Balancing Brain & Body: The Full Picture of Nervous System Regulation
Early in my career as a licensed therapist, the field of mental health was heavily focused on top down, cognitive approaches to nervous system regulation. For me, this meant cognitive behavioral therapy (CBT): teaching clients to identify distorted thoughts and challenge unhelpful beliefs, which would then shift the individual’s emotions and subsequent behaviors. (For example, instead of thinking, “I failed another test- I’m such a loser!” and then experiencing and acting from the emotion of shame, one could instead shift their self-talk to, “Yes, I struggled with that test, but I’m going to keep trying and ask for help”, leading to more self-compassion and empowered action.) These skills were helpful for many, but I noticed something- they just weren’t always enough. Clients would find themselves remaining in states of chronic stress; they could regulate and bring their arousal down momentarily, but long-lasting healing and regulation often felt elusive.
My analogy for only using top down approaches to nervous system regulation is this: imagine you are trying to learn how to play an instrument just by reading about it or visualizing yourself strumming a guitar or pressing the piano keys. You can mentally rehearse and visualize all you want, but at some point, you have to use your hands, hear the sound, and feel the feedback from your body. True learning happens through embodied practice. And the same is true for our nervous system.
The Difference Between Top-Down and Bottom-Up Approaches
When it comes to nervous system regulation, we can approach it from two primary directions: top-down (starting with the brain and thoughts) and bottom-up (starting with the body and sensations). Both are valuable, but understanding their differences—and how they work together—can be a game-changer.
Top-Down Approaches: Changing the Brain’s Interpretation
Top-down approaches focus on shifting our thoughts and beliefs to change our emotional and physiological responses. This includes:
Cognitive behavioral therapy (CBT)
Mindfulness and self-talk
Reframing and perspective-taking
Visualization techniques
These strategies are incredibly helpful for interrupting negative thought loops and gaining insight into why we feel the way we do. They can increase awareness and provide a sense of control over our emotions. However, when our nervous system is highly activated—when we’re overwhelmed, panicked, or shut down—our thinking brain (prefrontal cortex) can go offline. In these moments, rationalizing our way to calmness often doesn’t work. That’s where bottom-up approaches can be a huge benefit.
Bottom-Up Approaches: Changing the Body’s Sensations
Bottom-up approaches work directly with the body to shift the nervous system state. These techniques include:
Breathwork (e.g., diaphragmatic breathing, box breathing)
Movement (e.g., yoga, walking, stretching, shaking)
Sensory grounding (e.g., holding something textured, using temperature changes, engaging with nature)
Interoception (e.g., learning to identify and mindfully observe the body’s internal sensations)
Somatic therapies (e.g., EMDR, Somatic Experiencing, Polyvagal-informed interventions)