Bottom-Up vs Top-Down Processing: Why “Knowing Better” Doesn’t Always Feel Better
If you’ve ever found yourself saying, “I understand why I feel this way… but it still doesn’t change how I am actually feeling,” you’re not alone.
Many people come into therapy having already done a lot of thinking. They’ve read the books, can name their triggers, and often know what should help. And still, anxiety shows up in the chest, anger rises quickly, or fear takes over before logic has much of a chance to catch up.
This experience isn’t a personal failure, and it doesn’t mean therapy isn’t working. More often, it’s a sign that the support you’re receiving is engaging the thinking parts of the brain, but not fully reaching the parts of you that hold emotional and physiological memory.
Understanding the difference between top-down and bottom-up processing approaches can help explain why this happens — and why a different starting point can sometimes make all the difference.
What Are Top-Down Interventions?
Top-down approaches work primarily with thoughts, beliefs, and conscious awareness. These therapies engage the parts of the brain responsible for reasoning, meaning-making, and language.
Cognitive Behavioral Therapy (CBT) is the most familiar example. CBT helps people notice unhelpful thought patterns, challenge distortions, and develop more supportive or accurate ways of thinking. For many people, this can be incredibly effective—especially for building insight and learning coping skills. Top-down approaches often provide clarity, structure, and practical tools for coping differently.
Top-down approaches can help you:
Understand patterns and triggers
Challenge harsh or inaccurate self-talk
Build new ways of interpreting situations
Develop coping strategies and problem-solving skills
Increase a sense of self-understanding with insight and clarity
For some nervous systems, this kind of cognitive support is enough to create meaningful change.
When Insight Isn’t Enough
For others, something still feels stuck—even when the work makes sense intellectually.
A common experience we hear is,
“I know the thought isn’t true… but I still feel like it’s true.”
People may find themselves judging their progress, wondering why the tools aren’t “working,” or feeling frustrated that they can explain their experiences clearly but don’t feel much different emotionally.
This isn’t resistance or a lack of effort. It reflects how the nervous system responds under stress.
When emotional or traumatic experiences are involved, reactions are often driven by parts of the brain that operate outside of conscious thought. Dr. Bessel van der Kolk, author of The Body Keeps the Score, explains that trauma is not just remembered as a story, but as sensations, emotions, and physical states. In moments of threat or overwhelm, the body often responds first—the heart races, muscles tense, breath shortens—while the thinking brain struggles to keep up.
From this perspective, it makes sense that insight alone doesn’t always change how someone feels. The nervous system may still be operating from patterns learned long before logic was available.
What Are Bottom-Up Approaches?
Bottom-up interventions start from the opposite direction — with the nervous system and body sensations.
Rather than beginning with thoughts or interpretations, these therapies pay close attention to body sensations and physiological responses. A session might include:
noticing tension,
breath patterns,
impulses to move,
shifts in posture, and
exploring what happens when those sensations are met with curiosity and support.
Your therapist may ask you questions like,
“What do you notice in your body right now?”
“Where do you feel that emotion?”
“What happens when we slow this down?”
Bottom-up approaches are based on the understanding that much of our emotional learning lives in implicit memory—memory that develops without words and outside of conscious awareness. Implicit memories shape how safe or unsafe we feel, often without a clear narrative attached, even when there’s no present danger.
Pat Ogden, the founder of Sensorimotor Psychotherapy, describes trauma as something that lives in habitual patterns of posture, movement, and nervous system activation—not just thoughts. From this perspective, healing involves helping the body complete responses that were once interrupted and learn that the present moment is different from the past, rather than relying solely on cognitive insight.
Why Body Sensations Matter
The sensations that show up in the body aren’t random. They’re meaningful signals from the nervous system about safety, threat, and connection.
Tightness in the chest, heaviness in the limbs, shallow breathing, or a sudden urge to freeze often reflect automatic survival responses that developed earlier in life. Peter Levine, the creator of Somatic Experiencing, explains that trauma symptoms are not caused by the event itself, but by how the nervous system was unable to fully process and release survival energy at the time.
Bottom-up therapy works by gently renegotiate those responses, helping the body notice, tolerate, and reorganize these responses. As the nervous system learns that the present moment is different from the past, emotional reactions often soften without forcing them to change.
This helps explain why someone can know they’re safe while still feeling unsafe. The body simply hasn’t updated its expectations yet and bottom-up interventions can helps bridge that gap.
Bottom-Up Processing Examples
Some commonly used bottom-up or body-based approaches include:
Sensorimotor Psychotherapy
Works with movement, posture, and body awareness to help regulate the nervous system and integrate emotional experiences and build internal stability.
Somatic Experiencing
Focuses on restoring nervous system flexibility and completing interrupted fight, flight, or freeze responses.
EMDR (Eye Movement Desensitization and Reprocessing)
Uses bilateral stimulation to help the brain reprocess distressing experiences so they are no longer stored as raw, reactive implicit memories.
These approaches don’t necessarily replace thinking, insight, or skill-building. Instead, they support the body in feeling safe enough for insight to actually land and make a difference.
It’s Not Either/Or
This isn’t about deciding which approach is “better.” For many people, top-down therapy is exactly what they need. For others — particularly those dealing with trauma, chronic anxiety, or stress that lives in the body — a bottom-up or integrative approach may be what finally brings relief.
Often, the most helpful therapy includes both: understanding and embodiment, insight and nervous system regulation.
Exploring Your Options
If you’ve felt frustrated by “knowing the right answer” but not feeling any different, you can release yourself from judgment—you’re not alone. The key is using techniques that matches how your system actually processes experience.
If you’re curious whether a bottom-up approach might be a better fit for you, we invite you to reach out through our contact form. Many of our clinicians are trained in Sensorimotor Psychotherapy, EMDR, and other body-based approaches that work with implicit memory and the nervous system. We’re happy to help you explore options and find an approach that meets all of you — mind and body included.
This Post Written By:
Stephanie Otte, LPC – Journeys Counseling Center
Phone: (480) 656-0500 x 22
Email: stephanie@journeyscounselingaz.com
