How Our Brain Stores Trauma and Why Talking Therapies Aren’t Our Only Healers
Why I’m Considering Changing Therapists…
I’ve been in talk therapy for the past 6 months with the ammunition of 3+ years of personal growth research, writing, and awareness to tackle my deeper wounds. It’s gone well for the most part — I nerd out on these topics, so I enjoy having someone to share my innermost thoughts and ideas with and welcome in the 3rd party feedback. It was also something I wanted to invest in whilst preparing for my upcoming podcast (!).
And whilst the rational-based conversations and CBT framework my therapist often uses have helped me identify some limiting beliefs and core wounds, I wouldn’t say the practice has integrated or transformed them for me. To be honest, I often feel like the behaviour changes I implement and my newfound awareness is just layers I’m adding to a deeper wound that isn’t changing or being felt. Like covering up a problem by pushing it further away, it’s still there — to come out when I am triggered, or otherwise stressed.
As if my therapist was reading my mind as I was coming to these realisations, we spoke last week about trauma, and how we can target it by “bottom-up” approaches — a category of trauma therapies I hadn’t heard of before. She noted she wasn’t a trauma recovery practitioner herself but could refer me to someone who could help me in this way.
Since then, I’ve started reading more about trauma recovery and these so-called “bottom-up” approaches. While I’m doing this research to better understand what next steps I can take — like potentially finding a new therapist — I wanted to share my research with you, as I’m sure it’ll resonate.
So what are so-called “bottom-up” approaches to trauma recovery, and how do these differ from the more well-known top-down approaches?
Understanding the difference between the two is critical as not all therapies work the same, and we may require one or more approaches to heal and recover from our past wounding. In this article, we’ll discuss how trauma is stored in the brain, what the benefits and limitations of top-down approaches are, and why bottom-up approaches can heal differently.
A Brain In 3: Knowing Our Brain and Trauma Storage
The Triune Brain Model
To understand the top-down and bottom-up approach to trauma recovery, we first need to be aware of the triune brain model put forward in the 1960s by Paul MacLean, a renowned physician and neuroscientist for his contributions to psychiatry and brain research. In his simplified model, the brain is imagined as a “staircase” where each step represents a different phase in development and function, taking us further outwards from the centre. Below is a brief summary of each stair and its functions:
- Stair 1: The Brainstem, or “reptilian brain” is our evolutionarily oldest and deepest brain area. Its functions are managing autonomic processes such as our heart rate, body temperature, breathing, and arousal. This brain area also helps coordinate movement and processes sensory information. Our brain develops outwards, so it is the first to develop — hence why newborn babies are limited in their psychological and physiological capabilities.
- Stair 2: The limbic system, or “emotional brain” is linked to our emotional experiences, including anxiety and motivation (desires). It undergoes significant development throughout our childhood and teenage years — hence the rush of hormones and often irrational emotional outbursts we’re susceptible to at this age. It is where our fight/flight/freeze reactions arise, triggering reactions throughout the body.
- Stair 3: Comprising the brain’s outermost areas, our neocortex, or “rational” brain — as it can be referred to — gives us our “executive functioning” abilities. For example, if you sense anxiety coming up as anxious thoughts/bodily sensations — generated in our emotional brain — our frontal cortex helps us reason and potentially dampen these reactions with judgments like, “I feel anxious right now but I want to challenge myself and do what I want to do”. It helps us think ahead when caught in our often short-sighted and emotional reactions, giving us a big-picture perspective. You may hear this referred to as “Impulse control”.
Trauma Storage
Next, we need to recognise that trauma can be stored at the lower levels of our mental staircase (Stairs 1 and 2). This is because many of our traumas which now cause us problems likely occurred before our “higher” brain levels had fully developed. Such wounds are likely to be highly emotional in nature, integrating deep memory with emotions like fear, and so tied to intertwined closely with our limbic system. They often lie out of conscious awareness.
This is why some of our wounds don’t make sense to us, as they’re stored in an area that is far removed from our rational brain. For example, if you experienced fear towards a particular person or incident as your emotional brain was growing, brain structures related to fear-processing will have primed strongly around that experience. You may have even suppressed the reason for such reactions, making them difficult to recall. A form of implicit memory.
As our emotional brain triggers our fight/flight/freeze responses, it is tightly linked to our nervous system (hence our anxious reactions) and such full-body reactions can occur automatically — like when we are triggered and our heart rate quickens (fight) or slows (freeze). In this sense, our body is also tied to our emotional brain. You may rationally (stair 3) know you shouldn’t react a certain way, and yet your body does anyway. Our trauma response can initially lie beyond our conscious control.
Finally, as our rational brain has yet to develop in early childhood, we lack an ability to regulate our emotions — as we require a well-developed stair 3 for this (impulse control). We require others, mainly our caregivers, to do this for us (co-regulation). If we lack a supportive and stable caregiver we’ll be prone to irrational judgements that can form our limiting beliefs in adulthood. Instead of having a caregiver to rationally reason with us, we are instead left developmentally impaired to develop healthy beliefs.
Now let’s look at top-down vs bottom-up approaches to trauma recovery, and why bottom-up approaches can be so effective.
Top-Down Approaches: Their Benefits/Limitations in Recovery
Top-down approaches to therapy begin by targeting stair 3 of the brain, where our rational brain exerts its effects. Talk therapies such as CBT — cognitive behavioural therapy aim to target our perceptions and expand our awareness (mindfulness). These therapies can strengthen our ability to recognise 1), what emotions we feel arise from our emotional brain 2), why we experience them, and 3), what we can do to combat them. Whilst therapists trained in CBT will delve into the past, they don’t spend significant time there.
The problem with such top-down approaches is that they often don’t target deep, emotional, and body-based trauma. There is potential that rational awareness can “trickle down” to deeper brain areas, but bottom-up approaches are sometimes needed alongside this. For example, you may make behavioural changes to attract a secure partner but if a core wounding, stored in your emotional brain is telling you you’re unworthy, you’ll likely feel there’s something wrong in the connection: be it you or them.
Bessel Van Der Volk, another renowned psychiatrist for his work on PTSD and CPTSD speaks to this in his aptly named book, “The Body Keeps The Score” in which he delves into the psychology of trauma. Having treated war veterans, childhood trauma victims, and other significant traumas in his patients, he comes to the following conclusion regarding top-down vs bottom-up approaches:
“Psychologists usually try to help people use insight and understanding to manage their behavior. However, neuroscience research shows that very few psychological problems are the result of defects in understanding; most originate in pressures from deeper regions in the brain that drive our perception and attention. When the alarm bell of the emotional brain keeps signalling that you are in danger, no amount of insight will silence it.” — Bassel Van Der Volk, The Body Keeps The Score.
This isn’t to say top-down approaches aren’t effective. Expanding our awareness of our internal world is extremely beneficial. Mindfulness has been shown to decrease anxiety and depression symptoms, though isn’t so effective in addressing trauma-induced PTSD (arguably deeper psychological wounds) and long-term recovery.
Bottom-Up Approaches To Recovery
Bottom-up therapeutic approaches target our emotional and reptilian brain. They also target our somatic (body) experiences, as our physiology is highly sensitive to activity in these two areas, as previously mentioned.
Such therapies can take different approaches, below is a review:
Eye Movement Desensitisation and Reprocessing Theory
Eye Movement Desensitisation and Reprocessing Therapy is a form of exposure-response therapy developed initially for PTSD, with known success stories but some controversy to its mode of healing. Instead of targeting trauma with rational back-and-forth conversations, its aim is to target memories. Patients are asked to recall in detail their traumatic experience — often triggering them — in a stable environment. The hope is to bring the memory to the conscious awareness, where its emotional stimulus can be felt and reduced. Bessel talks about this in his book, though admittedly is unsure we he see’s transformative results in his patients by this method.
Somatic Therapies
Somatic therapies also target the lower stairs of the brain through a mind-body focus. For example, the practitioner may guide you toward a triggering memory, and help you develop tools to calm down your nervous system through breath work, grounding, or physical movement. Building mind-body awareness helps us identify our physical reactions in response to stress. Instead of fighting the thoughts and feelings with our rational mind (stair 3), we combat such thoughts with our physical bodies and sensations. Such movements/actions/sensations are then fed back to our emotional brain, where the trauma resides.
Internal Family Systems therapy, Expressive Arts Therapy, and free-writing therapies are other modalities.
Final Thoughts
Ultimately bottom-up approaches to trauma recovery take different routes from standard rational-based approaches. Some of these are thought of as “alternative” modes of therapy but are only alternatives due to our Western world’s preference for rational-based approaches to healing.