Bottom Up and Top Down interventions to support regulation

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In this post we will be exploring what people mean by ‘bottom up” and “top down” interventions and how you can use this information is relevant to regulation when we are emotionally overwhelmed.

In the field of psychotherapy/psychology there is a strange debate right now about whether bottom up models or top down models are superior. The debate has always confused me a bit as there are very few (if any) models which are elusively one or the other and it seems to stand to reason that the answer is that they are both helpful.

First lets start with a brief explanation/definition.

We are talking about the brain and neural pathways when we are talking about ‘top’ and ‘bottom’… the lower part of the brain communicates and influences the higher part of the brain and the higher part of the brain communicates and influences the lower part of the brain. The debate surrounds point of intervention – is it better to intervene on the lower part or the higher part?

The truths that are part of this debate are that the cortex has very little control over the lower regions, but the lower regions are very hard to intervene with in a way that will lead to lasting change (you can’t just change the way that you feel about a given stimulus – your feelings have been hardwired to the given stimulus – yes this can change, but it will take repeated exposure in an emotionally different context).

The top of the brain is the Cortex – this is the rational, abstract, creative, linguistic part of the brain. If I were to throw a Rock at you, the cortex would: label it as a rock, identify the rocks characteristics, and try and deduce if the rock was thrown in play or aggression etc… If you only had a cortex the rock would hit you in the face.

The Bottom of the brain is this context is actually both the bottom, which is the brain stem, and the middle, which is the limbic system.

The brain stem is mostly concerned with the automatic functions of the body (digestions, pulse, organ function, keeping body temperature correct, identifying basic needs like sex food and sleep etc) and the automatic responses for safety. If I threw a rock at you the brain stem would activate a body response to avoid the projectile.

The Limbic system is mostly concerned with emotions – these emotions are used to determine behavior based on past experiences. When the body receives a stimulus the limbic system has a corresponding emotional reaction which impacts whether a human will: move towards the stimulus (pleasure), move away from the stimulus (pain), or ignore the stimulus (neutral). If I threw a rock at you, the limbic system would determine your emotional reaction – perhaps you would be happy because your limbic system received the stimulus as playful (pleasure) or perhaps you would be scared and angry as your limbic system received the stimulus as a threat (pain).

Here is the oversimplified theory behind the two intervention points.

Bottom up = regulate the individual by intervening with the brainstem and limbic system directly.

  • how does this work? – without going to deep into neurosciences, there are ways in which we can use a person’s own nuerobiology to achieve regulation.

 

  • Examples: If you are scared and a loved one gives you a hug or looks you in the eye and accurately reflects and validates your emotional disposition, your brain will be flooded with “feel good – feel safe” chemicals that will serve to regulate your emotional state (this is effective at regulating the limbic system). Additionally, if you have a secure connection with a loved one who is regularly available your system will anticipate interregulation from your partner and will be able to experience more stress (without being flooded) and will be able to regulate more effectively. By this logic creating secure connection is the best way to promote regulation.

 

  • Example 2: deep abdomen breathing can directly impact your autonomic nervous system and switch you from sympathetic (the adrenaline feeling – hyper alert – tunnel visioned – lets get something done state – the state needed to fight or run or compete) to the parasympathetic (your rest and digest state of being)

Top Down = regulate the individual by enhancing the cortex’s (middle pre-frontal cortex) ability to pause and thereby not automatically react to the stimuli.

  • How does this work? – through enhancing ones ability to focus their attention and to mindfully observe stimuli, we can actually create a degree of pause so that we do not automatically think or behave in response to a given emotion. Additionally we can change our thoughts or beliefs related to an emotion or disrupt an irrational thought which was perpetuating an uncomfortable emotional response. By this logic enhancing a person’s ability to pause, focus attention, and mindfully observe the present moment is the most effective way of achieving regulation.

 

  • note: the cortex can not keep the emotion from happening, but the cortex can intervene to alter the emotion after it has arrived. Trauma survivors know this very well – you can not think your way out of experiencing panic, but you can positively impact your ability to manage panic after it occurs.

 

  • Examples: If your partner comes home from work and with anger and relays, “wait you have been here all day while I was working my ass off and we don’t have anything to eat!” you will automatically feel emotions such as shame, guilt, anger and fear. With increased cortical control you could observe your emotions, but override your automatic reactions such as defensiveness or over-personalization… you could even move all the way to a non-judgemental curious observance of your automatic emotions and strangely be very peaceful within your sea of emotions.

 

  • Example 2: emotions tend to cause automatic thoughts which then create a whole new set of emotions. The thoughts can be altered which will impact the emotions. If you were going to give a speech in front of a large audience you would likely feel fear… the fear may convince you to believe “I am not competent in what I have to say and people don’t want to hear my lecture.” through top down interventions one could take pause and alter this thought to, “I am nervous because I am excited and this lecture is very important to me.” the changed thought would change your emotional disposition.

Conclusion – to achieve regulations it is ideal to have both methods of intervention at your disposal.

Top down – you would increase self-reflection and mindfulness so as to reduce automaticity and increase your ability to focus your attention and observe without categorizing.

Bottom up – you would increase bonding and connection to significant others so as to be open for inter-regulation, you would engage in healthy eating and exercise practices to keep your ‘feel good chemicals’ (hormones, neurotransmitters etc.) balanced, and learn breathing techniques to influence your autonomic nervous system.

 

 

 

 

 

William Hambleton Bishop is a practicing therapist in Steamboat Springs Colorado.

William Hambleton Bishop

William Hambleton Bishop is a practicing therapist in Steamboat Springs Colorado.


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