The process of healing is tricky. It’s full of stops and starts, times of growth, and moments when you’ll feel stalled or even like you’re going backward.

In the moments where the night seems darkest, it’s worth keeping in mind that healing can be reignited or even given a boost by shifting your perspective. Sometimes we’re not ready to talk through what has happened to us – sometimes talking and thinking may even have become part of the problem. Moving from a ‘top down’ to a ‘bottom up’ approach might be just what you need to get un-stuck or make sense of your experience.

So what am I talking about?

Bottom up and top down approaches refer to the ‘point of access’ we’re starting with. A ‘top down’ approach starts at the top – with our brains, and a ‘bottom up’ approach starts with the body.

‘Top down’ approaches involves focus on our conscious minds by doing things like:

  • Talking things through with someone, which can untangle the knots of what has happened to us, how we have coped, or how our coping mechanisms have let us down.
  • Learning about what psychological theory has to say about your experience. This is sometimes called ‘psychoeducation’ and it can also be helpful for reframing and expanding our sense of who we are, and what our symptoms mean. Learning new skills, reading books or research, or doing courses like DBT skills training is also in the ‘psychoeducaton’ field.
  • Participating in groups or online forums, which can help us see how others have made change, or to feel less alone.

Sometimes ‘top down’ approaches can be effective all by themselves. Talking can help us articulate and reframe painful stories we’ve told ourselves as well as to increase our understanding of the contexts and systems impacting our experience, or unravel knots that have held us at an impasse for years.

Many people benefit from a ‘top down’ approach, and some people will need only a few sessions of therapy and some resources like books, grounding skills or referral to a peer support group to get un-stuck. For others, ‘top down’ approaches aren’t enough. Sometimes they don’t seem to work at all.

This is one of the challenges a ‘talk therapist’ faces – that occasionally there’s only so far thinking and talking about an issue can take us. Sometimes you’ll go to therapy and work hard and be sincere in your desire for change, but find that meaningful change just doesn’t happen. Maybe you’re not in a place where you’re ready to act on the things you learn by talking, or you’ve talked and understood until you’re blue in the face, but the painful inner experiences you came to therapy to work on haven’t shifted.

For people impacted by trauma or dysregulating experiences this frustrating block to change  is especially true. Sometimes all the intellectual insight in the world doesn’t start to shift the feelings our body carries around, and every once in a while, it’s actually the ‘thinking’ and ‘problem solving’ activities that are keeping us stuck! If you’re a person who reflects deeply, considering all options, and seems unable to feel confident or good about the choices she is making, then perhaps taking a break by engaging with “bottom up” modes of healing can be a useful step.

A ‘bottom up’ therapeutic modality is one that starts with the body – its sensations, feelings, and other ‘somatic’ experiences. ‘Somatic’ technically refers to our internal experience of our bodies. We sense our inner experience via systems like:

  • The vestibular system – this is related to the inner ear and gives us our awareness of balance and motion.  
  • The proprioceptive system – this comes from ‘proprioceptors’ – neurones in our muscles, tendons and joints, and they give us our sense of movement, position in space and the force our muscles are using.
  • The more familiar five senses of vision, hearing, touch, smell and taste – all of these have complex relationships with one another and with the nerves and neurons. For example, it’s possible for a person born blind to have well developed areas of the brain that deal with sight, and for amputated limbs to ‘feel’ itchy.
  • All of this is coordinated at lightning speed by our central nervous systems, including our sympathetic and parasympathetic nervous systems. This is where polyvagal theory (exciting and useful but still to be accepted as strongly evidence based) comes in, and anyone interested in a ‘bottom up’ approach will likely be interested in polyvagal modes of healing!

“Bottom up” activities aren’t always formal mental health therapies, but they are increasingly recognised as powerful partners in healing. Neuroscience has spent the last couple of decades catching up with the idea that our bodies are intelligent contributors to our consciousness, and there’s tons of evidence that our felt emotional and sensory systems are (in fact) as important to the quality of our lived experience and wellbeing as our brains. In fact, there’s evidence that some memories might be accessed via sensory information rather than the brain.

The most widely recognised ‘bottom up’ therapy might be yoga, which has been shown to improve all sorts of mental health challenges, with anxiety responding particularly well to regular yoga sessions. Meditation is another very widely recognised ‘bottom up’ approach, one that seems to start in the mind, but is (when practiced ethically, safely and in a trauma-informed way) an effective means of making measurable beneficial changes to the physical way our brains operate, which in turn impacts the information and chemicals the brain is giving to the body (hello dopamine and oxytocin) improving mental and emotional health and resilience.

As you have probably expected from the beginning of this article, the binary of “top down’ versus ‘bottom up’ is false. The most powerful approach to healing is having access to a range of therapeutic supports that help foster dual awareness.

Dual awareness includes both the thinking and the somatic parts of our journey. In practice this might mean all sorts of things:

  • Having a therapist and a meditation practice (especially if you are attending classes with others).
  • Practicing a physical movement discipline that allows you to tune in to what your body is feeling (something that requires focused attention), plus attending a support group where you can talk to others having a similar experience.
  • Having a range of “regulating” activities that you do (meditation, mindful running, painting, getting massages) as well as working through evidence based therapy books.

Dual awareness is also a part of many formal therapies that are considered effective for treating trauma or chronic pain, such as Eye Movement and Desensitization and Reprocessing (EMDR), Somatic Experiencing, and Mindfulness Based Stress Reduction (MBSR).

There’s no right or wrong way to approach dual awareness – it’s just about experimenting and finding what feels helpful. It’s also important to know that this may change over time. You might start off with a therapist and a yoga class, and after a while move on to reading evidence-based self-help books and hitting the climbing gym near you for lessons and to practice tuning in to your body in a safe way with lots of social support.

Interested in finding your own ‘bottom up’ modality to add to your healing resources? The best tip (as always) is to begin by considering what you like and might actually do. If you find circus arts appealing but feel too shy to go to a class, then start with something simpler. A walk around the back streets without your headphones on beats the yoga class you cancelled every time.

Image taken from Electric Palace’s Punk Choir page (UK)

Here’s a quick list to start your brainstorming:

  • Meditation – with a special mention for Loving-Kindndess and self compassion meditation which can be more accessible for people who struggle with simple ‘focus’ meditations, and has been shown to alleviate and interrupt feelings of social isolation and loneliness (and may also be faster to make a helpful impact to our brains).
  • ANY kind of movement – but especially those that include mindfulness or deep concentration. Yoga is the darling of the mental health world, and there’s lots of tentative evidence that a variety of yoga modalities can be helpful for our nervous systems, mental health and for our bodies. It may also be possible that the reason yoga is the front runner is that it asks you to be mindful while you practice*. Many studies are hinting that any kind of effortful exercise may produce the same mental health benefits as yoga if you add mindfulness to it. A great example of doing this would be running without headphones and really tuning in to the mechanics of your body and your moment-to-moment experience as you run. Do ten minutes of meditation after going running to a soundtrack of banging tunes and you’ve (likely) also hit the sweet spot.
  • If you’re living with fatigue, chronic pain or other experiences that make it difficult to get moving, chair yoga, restorative yoga, or just a decent stretching session also have evidence-based benefits. Tune in to your body as you stretch for proper ‘bottom up’ healing impact.
  • Any kind of dance – partnered or solo – in a class or that requires you to focus. Any ‘bottom up’ modality done in a class packs a huge extra punch of co-regulation and good-feeling social connection. And yes, learning other people’s dance moves off the internet in your bedroom is okay to start with, as long as you’re challenged, engaged and interested. There’s also a lot to be said for free expressive dance, and the cathartic effect of having a long sweaty dance or being down the front at a gig is a no-brainer. Loungeroom dancing, No Lights, No Lycra, or anything you can do while sober will work. Save the ‘up all night’ variety as a once-in-a-blue-moon hedonistic treat if you’re using dance for mental health.
  • Visual arts practices – painting, sculpture, embroidery, printmaking, ceramics… meditative colouring and doodling, crochet, macrame… There’s a reason ‘basket weaving’ is a clichéd mental health activity: rhythmic and ‘flow state’ inducing movements as well as the addictive ‘problem solving’ of how to make a pattern or shape or figure out how to finish a row are absolutely legitimate ways to use your senses to tune in to and express what is happening for you. Visual arts approaches to sensory healing are especially useful if you experience feelings that don’t “make sense” to you, or have resisted healing in talk therapy.
  • Music and singing. All the same problem solving, potential to get into a ‘flow state’ and sensory info that is helpful for our bodies and brains in art making is also helpful in making music. There’s a huge added bonus of deep neurological stimulation and co-regulation if you’re practicing with others, whether in a choir, amateur orchestra, band, jam session in the kitchen or karaoke night – again, keep in mind that less booze = more benefit 🙂

And that’s the lot for the moment. Wishing you a fruitful exploration of your ‘bottom up’ options, whatever your needs. In doubt? Talk it through with your counsellor 😉

*Special note: For the life of me I cannot find the study I read (a recent meta-analysis of the impacts of yoga vs exercise on various mental health challenges) that gave me this info. After spending hours trawling through various keyword searches on Google Scholar the idea that the mindfulness aspect of yoga is what is making a difference (and by extension any combination of mindfulness and exercise will have a similar impact) is implicit in many of the abstracts and ‘discussions’ of the meta-analyses I read, but the original study has gotten lost in the swamp of yoga, mental health and mindfulness studies published in the last ten years!! I’d LOVE to find this study again so please do reach out if you have it!! In the meantime my sense is that there’s a strong likelihood that mindfulness and exercise combined is where the benefit of yoga is coming from – for mental health – but I am VERY happy to be corrected by good evidence 🙂