TL;DR Summary:

Trauma’s Mainstream Arrival
The Neurobiological Underpinnings of Trauma
Top-Down & Bottom-Up Explained
The Trauma In the Mind, Brain & Body
The Science Of Top-Down & Bottom-Up Methods
Which Method is Best for Healing Trauma?
Supporting Research

With books like “What Happened to You?” pushing forward the Trauma Informed Care (TIC) approach, the word “Trauma” is on our news feeds more than ever.

What happened to you: Conversations on trauma, resilience and healing | The MacKillop Institute

I have written extensively about the Neuroscience of Trauma in other blogs & posts, so today I would like to discuss how to heal trauma.

There are multiple modalities for this healing work, and they all fall under two big-picture categories: Top-Down or Bottom-Up

Today we will discuss the differences between each, and which is best for healing trauma.

What is Trauma?

Adverse Childhood Experiences (ACES) and Developmental Trauma (DT) are highly correlated with serious emotional problems, health risk behaviors, social problems, adult disease and disability, mortality, high health care and other costs, and worker performance problems.

Health: Overdose Prevention: Adverse Childhood Experiences

The best way I’ve found to understand what “Trauma” is, is with the Event, Experience, and Effect Model I describe in the Neuroscience of Trauma.

To summarize it, we all experience the world differently, meaning different events can be traumatic to some, but not to others.

For example, a house fire might traumatize the owner of the home, but it wouldn’t necessarily have that same effect on a firefighter.

Police and KCFD investigating two vacant house fires

The owner & the firefighter are experiencing the same event, but in different ways based on their role, which means the same event can affect them both differently.

Using this analogy, you can start to understand how others might feel traumatized by things you don’t & vice versa.

Childhood Trauma & The ACE Study

Childhood trauma can have a profound effect on our overall health and life outcomes.

The ACE study is the most comprehensive study of childhood trauma ever done.

ACE stands for Adverse Childhood Experiences.

In this study, 17,500 participants' childhood experiences were measured and correlated to outcomes in their life.

These ACEs could be neglect, sexual or physical abuse, or household dysfunction like divorce or having a parent with mental illness.

There were 10 total categories of ACEs. You can take a test to find yours here: The ACE Test

The results of this study are mind-blowing…

They found that 1 in 11 people have experienced 6 or more ACEs.

Having an ACE score of 6, meaning they checked yes on 6 of the ACE categories, correlated to a 4600%, yes, 4600% increase in the likelihood of drug abuse in adulthood.

An ACE score of 6 also correlates to a 3500-5000% increase in the likelihood that that person will attempt suicide in their lifetime.

About the CDC-Kaiser ACE Study |Violence Prevention|Injury Center|CDC

Also, this same score correlates to a shortening of life expectancy by 20 years.

Higher ACE scores, even if they’re under 6, correlate to higher instances of depression, anxiety, eating disorders, and smoking.

These ACEs also affect long-term physical health, increasing that person's risk for diabetes, stroke, cardiovascular disease, and cancer.

How is this possible? The answer lies in the stress/inflammatory response of our brain & body.

Psychoneuroimmunology and immunopsychiatry of zebrafish - ScienceDirect

Trauma gets stored in our body because it’s our first line of defense in our environment and our mind can’t handle what’s happening to it at that moment so it shuts down the Pre-Frontal Cortex & Hippocampus & turns on our Amygdala, Limbic System & Sympathetic Nervous System…

It’s obviously a bit more of a complicated neurobiological process than this, but this process is important to note as we dive deeper into how to heal trauma trapped in the body!

Top-Down vs. Bottom-Up

First of all, where on earth do the terms “Top-Down” & “Bottom-Up” come from?

Between your ears, that’s right, your brain! These terms come from Neuroscience. They are the 2 ways your brain processes information.

When you’re processing something Top-Down you’re using knowledge already in your head to influence your perception.

The easiest way to understand this is a demonstration, look at the picture below.

Zone 2: Gestalt in Solid Space — Spatial Perception & Concrete Experience at USC

What shape do you see? Can you see the cube?

This is really a picture of black circles with lines in them, not a cube, but it’s almost impossible to not see the cube, why?

Top-Down processing! You have background knowledge & reference frames for a cube in your mind already, so your brain creates the cube inside the image with this knowledge.

Another example of a Top-Down process is the game Where’s Waldo?

You take the background knowledge of what Waldo looks like, and your understanding of the game’s goal, and then use your senses to find him in a picture.

Bottom-up Processing is the opposite. Here’s another demo, look at the picture below.

aircraft design - Why are the cockpit controls of airplanes so complicated? - Aviation Stack Exchange

Unless you happen to be an airline pilot, when you look at this picture, you have to analyze all its parts with your senses.

As you do this, you start to build a construct in your mind about it’s different parts & what they might do.

So, Bottom-Up means going from the senses your body collects up to your brain!

We need both types of processing to survive, one isn’t “better” than the other, they are both important!

This is true in relation to healing from trauma as well.

What Does This Have To Do With Therapy?

Great question. When thinking about this in relation to therapy & healing the mind, brain & body, I find the picture below to be helpful!

These 3 parts of us are separate but inseparable and each affects the other.

The body holds the brain, and the brain holds the mind. This makes the body the soil for the brain & the brain the soil for the mind.

You can think of the mind as the voice you hear in your hear or your thoughts.

The body is where emotions are generated, stored, and felt.

The brain connects the two! This is obviously oversimplified, but for our purposes today, it’s a helpful construct.

Using this concept, you can think of therapeutic modalities in two ways, you guessed it, Top-Down & Bottom-Up.

Top-Down methods works with the mind to reprocess & talk through our thoughts, memories, experiences, etc.

Bottom-Up methods work to heal the body first, effectively “fertilizing the soil of the body” so that the brain can heal & grow, which in turn heals the mind because now it’s “planted” in a healthier brain.

So, which is better for healing trauma?

What’s the Science Say?

Clinicians & scientists used to believe you could “think” your way out of trauma responses, which is why traditional Top-Down therapies were some of the first solutions for people who have experienced trauma.

Some examples of Top-Down therapies include:

Cognitive-Behavioral Therapy (CBT), including Trauma-Focused CBT (TF-CBT)
Dialectical Behavior Therapy (DBT)
Cognitive Processing Therapy (CPT)
Prolonged Exposure Therapy (PE)
Psychoanalysis
Solution-Focused Brief Therapy (SFBT)
Psychodynamic Therapy

However, in the late '90s and early 2000s, there was a large advancement in medical technology, leading to more accurate neuroimaging of the brain.

Can Computers Use Brain Scans to Diagnose Psychiatric Disorders? - Science in the News

Around this time, research started to suggest that Recall Therapy (recalling or talking about past trauma) did 3 things:

Drastically activated the amygdala (the fear/threat center in the brain)
Decreased activity in the Prefrontal Cortex (the "talking and thinking" part of the brain)
Exasperated symptoms such as anxiety, depression, and PTSD

These findings suggest that just talking about your trauma can actually be more harmful than helpful.

Since then, we’ve learned that memories of trauma are stored all over our bodies which makes it hard for our minds to create a coherent story to process.

Can damage caused by extreme stress be seen in a brain scan? - Quora

Research has also suggested that the explicit memory center of the brain (hippocampus) deactivates during some types of trauma.

Meaning it’s hard to even “think” about or put words to these memories.

Trauma has been shown to be stored in the implicit memory centers of the brain (emotional memory, muscle memory, sensory memory & autonomic memory).

Bottom-Up Approaches & Trauma

This is why starting Bottom-Up has been shown to be a much more effective way to work on releasing trauma.

This is because we're "bottom-up" beings, meaning that 80% of the informational messages happening in our Nervous System is BODY TO BRAIN, and only 20% is BRAIN TO BODY.

Processes like Somatic Experiencing focus on what your body is feeling and where, to start collecting the scattered memories of trauma while also being sure to keep the amygdala dialed down so that once the scattered memories are collected, they can be processed, and released by our mind.

Once these bodily sensations of the trauma are processed, using Top-Down approaches like CBT, DBT, IPT, NLP, etc can be much more effective.

Other ways to do some of this type of Bottom-Up work include things like:

Yoga therapy
Somatic Experiencing
Eye Movement Desensitization Reprocessing (EMDR)
Sensorimotor Psychotherapy
Internal Family Systems
Brainspotting
Tai Chi
Accelerated Experiential Dynamic Psychotherapy (AEDP)
Hakomi Method
Play Therapy
Equine-Assisted Psychotherapy

All of these practices help you become more aware of your body, and where you have stored tension, energy, and emotions to release.

At Rewrite & Rise, we focus on a Bottom-Up & Top-Down approach called Internal Family Systems (IFS) and use Biometric devices & AI/ML models to track/measure our client’s mental & emotional well-being, as well as make wellness suggestions based on their data.

If you believe there's something in your past causing your trouble in the present, feel free to reach out to us, we’re always here for you!

Consultation w/ Cody

I hope today’s edition of the Heroes Digest was helpful and until next time… Live Heroically 🧠

Supporting Research:

Van der Kolk, Bessel A. "The body keeps the score : brain, mind, and body in the healing of trauma." New York, New York : Viking, 2014.
Corrigan F. M., Hull A. M. (2015). Neglect of the complex: Why psychotherapy for post-traumatic clinical presentations is often ineffective. BJPsych Bulletin, 39(2), 86-89.
Courtois C. A., Ford J. D. (Eds.). (2014). Treating complex traumatic stress disorders: Scientific foundations and therapeutic models. New York, NY: Guilford Press.
Haase L., Stewart J. L., Youssef B., May A. C., Isakovic S., Simmons A. N., . . .Paulus M. P. (2016). When the brain does not adequately feel the body: Links between low resilience and interoception. Biological Psychology, 113, 37-45.
Leitch L. (2007). Somatic experiencing treatment with tsunami survivors in Thailand: Broadening the scope of early intervention. Traumatology, 13, 11-20.
Leitch L., Miller-Karas E. (2009). A case for using biologically-based mental health intervention in post-earthquake china: Evaluation of training in the trauma resiliency model. International Journal of Emergency Mental Health, 11, 221-233.
Leitch M. L., Vanslyke J., Allen M. (2009). Somatic experiencing treatment with social service workers following Hurricanes Katrina and Rita. Social Work, 54, 9-18.
Levine P. A. (1997). Waking the tiger: Healing trauma. Berkeley, CA: North Atlantic Books.
Levine P. A. (2010). In an unspoken voice: How the body releases trauma and restores goodness. Berkeley, CA: North Atlantic Books.
Ogden P., Fisher J. (2015). Sensorimotor psychotherapy: Interventions for trauma and attachment. New York, NY: W. W. Norton.
Payne P., Levine P. A., Crane-Godreau M. A. (2015). Somatic experiencing: Using interoception and proprioception as core elements of trauma therapy. Frontiers in Psychology, 6, 93.
Rothschild B. (2011). The body remembers: Vol. 1. The psychophysiology of trauma and trauma treatment. New York, NY: W. W. Norton.
Rothschild B. (2017). The body remembers: Vol. 2. Revolutionizing trauma treatment. New York, NY: W. W. Norton.
Scaer R. C. (2001). The body bears the burden: Trauma, dissociation, and disease. Binghamton, NY: Hawthorn Medical Press.
Tang Y. Y., Holzel B. K., Posner M. I. (2015). The neuroscience of mindfulness meditation. Nature Reviews: Neuroscience, 16, 213-225.

The Mind, Brain, Body Digest

"Bottom-Up" or "Top-Down" for Healing Trauma…