Bottom-Up vs. Top-Down Healing

Of all the treatment modalities I learned about as a psychology major, I was reflexively most drawn to cognitive-behavioral therapy. In essence, CBT is a type of therapy that aims to remedy people’s narrow/illogical/negative thinking patterns, and by doing so, empower them to make better decisions.

I see tremendous potential in CBT, and the notion that changing our thoughts can transform our lives resonates with me. Still, there is something about CBT’s simplicity that strikes me as incomplete. And it is this – we humans are not solely governed by logic, and just knowing something may not change the way we feel or how we behave. Further, there are things tucked away in our mind that will take time to unearth, and subconscious hard-wiring is not so easily accessible to us.

Let’s potter in the neuroscience for a moment, shall we? Neuroimaging studies have demonstrated that emotional arousal, i.e. fear or anxiety, activates the most ancient part of our brain, while paralyzing the most evolved part of our brain, the prefrontal cortex (PFC). The PFC serves as the control center for our highest cognitive capacities, and when it becomes crippled, planning, articulating, and critical thinking become significantly compromised. It's why those suffering from test-taking anxiety may draw a blank during an important exam, or why those delivering a speech may find themselves stuttering.

And so, for people who are chronically anxious or angry, CBT may not work as a first line of treatment. What’s more, CBT is unlikely to dig deep enough beneath the surface of years of heavily employed defense mechanisms.

Perhaps we should heed to the mantra “step by step”. Asking individuals to grasp the reins of their thoughts is no small feat, especially in the throes of intense emotional waves. And so, let’s teach people to calm their physiology as an entry-point. This might look like coaching people to breathe in a way that slows their heart rate, leading individuals through a light yoga session that will put their bodies into a parasympathetic state, or guiding people in a music or art therapy session that eases anxiety and allows for self-expression. "Bottom-up" interventions may also be geared towards improving physical health, such as promoting exercise, adequate sleep, and proper nutrition. These interventions could improve mental health, as studies have found that sleep protects our ability to regulate emotions, that exercise possesses anti-depressant effects, and that high sugar intake may play a causal role in depression. All the above “bottom-up” approaches to well-being immediately fortify and calm the body, and by doing so, move us towards a state that is conducive to healing.

Metaphorically speaking, let us teach people proper form before we demand they lift heavy weights. In other words, let us give people the tools to breach their thoughts before we work on altering them. Once we teach people to feel safe and comfortable in their own skin, they will be better equipped to face their demons level-headed.

All the above musings are to say that an integrative approach promises greater potential, and that perhaps the thoughts-emotions pathway is bidirectional. In other words, we know that our thoughts can impact our emotions and behaviors, but what if channeling an emotion or engaging in a certain behavior can directly influence our thoughts, too.

Every individual is different, and there is rarely one right answer. Let this be a humble reminder that we should meet people where they are, and dabble in both top-down and bottom-up approaches to healing.