An exploration of sensory versus cognitive therapy
As humans, we respond to our environment (e.g., friends, sound, food, stress, light, news) in two general ways: through bottom-up responses and top-down responses. We often feel our emotions in our bodies before we consciously think about them. Since our brains are essentially guessing machines, the narrative we attach to those feelings is only partially accurate, depending on various factors. Different types of therapy are designed to address different patterns of responses.
Top-Down Response
Top-down processing refers to the highest level of out brain function, meaning it involves cognition that occurs in the prefrontal cortex. This part of the brain doesn’t fully develop until our 20s, and some individuals have neurotypes that make accessing or engaging the prefrontal cortex more challenging.
When thinking becomes distorted (“I’m not lovable,” “No one likes me,” “I’m a failure,” “People are awful”), cognitive therapies that focus on reframing thoughts and narratives can be very effective. These include CBT (Cognitive Behavioral Therapy), DBT (Dialectical Behavior Therapy), psychodynamic therapy, solution-focused brief therapy, and ACT (Acceptance and Commitment Therapy).
However, if these “thinking” therapies aren’t effective, it may be because the beliefs are rooted deep in the unconscious mind. In such cases, approaches that address sensory responses—often unconscious and rooted in the body—may be more beneficial. This is where bottom-up responses come into play.
Bottom-Up Response
Bottom-up processing is primal and originates in the body and emotional systems. These responses travel upward toward the “head space” (cognition), which often isn’t fully aware of why the reaction is so intense. Because they come from a pre-cognitive, non-verbal place, these reactions typically can’t be “explained” through logic alone.
As adults, it’s important to audit the basic environmental and physical stimuli affecting our bodies. Have we eaten recently? Moved our bodies in the past 24 hours? Slept enough? How much screen time have we had (phone, tablet, TV)?
As caregivers, we must consider that intense reactions from our children may stem from sensory overload or discomfort. Some detective work might be needed: Are the pants too tight? Is the person hungry? Are the noises too loud or chaotic? Have we not slept? Does the sweater feel itchy? Is it too hot or too cold—or some overwhelming mix of these sensory inputs?
Bottom-up responses are best addressed through co-regulation and somatic soothing. Therapies that involve the body and non-verbal aspects of the mind are especially effective here, including play therapy, art therapy, EMDR (Eye Movement Desensitization and Reprocessing), sand tray therapy, somatic therapy, or equine-assisted therapy.
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