Bottom-up therapy is a form of care that works to heal the mind by calming the body. It’s different from the traditional “top-down” approach, which focuses on thoughts and feelings.
Eye movement desensitization and reprocessing (EMDR), breath work, and somatic therapies are examples of bottom-up care. They're especially helpful for treating trauma that’s “stored” in the body.
Bottom-up therapy can support emotional regulation, which can help you feel safer in your mind and body. It can also be combined with other approaches (like talk therapy), depending on your needs.
Imagine that strengthening your mental health is like climbing a mountain, and your therapist is your guide. Before starting out, you’ll have to choose which trail you’ll use to make your ascent. Therapists approach these journeys differently based on their training and experience. What matters most is finding the path that works best for you.
Some therapists focus on exploring thoughts and feelings. This is sometimes referred to as “top-down” or traditional talk therapy. But other paths to healing can be just as effective. Some people benefit from the inverse approach, known as “bottom-up” therapy [1]. These types of therapy focus on healing the body and calming the nervous system as a way to reduce stress and release trauma.
Historically, there’s been some debate surrounding top-down and bottom-up therapy. Some people think that if you heal the body, the mind will follow. Others believe the opposite is true. We know certain therapies [2] can be more effective than others for specific diagnoses. But mental healthcare isn’t a one-size-fits-all situation. There are many paths you can take to improve your mental health. Learning more about bottom-up care can help you decide whether it might be a good fit for your needs.
How bottom-up therapy works
Our bodies are constantly absorbing external stimuli and reporting this information back to our brains [3]. As a result, our thoughts, feelings, and behaviors are shaped by the feedback we receive from our bodies.
The main principle behind bottom-up therapy is that healing happens when you focus on the body. The idea is that if the body is constantly sending up warning signals or sensing danger — even when none exists — it can cause your brain to go into an anxious or hypervigilant state [4]. Left untreated, this can lead to a wide range of physical and mental health concerns. Bottom-up therapy works by interrupting this cycle. It uses things like breath work, physical movement, gentle touch, and other techniques to help people feel safer in their bodies. In response, they’re better able to regulate their thoughts and feelings and feel more in control.
Some examples of bottom-up therapy include:
Eye movement desensitization and reprocessing (EMDR): Using bilateral stimulation — often back-and-forth eye movement — clients revisit painful memories. This helps the brain reprocess these experiences so that they become less upsetting.
Somatic therapy: This includes body-focused activities like breath work, grounding exercises, and body scans. The goal is to bring awareness to tension in the body and use movement to release it.
Play therapy: Typically used with children, this approach helps clients physically act out real-life experiences. It’s a way of processing and releasing emotions that children may not have the vocabulary to express.
Psychodrama: Similar to play therapy, in this type of therapy, clients dramatize their experiences [5] to better understand them. In playing different “roles,” [6] people can examine their subjective reality, try on new ways of interacting, and gather insights to promote positive change.
The care you need, when you need it
Learn how Rula can support your mental health journey
The benefits of a bottom-up approach to healing
One of the key strengths of a bottom-up approach is that it can be used alongside other approaches. If you feel safer and more regulated in your body, it can make top-down approaches more effective.
Bottom-up therapy can be used to treat a variety of mental health concerns [1]. But it’s frequently used to support people living with post-traumatic stress disorder (PTSD). Trauma can change our bodies [7] on a cellular level. It can make a person feel like they have to be on high alert all the time. This can cause trauma to be “stored” in the body in ways that talk therapy alone [1] can’t address.
People who survive trauma may become triggered [8] by thinking about it. This can be highly distressing, and it’s why top-down approaches may not be appropriate for this population. Instead, treating trauma often requires incorporating a bottom-up approach. Focusing on the body can help trauma survivors process experiences and release uncomfortable emotions in a safer way.
Ways to explore bottom-up therapy
If you’re already in therapy and interested in exploring a bottom-up approach, talk to your provider. Let them know if specific techniques or activities interest you, and ask if they’re able to incorporate body-based interventions into your treatment plan. If this isn’t something they offer, they may be able to refer you to a different provider. Typically, you can do top-down and bottom-up therapy at the same time.
To find a therapist who provides bottom-up care, search online directories or teletherapy platforms. Look for therapists who use terms like “somatic” or “mind-body” in their profiles. You can also search for therapists and psychiatrists who specialize in trauma. These providers are more likely to have training in bottom-up approaches. With their support, you can process trauma, release tension, and feel calmer in your mind and body.
When clients realize their body has been holding tension or trauma that talk therapy never reached, a common shift I see is relief mixed with clarity. They stop blaming themselves for ‘not trying hard enough’ in therapy and begin to understand their symptoms as the body’s learned response to stress.
Brandy Chalmers, LPC
Clinical reviewer
Find care with Rula
Bottom-up therapy is a form of mental healthcare that focuses on the body. The main principle behind it is that if you heal the body, the mind will follow. Bottom-up interventions like EMDR, breath work, and somatic therapies can help when cognitive or “thought-based” therapies feel too overwhelming. This mind-body approach can help increase mental clarity, improve emotional regulation, and make it easier to benefit from other forms of care.
At Rula, we’re here to help you feel better. Rula makes it easy to find a licensed therapist or psychiatric provider who takes your insurance. That way, you don’t have to choose between great care and a price you can afford.
Rula patients pay about $15 per session with insurance, and 93% say they feel better after getting care through Rula. We have 21,000+ providers, and appointments are available as soon as tomorrow. We’re here to help you take the next step — wherever you are in your mental health journey.
References
- The Trauma Resiliency Model: A “Bottom-Up” Intervention for Trauma Psychotherapy https://www.pacesconnection.com/fileSendAction/fcType/0/fcOid/529522553723327125/filePointer/529522553723327157/fodoid/529522553723327154/Trauma%20Resiliency%20Model.pdf
- Why Cognitive Behavioral Therapy Is the Current Gold Standard of Psychotherapy https://pmc.ncbi.nlm.nih.gov/articles/PMC5797481/
- Top-Down and Bottom-Up Mechanisms in Mind-Body Medicine: Development of an Integrative Framework for Psychophysiological Research https://pmc.ncbi.nlm.nih.gov/articles/PMC2818254/#S24
- Always on Alert: Causes and Examples of Hypervigilance https://health.clevelandclinic.org/hypervigilance
- psychodrama https://dictionary.apa.org/psychodrama
- Surveying 80 Years of Psychodrama Research: A Scientometric Review https://pmc.ncbi.nlm.nih.gov/articles/PMC8634339/
- What is somatic therapy? https://www.health.harvard.edu/blog/what-is-somatic-therapy-202307072951
- Somatic experiencing – effectiveness and key factors of a body-oriented trauma therapy: a scoping literature review https://pmc.ncbi.nlm.nih.gov/articles/PMC8276649/
Liz Talago
Liz Talago, M.ed. is a mental health professional turned content writer and strategist based in the Detroit metro area. As an independent consultant for mental health organizations, Liz creates meaningful connections between brands and their audiences through strategic storytelling. Liz is known for championing diverse perspectives within the mental health industry and translating bold ideas into inspiring, affirming digital experiences.
In her free time, you can find her hiking with her two German Shepherds, puttering around her dahlia garden, or spending time with her family.
Brandy Chalmers, LPC
Having faced challenges like childhood abuse, neglect, and the loss of her father to suicide, Brandy Chalmers is deeply passionate about providing compassionate care. She is a Licensed Professional Counselor, Nationally Certified Counselor, and Registered Play Therapist with a Master’s Degree in Clinical Counseling and Marriage and Family Therapy.
Brandy also teaches at a university, sharing her expertise with future mental health professionals. With over a decade of experience in settings like inpatient care and private practice, she specializes in helping clients with perfectionism, trauma, personality disorders, eating disorders, and life changes.
Rula’s editorial process
Rula’s editorial team is on a mission to make science-backed mental health insights accessible and practical for every person seeking to better understand or improve mental wellness.
Members of Rula’s clinical leadership team and other expert providers contribute to all published content, offering guidance on themes and insights based on their firsthand experience in the field. Every piece of content is thoroughly reviewed by a clinician before publishing.
