a transformative approach to trauma therapy that addresses the root causes of trauma in the body. While cognitive therapies have their place, a comprehensive, effective trauma treatment plan should include both top-down and bottom-up approaches, recognizing the intricate interplay between the mind and body in traumatic responses.

Inquire Talk is committed to fostering mental health and wellbeing. Our therapists are trained in various therapeutic approaches, including bottom up treatment, to provide holistic, personalized support for individuals navigating trauma and other mental health challenges. Reach out to us today to embark on your healing journey.

Inquire Talk certified therapists who you can get in touch and book a therapy session with:

Dr Simon Cassar

Glen Gibson

Simon Jacobs