What Do “Top-Down” and “Bottom-Up” Processing Mean in Trauma Therapy?
What Do “Top-Down” and “Bottom-Up” Processing Mean in Trauma Therapy?
If you’ve explored trauma therapy, you may have come across the terms “top-down” and “bottom-up” processing. These phrases can sound technical, but the ideas behind them are actually quite simple — and helpful to understand if you’re considering therapy.
At their core, these terms describe different ways the mind and body process experience, particularly when someone has been through trauma.
Top-Down Processing: Starting with the Thinking Mind
Top-down processing refers to approaches that work primarily through thinking, understanding, and meaning-making.
In everyday terms, this includes things like:
Talking about experiences
Understanding patterns in thoughts and emotions
Making sense of what happened and how it has affected you
Learning strategies to manage distress
Many traditional forms of talk therapy, including Cognitive Behavioural Therapy (CBT), work largely in this way.
For many people, top-down approaches can be very helpful. They can bring clarity, insight, and a sense of validation. Understanding why you feel the way you do can be an important part of healing.
At the same time, some people notice that even when they understand their trauma logically, their body still reacts automatically — through anxiety, tension, shutdown, or panic.
Bottom-Up Processing: Starting with the Body and Nervous System
Bottom-up processing starts from a different place. Instead of beginning with thoughts, it focuses on physical sensations, emotions, and the nervous system.
This might involve:
Noticing bodily sensations (such as tightness, warmth, or heaviness)
Paying attention to breathing, posture, or movement
Learning ways to support nervous system regulation
Developing a sense of safety in the body
These approaches recognise that trauma often affects the body before the thinking mind has a chance to intervene. Reactions can happen very quickly and outside of conscious awareness.
For some people, working gently at this level can help reduce overwhelm and create a foundation of safety that makes talking and reflection easier later on. These ideas are well supported in trauma research that explores how cognitive understanding and nervous system responses interact.
Why Trauma Therapy Often Uses Both
Rather than being “either/or,” top-down and bottom-up processing are often most effective when used together.
Top-down approaches can help you understand your experiences and feel less confused or self-blaming.
Bottom-up approaches can help your nervous system feel safer and less reactive.
When combined thoughtfully, they support both insight and regulation — helping the mind and body move in the same direction.
Importantly, trauma therapy is not about forcing memories or pushing through distress. A trauma-informed approach prioritises choice, pacing, and safety, recognising that everyone’s nervous system responds differently.
A Gentle, Individualised Process
There is no single “right” way to process trauma. What feels helpful for one person may feel overwhelming or unhelpful for another, and this can change over time.
Understanding these concepts can help you make sense of why a therapist might sometimes focus on talking and reflection, and at other times on grounding, body awareness, or regulation skills.
Both approaches aim toward the same goal: supporting greater stability, safety, and capacity in daily life.
References
Ogden, P., Minton, K., & Pain, C. (2006). Trauma and the Body: A Sensorimotor Approach to Psychotherapy.
Siegel, D. J. (2012). The Developing Mind (2nd ed.).
Herman, J. L. (2015). Trauma and Recovery.
Disclaimer:
This article is intended as general information only and does not replace individual psychological assessment or treatment.