1. at the end of this section, participants will be able to decribe the difference between top down and bottom up appoaches
2. participants will be able to name three bottom up approaches
3. Participants will be able to describe a bottom up approach they can quickly implement within their scope of practice
The terms top-down and bottom-up refer to the general areas of the brain and where you start in therapy (from the top or the bottom). Different parts of the brain work together to help us use information to survive and thrive in the world.
When we talk about a top-down approach, we’re focused on starting therapy with the parts of the brain we associate with thinking, speaking, and current emotional awareness. These are the topmost areas of the brain, and include the neocortex, frontal lobes and prefrontal lobes.
When we talk about the bottom-up approach, we’re talking about starting therapy with the parts of the brain located toward the base. These are the brain stem areas responsible for reflexes, memories, and automatic survival responses. This area also has a role in learning.
A simple way to think about it: has anyone ever jumped out from behind a door and scared you? In that moment, could you have explained why. you were scared? Probably not! In that moment, your heart is racing, you may notice the palms of your hands start to sweat. In these moments, the primitive parts of our brains take over.
So, think about your clients. When they are overly anxious or perhaps thinking about a past trauma, they cannot process the higher orderered thoughts. This is why we use bottom up approaches. It is much easier to have someone take a deep breath, move around, dance, color, or many or the other things we will cover then to ask them why they are thinking what they are thinking.
We will go into this in more detail in somatic approaches
Some things you can do if a client appears distressed, overly anxious or needs help grounding.
Grounding exercises- name three things with each sense (sight, smell, taste (if possible), hear, touch
Present moment- I am in (name location, date, your name, i am safe
Movement- get up and walk, change positions
**note- be careful to not use imagery that can be triggering. This is something you may want to consult the therapist about