When Assessment Is Helpful: Understanding Psychological Assessments
April 18, 2026
Behind the Scenes of Counselling Care in British Columbia
May 23, 2026
Understanding yourself is one thing; creating lasting change is another.
Many people assume counselling is only about talking through thoughts and feelings. While that can be powerful, it’s not the only path to healing. In fact, there are different ways therapy can help, depending on whether you start with the mind or the body.
Top-Down Versus Bottom-Up
In therapy, support often comes in two main forms: top-down and bottom-up approaches.
Top-down approaches start with your thoughts and beliefs to influence your emotions and behaviours. They work from your brain outward, helping you make sense of your experiences and build insight.
- For example, talking through a problem with a friend or making a pros-and-cons list to decide on a choice is a top-down strategy.
Bottom-up approaches start with your body and nervous system, using movement, sensation, or other bodily experiences to influence your emotional state. The change begins in the body and works its way up to your mind.
- For instance, going for a walk to clear your head and ease overthinking is a classic bottom-up approach.
Both approaches are valid and can even be combined, depending on what feels most helpful for you. Some people benefit from starting with their thoughts, others by tuning into their body, and many find a mix works best.
A Simple Metaphor
Think of your mental health like a forest.
Top-down approaches are like adjusting the sunlight that reaches the forest floor. By changing the canopy (your thoughts and beliefs) you influence how everything below it grows.
Bottom-up approaches are like enriching the soil and roots. When the foundation is strong and nourished, the whole forest (your mind, emotions, and body) thrives.
Both directions matter! Sometimes growth begins with the canopy guiding what comes next, and other times it starts with the roots building a strong base. Together, they keep the forest healthy and balanced.
How Do I Know What Works Best for Me?
Different approaches can feel more natural depending on how you experience stress, emotions, and thoughts.
Top-down approaches (Mind → Body) may be helpful if you:
- Can reflect on your thoughts and explain your experiences.
- Want practical tools to challenge unhelpful thinking and manage emotions.
- Feel grounded enough to think things through without becoming overwhelmed.
Why it helps: These approaches provide strategies and frameworks to reframe thoughts, solve problems, and gain insight.
Examples: Cognitive-Behavioural Therapy (CBT), Solution-Focused Brief Therapy (SFBT), Narrative Therapy.
Bottom-up approaches (Body → Mind) may be helpful if you:
- Feel overwhelmed when analyzing or talking through experiences.
- Carry trauma in your body that’s hard to put into words and want to feel safe and regulated.
- Notice physical stress symptoms, like tension in the chest or stomach, or feeling disconnected.
Why it helps: These approaches focus on safety and bodily regulation first, making it easier to process thoughts and emotions later.
Examples: Somatic Experiencing (SE), Expressive Arts Therapy, Brainspotting.
Final Thoughts
Take a moment to notice your own patterns. Think about moments when you naturally turned to your thoughts to solve a problem, or when tuning into your body or taking a breath helped you feel calmer. That’s your mind and body at work, each in its own way.
Everyone’s experience is unique, and often the most effective support blends both approaches.
We’re here for you
At OK Clinical, we provide secure and professional online counselling services tailored to your unique needs. Our team can connect you with a counsellor who is the right fit for you and help you book a free 20 minute consultation or your first appointment.
Call us at: (250)-718-9291 or email us at [email protected]
References:
Grabbe, L., & Miller-Karas, E. (2017). The trauma resiliency model: A “bottom-up” intervention for trauma psychotherapy. Journal of the American Psychiatric Nurses Association, 24(1), 76–84. https://doi.org/10.1177/1078390317745133
Monachesi, B., Grecucci, A., Ahmadi Ghomroudi, P., & Messina, I. (2023). Comparing reappraisal and acceptance strategies to understand the neural architecture of emotion regulation: A meta-analytic approach. Frontiers in Psychology, 14. https://doi.org/10.3389/fpsyg.2023.1187092
Sievert, K. (2023). A systematic review of bottom-up and top-down psychotherapy methods for the treatment of posttraumatic stress disorder (PTSD). SPFC Research Conference. Retrieved from https://digitalcommons.spu.edu/spfc_research_conference/spfc_conf_2023/spfc_conf_2023_events/21/
Taylor, A. G., Goehler, L. E., Galper, D. I., Innes, K. E., & Bourguignon, C. (2010). Top-down and bottom-up mechanisms in mind-body medicine: Development of an integrative framework for psychophysiological research. EXPLORE, 6(1), 29–41. https://doi.org/10.1016/j.explore.2009.10.004
Written by: Lauren Lawrence
To book: Click Here!
