How Top-Down and Bottom-Up Therapy Works Together

At Sequoia, we use an integrative approach to treatment, meaning that we utilize multiple different therapies in tandem. It’s not because we’re simply seeing what works. We do it because different therapies work differently, and when they’re used together, work better than alone.

In this article, we’ll talk about the different approaches to therapy and why we use them together at Sequoia Behavioral Health.

Top-Down Therapy

Talk therapies that focus on controlling emotions and finding logic are considered top-down methods. These work on finding reasons for your reactions and paving the way to regulate yourself better.

The most common examples are cognitive behavioral therapy (CBT) and dialectical behavioral therapy DBT). Both of these help you connect thoughts, emotions, and behavior in order to control them and create healthier behavior patterns.

Learn more about cognitive behavioral therapy and dialectical behavioral therapy at Sequoia.

The reason we call these and similar modalities top-down therapy is because they create change in the prefrontal cortex of the brain. This section of your brain is where we use reasoning and problem-solving. It uses current inputs and memories from the hippocampus to make your decisions. Top-down processing is rooted in making conscious decisions and controlling your thoughts. 

Bottom-Up Therapy

Bottom-up processing begins within the body with unconscious interpretations of external stimuli. The most apparent example of bottom-up therapy is somatic-based interventions.

What differentiates bottom-up processing and top-down processing is where the “re-wiring” begins. Top-down therapy targets our brain to use logic to change our reactions and behaviors. Bottom-down therapy targets the unconscious body systems to affect change. 

Somatic Therapy

Somatic therapy works by paying attention to your physical reactions to traumatic memories. This usually involves being mindful of trauma responses, including increased heart rate, tense muscles, heavy breathing, or even crying. Through somatic interventions, you’ll neutralize your feelings about the trauma by placing meaning on your feelings and responses.

Learn more about somatic-based therapy at Sequoia.

EMDR

Eye movement desensitization and reprocessing (EMDR) is another very common example of bottom-up therapy. It uses natural brain mechanisms to reframe how we recall traumatic memories.

Learn more about EMDR at Sequoia.

Why They Work Best Together

There are certain scenarios and mental health concerns that can be resolved with just top-down therapy. However trauma, substance use, and severe anxiety and depression are best treated using both types of therapy.

Top-down therapies can help you understand what you’re experiencing and how to be mindful. This creates a sense of safety and helps you stay grounded during difficult trauma processing in bottom-up therapies. 

Inversely, a bottom-up therapy can resolve those unconscious reactions to trauma so that your therapist can utilize a top-down approach to work through your thoughts and feelings without a fight-or-flight response.

Integrative Therapy at Sequoia Behavioral Health

Trauma and mental health disorders aren’t universal, and the treatment for them shouldn’t be either. Combining top-down and bottom-up approaches help resolve symptoms and treat the root of your concerns together. 

Your journey at Sequoia begins with a few conversations so that we can get to know you, what brought you to us, and what we can do to help. Our team are experts in multiple different top-down and bottom-up therapy modalities that we use together for complete healing.

Reach out today to get started.