Top-Down 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. However, research has shown that the brain’s ability to regulate arousal by thoughts alone is limited when faced with acute stess (LeDoux, J.). Bottom-up 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. In this way a person can integrate body sensations, thoughts and feelings.
