Recovery from the Top Down or the Bottom Up?

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Recovery from the Top Down or the Bottom Up?

Your brain and your body, closely linked by the nervous system, are partners in a constant stream of two-way communication. For every thought, emotion, impulse, action, or perception there is a corresponding response in your body. For instance, your jaw may tense when you’re angry, your chest may swell at the sight of a beautiful sunset, or there may be pressure in your throat and chest when you have an urge to binge.

What’s more, body sensations influence the thoughts and feelings in your brain and vice versa. When the influence goes from brain to body, we call it “top-down” influence. When the influence goes the other way, with body states affecting brain processes, we call it “bottom-up” influence. While top–down and bottom–up influences occur automatically all the time, each can be engaged consciously to make changes in your experience. Thus, both can be useful in recovering from an eating disorder.

Traditional therapy methods, such as psychodynamic therapy and cognitive behavioral therapy (CBT), work from the top down. You rely on your thinking, logical brain to be the agent of change and to create some law and order among unruly internal processes. This is what you’re doing when you develop insights about yourself, focus on changing disordered thinking, or learn about nutrition.

Bottom-up approaches, in contrast, rely on the opposite direction of influence. You learn to change the way you think, feel, and act by contacting and modifying internal processes such as “gut” sensations, impulses, or your “felt sense.” You may have seen such treatments referred to as mind-body, body-based, energy, or somatic therapies.

The key to the effectiveness of these therapies is the development of body awareness, both as a way to know yourself more accurately and deeply and as a resource for creating lasting change. Body awareness enables you to rewire the internal communication loop of brain, nervous system, and body so that it stops recycling outdated, harmful, self-limiting messages about you and your possibilities in life.

Some bottom-up treatments focus almost exclusively on body-based interventions. (“Body-based,” by the way, does not imply or require physical touch by the therapist.) Thought-field therapy (TFT) and the Feldenkrais Method are examples of treatments that are primarily body-based. Other approaches, such as EMDR (Eye Movement Desensitization and Reprocessing), Somatic Experiencing, and Sensorimotor Psychotherapy, combine top-down and bottom-up techniques.

Body-based treatment approaches can make a significant contribution to eating disorder recovery.

Unruly Emotions

You already know that you turn to food—or restricting or purging—when uncomfortable feelings arise. So you’ve probably also figured out that developing more effective ways to handle your emotions will be essential if you are to truly leave your eating disorder behind.

Working from the bottom up means learning to calm and quiet the body sensations of negative emotions. When you are experiencing an emotion, slip down into your body and you will notice a corresponding body sensation: the racing heart or shallow breath that goes with fear, the tingle in your chest when you’re excited, or the flushed face that accompanies embarrassment or shame. You will discover that when you calm down your body—for example through deep breathing exercises or other relaxation techniques—your mind and emotions calm down right along with it!

Limiting Learnings

Limiting learnings are deeply engrained, often unconscious beliefs or habits that squelch your sense of personal possibility. Most likely the “limiting” resulted from childhood family patterns in which certain behaviors were discouraged, or not sufficiently encouraged. You may have learned, for example, that nice girls never get angry. Or you might have lacked models for healthy self–assertion. Limiting learnings may show up in the present primarily when you feel threatened—such as becoming defensive when you feel criticized—or may have generalized into a more basic orientation to life, such as a lack of any sense of inner spark or capacity to change yourself or your circumstances.

When you work on these habitual patterns from the bottom up, your therapist may suggest you try movements or gestures that will eventually support new ways of experiencing yourself or new patterns of interacting with others. For example, your therapist may invite you to make the motion of pushing away that means “no.” This can be the start of defining personal boundaries.

Your therapist may also notice and encourage movements that develop spontaneously during your treatment. For instance, a gesture of reaching out can be the starting point for developing deeper connections to others. Or, awareness and support for subtle muscle sensations that signal an impulse to act can be a first step toward expressing personal agency and initiative. When physical options you didn’t learn in childhood come online, they change your experience of yourself. You start on a path toward becoming more flexible and adaptive in the way you respond to what life brings you.

Binge Urges

If you binge, the binge urges probably feel outside your control. Top-down approaches to bingeing wisely engage your observing mind to identify binge triggers and make mindful choices about how to respond. Complementary bottom-up approaches can significantly enhance your efforts.

Binge urges, like any urges, are fundamentally body sensations. When you learn to contact these sensations and identify them, you begin to experience them in a new way. With practice, you can learn to stretch your capacity to tolerate these sensations without acting on them, much as you stretch your muscle capacity through incremental workouts. A body sensation you simply observe and track will often fizzle on its own (or uncover experiences fueling the urge that you can then work to resolve). When body sensations related to a binge urge don’t resolve, you can learn how to quiet them much as you’d quiet the sensations of uncomfortable emotions. For example, you might imagine yourself in a calming, soothing environment or with the arm of a comforting person around your shoulder. Or you might talk to yourself in a quieting way, saying things like “You’re alright.” or “It’ll be okay.” Your body will tell you when you’ve hit on the right thing: it will feel a little more relaxed and the sensations of the binge urge will be less intense.

Trauma

If you have an eating disorder, the chances are higher than for most others that you also have a history of trauma. By trauma I mean any experience that overwhelmed your capacity to cope at the time it occurred. Trauma may include experiences such as physical, sexual, or emotional abuse as well as neglect or catastrophic loss. Eating disorders frequently represent a desperate attempt to cope with the enduring effects of trauma on daily living.

Many body-based treatments, such as EMDR, Somatic Experiencing and Sensorimotor Psychotherapy, began as trauma treatments. Trauma therapists have long recognized that the tenacious effects of trauma reside in the body and nervous system, exerting disruptive effects upward onto thought, perception, and emotion.

When you observe and track your body sensations, you have direct access to your nervous system while it is responding to trauma triggers. This opens the possibility of changing the response and calming it down. In trauma treatment, staying connected to sensations tells you how much stimulation your nervous system is experiencing. This allows you to adjust your response so that you neither become flooded nor preempt flooding by shutting down or dissociating. Body experiences that represent the trauma can be digested in manageable bits and resolved.

Body-based, bottom-up methods can help resolve common eating disorder problems such as these and help build resiliency essential for recovery. They do so by exploiting the two-way street of influence between body and mind, as well as the nervous system’s built-in capacity to learn to regulate itself. It’s nice to know that your body, which has often been such a source of distress and despair, can become a potent source of hope and healing.

By Susan Schulherr
Reprinted with permission from Eating Disorders Recovery Today
Summer 2009 Volume 7, Number 3
©2009 Gürze Books

About the Author

Susan Schulherr, LCSW, is the author of Eating Disorders for Dummies (Wiley, 2008). She has a private practice in New York City. In additional to more traditional therapy approaches, Susan uses the “bottom–up” methods of Somatic Experiencing and EMDR, each of which she has adapted for use with eating disorders. Her Web site, www.susanschulherr.com, includes a recovery section and Susan’s blog, “Wise Words for Recovery.”

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