Therapy is often imagined as talking through thoughts, feelings, and past experiences. While this “top-down” approach is very useful, it is also important to address how distress is processed in the body. As opposed to analyzing thoughts, the somatic, or “bottom-up,” approach offers a space to focus on the mind-body connection through psychophysiological somatic work. This means that rather than analyzing thoughts, the bottom-up approach works with bodily sensations, thereby supporting healing across diverse presenting concerns.
Understanding the Somatic Approach
Contrary to cognitive-behavioral therapy (CBT) that focused mostly on the cognitive and emotional experience, the somatic approach supports individuals in deepening their experience by directing their attention to their internal sensations. The somatic approach is a body-based therapy that targets the nervous system by noticing physical sensations, such as breathing patterns, tensions, or heart rate, which provide useful information to our internal world.
Understanding this physio psychological point of view makes sense in therapy. When the body’s nervous system can become somatically and emotionally dysregulated from a permanent reaction to an overwhelming stressor, it can maintain us in “fight or flight” mode. Therefore, the goal of the bottom-up approach is to modify this stress response by gradually reducing the nervous system’s stress response.
Healing Using a Somatic Approach
Humans will continue to undergo traumatic experiences, but we are resilient. By focusing on bodily awareness, we can learn to care for ourselves and adapt more positively to unfortunate circumstances. In somatic work, clients can expect:
- Heightened body awareness and better capacity to recognize signs of dysregulation.
- Increased empowerment and sense of safety.
- To learn distress tolerance skills, developing a resource toolbox and skills to regulate the nervous system, among other.
The somatic approach can be valuable in treating post-traumatic stress disorder, anxiety, depression, dissociation, and suicidality. van der Kolk (2015, as cited in Kuhfuß et al., 2021), the author who wrote the book The Body Keeps the Score, recommends that the bottom-up approach be used in addition to top-down therapy. In such, these approaches complement each other. Your therapist may use a top-down approach to challenge unhelpful thoughts, while also integrating bottom-up techniques to address the psychophysiological aspects of your presenting concerns.
How Does it Work?
A therapist who uses somatic therapy can use different interventions, with your consent, to release the build-up of emotions held in the body. Some techniques can involve:
- Body awareness, which helps clients in recognizing what is happening in their bodies
- Pendulation, which gently guides clients from a relaxed state, to heightened emotions relating to the concerning situations, and back to a relaxed state
- Titration, which helps people to recognize their emotions in real time when reliving a challenging past situation
- Resourcing, which supports people in finding resource’s, such as people or places, that bring them a sense of safety and calm.
Final Thoughts
Understanding the difference in approaches is helpful for both the clients and therapists in collaboratively choosing useful interventions, which can depend on the situation. By using a bottom-up approach, therapy can become more efficient in regulating the distress experienced by incorporating principles of psychophysiology.
At Vital Minds Psychotherapy, we offer tailored services in-person, online and telephone consultations to determine how we can best support you and your needs. Feel free to book a FREE virtual or telephone consultation with one of our licensed therapists to learn how somatic work can be useful to you. We look forward to connecting with you in the format that best suits your needs.
