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  • Sean Cuthbert

Why trauma and anxiety treatment needs to be different...

Much of my career has been spent with clients who have had strictly talk therapy where they have gained benefits, but there has ultimately been a ceiling on their change. This says nothing about the quality of the professionals who treated them, or even how much the client has engaged with the process. But it speaks to common lack of understanding about what are the most effective treatments when dealing with trauma-related issues, which requires special training and a very different approach to high prevalence psychological issues.


To understand why trauma treatment needs to be different, first a little basic neuroscience primer. Using the model of the triune brain (the reptilian brain regulating our body, the mammalian brain regulating our emotions and the neo-cortex regulating our thinking) in integrated brain functioning all three parts of the brain are communicating with each other and are working together. In a triune brain, when one of the three parts of the brain changes (toward positive or toward negative), the other two parts of the brain are similarly affected (toward positive or toward negative). The triune brain allows each part of our brain to positively affect the other two parts. As any of the three parts of the triune brain changes, the other two parts also automatically change. This interconnection of the three parts of the brain allows a non-rigid form of change to occur.


Traditional supportive “talk” and strictly cognitive therapies teach what are commonly called top-down methods. Top-down approaches use the thinking areas of the brain (including the neo-cortex) and then assess or challenge thoughts to change the brain. These techniques have a lot of scientific evidence and have many great benefits. However, if you have experienced a significant traumatic event, overwhelming stress, or suffer from crippling anxiety, the traditional top-down methods of therapy will not be enough to create significant change.


Effective treatment for trauma-related issues - and I would argue most complex psychological issues - requires significantly more than merely working with cognitive processes or engaging the client’s thinking brain. So, in addition to top-down approaches, effective therapy for trauma and anxiety needs to incorporate bottom up approaches in the treatment package. This is the key piece in working successfully with a client’s trauma history. In bottom up processing, we work with the client’s body, and autonomic nervous system to bring about changes at the higher levels of the brain. The bottom up approach states that if we reduce the stress in the body, or if we can process a sensation or a movement using a somatic intervention, this was have a cascading effect in the emotional brain. Similarly, if we are able to regulate the emotional brain, this will then allow the client’s thinking brain to be at ease, allowing them more access to rational thought. There are a number of very well-known therapies that work with psychological issues in this way, in particular, Sensorimotor Psychotherapy, Somatic Experiencing, and the Comprehensive Resource Model. In reality, I would argue most trauma therapies use a combination of both top down and bottom up interventions. Internal Family Systems (IFS) Therapy and Eye-Movement Desensitisation and Reprocessing (EMDR) keep the body front and centre during trauma processing. However, most importantly the integration of brain areas and the transformation of traumatic experience through innovative treatments

is the key to true and lasting change.

© 2020 created by Sean Cuthbert, Clinical Psychologist