Bottom-Up Processing: Why Work With the Body in Trauma?
Bottom-up processing refers to body-based approaches to therapy that work directly with the nervous system and physiological experience of trauma. In trauma treatment, this matters because many of the effects of trauma are not primarily cognitive, rather, they are held in the body. Working only with thoughts is often not enough; we also need to work with what is felt.
The Shift Toward Body-Based Approaches
This blog relates specifically to trauma and trauma-related conditions. In recent years, there has been a significant shift within psychotherapy toward incorporating more body-based approaches.
This shift has largely emerged from developments in the field of traumatology and our growing understanding of how trauma affects the brain and body. One of the most widely recognised contributions to this area is The Body Keeps the Score by Bessel van der Kolk, which brought these ideas into mainstream awareness.
What this body of work highlights is that trauma is not only something we think about, it is something we experience physiologically.
Trauma and Memory: Two Systems
To understand why body-based work is important, it helps to understand how memory functions. Broadly speaking, we can think of two memory systems:
Autobiographical memory, which is narrative and language-based
Implicit memory, which is non-verbal, emotional, and bodily
For the purposes of understanding trauma, implicit memory is particularly important.
Implicit (or procedural) memory refers to experiences that are encoded in the body. These include emotional responses, relational patterns, and behavioural tendencies that often develop early in life.
Before around the age of three, when language and narrative capacity develop, our experiences are stored almost entirely in this implicit form.
How Trauma Is Stored in the Body
Traumatic memory is different from ordinary memory. It is not always processed and integrated in the usual way.
Instead, aspects of the experience can become dissociated and remain “stuck,” continuing to exist outside of a coherent narrative. As Brown (1998) describes, traumatic memory tends to be more indelible, sensory, and tied to fear responses than typical autobiographical memory.
Because of this, the emotional and physiological components of the experience (fear, terror, numbness) can persist across time without fully resolving.
This helps explain a common experience in trauma: a person may know they are safe on a logical level, yet still feel unsafe in their body.
From a therapeutic perspective, this is why simply telling someone they are safe is often not effective. The sense of safety needs to be experienced, not just understood. This involves working with implicit memory.
Why Bottom-Up Processing Matters
If trauma is held at an implicit, physiological level, then treatment needs to address that level as well.
Top-down approaches (those that focus on thinking, insight, and talking) can be helpful, but are often not sufficient on their own. They primarily engage the cognitive, narrative parts of the brain.
Bottom-up processing, by contrast, works directly with the nervous system. It allows us to engage with the physiological patterns and responses that have been shaped by traumatic experiences.
In this way, therapy becomes not just about understanding what happened, but about helping the body process and reorganise what it has been holding.
Integration and the Role of the Body
An integrative approach to trauma brings together both top-down and bottom-up processes.
By working with the body, it becomes possible to gradually access and process the implicit memory of the trauma. This can allow for the discharge and integration of emotional experiences that may have previously felt overwhelming, frozen, or out of reach.
The body, in this sense, carries its own story of what has happened. A bottom-up approach creates the conditions for that story to be expressed, understood, and eventually integrated.
Over time, this can support a greater sense of safety, regulation, and connection—both within oneself and in relationship with others.
Reference
Brown, D., Scheflin, A. W., & Hammond, D. C. (1998). Memory, trauma treatment, and the law. WW Norton & Company.
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