Bottom-Up vs. Top-Down Healing: Why Insight Alone Often Isn’t Enough

Many people enter therapy expecting that understanding why they feel the way they do will automatically lead to relief. Insight matters. Language matters. Meaning matters.
But when it comes to grief and trauma, the brain does not heal from the top down alone.

To understand why, we need to return to the basic neurobiology of how the brain and nervous system respond to threat, loss, and overwhelming experiences.

A Brief Neurobiology Refresher

The human brain developed over an incredibly long period of time. Rather than replacing older systems, evolution layered new structures on top of them. As a result, the brain still relies heavily on older, faster systems designed for survival, while newer systems handle reasoning, planning, and reflection.

At its most fundamental level, the brain’s primary job is survival. What we often label as “symptoms” in therapy—hypervigilance, dissociation, emotional reactivity, numbness—are frequently adaptive responses that once served a protective function.

The brain is also oriented toward efficiency. Because the brain consumes significant energy, it relies on shortcuts. One of those shortcuts is implicit memory—storing experiences, especially threatening ones, in a way that allows for rapid response without conscious thought.

This becomes particularly relevant in grief and trauma.

The Brain Under Threat: Why Logic Goes Offline

A simplified way of understanding brain organization is:

• Hindbrain: automatic functions (breathing, heart rate, digestion)

• Midbrain / Limbic System: emotion, threat detection, survival responses

• Forebrain (Prefrontal Cortex): reasoning, reflection, planning, meaning-making

Lower brain structures act faster and are more reactive. When the limbic system—especially the amygdala—detects threat, it activates the autonomic nervous system and can dampen activity in the prefrontal cortex.

This is not a malfunction. It is adaptive.

If danger is immediate, the brain prioritizes action over analysis. The problem arises when this system becomes chronically activated by grief or trauma. In those moments, insight alone cannot override the response, because the part of the brain responsible for insight is no longer fully online.

This is the central limitation of purely top-down approaches.

What Are Top-Down Approaches?

Top-down therapies primarily engage the prefrontal cortex. They rely on:

• Talking through experiences

• Cognitive reframing

• Gaining insight

• Understanding patterns

• Meaning-making

These approaches are valuable, especially for identity, values, and narrative reconstruction. They are often essential later in the healing process.

However, when a traumatic or grief-related memory is stored primarily in the amygdala and body, the rational brain cannot simply “talk it out” of alarm.

This is why people often say:

• “I know I’m safe, but my body doesn’t believe it.”

• “I understand it logically, but it still feels overwhelming.”

• “I’ve talked about it for years, but nothing changes.”

That is not resistance. It is neurobiology.

Bottom-Up Processing: Where Healing Often Begins

Bottom-up approaches work from the body and lower brain upward, rather than starting with cognition.

They focus on:

• Sensation

• Emotion

• autonomic nervous system regulation

• implicit memory

• relational safety

Rather than asking “Why do you feel this way?”, bottom-up therapies ask:

• “What is happening inside right now?”

• “What does this part of you need?”

• “Can the body experience safety while this memory is present?”

The goal is to activate the traumatic or grief-related material while keeping the nervous system regulated enough that higher brain structures remain online.

This is how processing happens neurobiologically.

Somatic Therapy as a Bottom-Up Approach

Somatic therapies work directly with the nervous system and body-based memory.

Traumatic and grief-related experiences are often stored somatically—as tension, shutdown, pain, numbness, or agitation—because the original experience overwhelmed conscious processing.

Somatic approaches help clients:

• Track internal sensations

• Notice shifts in arousal

• Gently discharge survival energy

• Restore autonomic flexibility

By working with sensation rather than narrative alone, the brain is able to relearn safety at a physiological level. Over time, this reduces chronic sympathetic activation (fight/flight) or dorsal vagal shutdown (numbing, dissociation).

Importantly, somatic therapy does not require reliving or recounting traumatic details repeatedly. The body leads the pace.

Internal Family Systems (IFS) as Bottom-Up Therapy

Although IFS uses language and imagery, it is fundamentally a bottom-up, right-brain-oriented approach.

IFS recognizes that the mind is organized into self-states or parts, many of which formed in response to overwhelming experiences. These parts are not pathological; they are adaptive.

From a neurobiological perspective:

• Protective parts often correspond to limbic and autonomic activation

• Traumatized parts hold implicit emotional and somatic memory

• Extreme reactions reflect nervous system states, not character flaws

IFS does not attempt to eliminate parts or override them with logic. Instead, it helps the system establish internal safety and regulation so that wounded parts can be accessed without overwhelming the nervous system.

When a part is witnessed while the system remains regulated, the brain is able to update the memory—distinguishing past danger from present safety. This mirrors the same mechanism discussed in trauma processing: amygdala activation with the prefrontal cortex still online.

Why Bottom-Up Approaches Matter in Grief

Grief is not only emotional—it is biological.

Loss represents the severing of an attachment, which the nervous system interprets as a threat to survival. This can lead to:

• Hyperarousal

• Dissociation

• Sleep disruption

• Somatic symptoms

• Identity confusion

Bottom-up therapies help the nervous system gradually adapt to the new reality of the loss, rather than forcing acceptance cognitively before the body is ready.

This is why grief cannot be rushed—and why safety, pacing, and regulation are central to healing.

Integration: Bottom-Up and Top-Down Together

Bottom-up and top-down approaches are not opposites. They are complementary.

Bottom-up work stabilizes the nervous system and allows traumatic or grief-related material to be processed safely. Top-down work helps integrate meaning, identity, values, and narrative once regulation is restored.

Healing happens when:

• The body learns it is no longer in danger

• The brain updates old threat memories

• The mind can reflect without being overwhelmed

This is not about insight versus somatics. It is about timing, sequence, and neurobiology.

Final Thoughts

If healing feels stalled despite deep insight, the issue may not be motivation, effort, or readiness. It may simply be that the nervous system has not yet been addressed in the way it needs.

Grief and trauma live in the body and lower brain first.
Healing often begins there too.