While there are multiple therapy modalities, they essentially all fall into categories of “top-down” or “bottom-up”. Neither is “better” or more “right” than the other but rather different ways of approaching therapy and this can be individualized for each person. I often find the greatest success is a combination of both.
So, what exactly is the difference? A “top-down” approach works by interpreting incoming information based on prior knowledge, experiences, and expectations. "Bottom-up" works by bringing awareness to our physical sensations and interpreting these to make sense of our thoughts and emotions. Think of “bottom-up” as a way to recognize the mind-body connection to soothe and navigate thoughts and emotions and the “top-down” approach which focuses on our thought patterns impacting our physical sensations/symptoms.
Some examples of “top-down” include:
Cognitive Behavioral Therapy/CBT also includes Trauma Focused Cognitive Behavioral Therapy/FT-CBT: works to challenge and change unhelpful thoughts and behaviors, improve skills for emotional regulation through the use of coping skills.
Insight Oriented Therapy: helping you understand the basis of your thinking, behaviors, emotions, and perceptions to build awareness into the cause so we can create change.
Dialectical Behavior Therapy (DBT): teaches acceptance and works to change thoughts, feelings, and behaviors. It's based on CBT but focuses more on the social and emotional aspects of life.
Psychoanalysis: helps clients to identify self-limiting patterns, heal from past experiences, and understand how the unconscious mind influences their behavior.
Solution-Focused Brief Therapy: is a short-term, goal-oriented therapeutic approach that focuses on building solutions rather than solving problems. SFBT is based on the idea that people already have the resources and skills to solve their problems, and that solutions can be found in the present and future.
Some examples of “bottom-up” include:
Mindfulness: helping you to explore and develop relaxation, calming, and grounding techniques.
Emotional Freedom Technique (EFT/Tapping): uses tapping on various energy meridians to decrease physical presentations and emotional distress by creating a balance in energy system.
Polyvagal Theory: helps and supports the use of insight and use of coping skills to impact nervous system functioning.
Internal Family Systems (IFS): helps with accessing and healing protective and wounded inner parts of yourself so you feel in control of and ability to manage symptoms.
Breathwork: allows for an emotional release to move energy and emotion through the body to break free from emotional blockages (breathwork is not appropriate for women who are pregnant or those with health conditions correlated with breathing or circulation including but not limited to asthma, lung conditions, cardiovascular issues, and epilepsy).
Walk and Talk Therapy: by incorporating the physical health benefits impacting mental health, this helps not only assist you in feeling comfortable in discussing difficult issues but also creating an environment of possibility and change.