Why Top-Down Approaches May Not Heal Shame—and How Bottom-Up Therapy Can Transform Your Healing

Shame is a tricky, deeply rooted emotion. It doesn’t just live in your mind; it’s woven into your body, your nervous system, and your sense of self. If you’ve ever tried to “think” your way out of shame—convincing yourself you shouldn’t feel it, or trying to reason with it—only to find it still lingering, you’re not alone.

That’s because shame isn’t just a mental experience. It’s a visceral one. And while traditional, top-down approaches to therapy focus on thoughts and behaviors, they can often overlook what’s happening in your body. This is where a bottom-up approach shines. Let’s explore why top-down strategies might not fully address shame and how bottom-up therapy offers a more integrated path to healing.

What Is a Top-Down Approach to Therapy?

Top-down therapy focuses on the mind first—working to change your thoughts, which in turn influence your emotions and behaviors. Techniques like Cognitive Behavioral Therapy (CBT) often fall into this category, emphasizing reframing negative thoughts or challenging cognitive distortions.

While these methods can be helpful for many issues, they tend to assume that our thoughts drive our emotions. But when it comes to shame, it’s not just about what you think—it’s about what your body feels.

Why Top-Down Therapy Often Falls Short with Shame

Shame isn’t just a mental narrative; it’s a bodily experience. It’s the heavy feeling in your chest, the knot in your stomach, the urge to shrink or disappear. These sensations are tied to your nervous system, which means no amount of thinking can fully address them.

Here’s why top-down approaches might not work:

• Shame Is Stored in the Body: Shame often stems from past experiences, especially those from childhood, that left an imprint on your nervous system. These imprints are not easily accessed or healed through logic alone.

• The Body Overrides the Mind: When shame is triggered, your nervous system activates a fight, flight, or freeze response. In these moments, your body is in survival mode, and reasoning with it isn’t effective.

• Thoughts Follow Sensations: Often, the critical, shame-filled thoughts you experience arise as a response to the physical sensations of shame in your body. Addressing the sensations themselves can shift the thoughts more effectively than trying to reframe them.

What Is a Bottom-Up Approach to Therapy?

A bottom-up approach starts with the body and the nervous system. It focuses on calming and regulating your body first, creating a foundation for emotional healing. Bottom-up methods include somatic experiencing, mindfulness, movement, and breathwork—all designed to help you process emotions physically, not just mentally.

How Bottom-Up Therapy Helps Heal Shame

1. It Calms the Nervous System

Shame often activates a freeze response—a state where you feel stuck, paralyzed, or numb. Bottom-up techniques focus on helping you regulate your nervous system, moving you out of survival mode and into a state of safety where healing can happen.

• Example: Grounding techniques, like feeling your feet on the floor or placing a hand on your chest, help signal to your body that you’re safe in the present moment.

2. It Creates Space for Emotional Processing

Shame is often stored in the body as unresolved tension or heaviness. Bottom-up approaches allow you to release these sensations physically, creating space for emotional processing.

• Example: Gentle movement, like swaying, stretching, or even shaking, can help release the stored energy of shame from your body.

3. It Builds a Felt Sense of Worthiness

Shame tells you you’re not enough, but bottom-up approaches help you access a felt sense of worthiness—an embodied experience of safety and self-compassion.

• Example: Somatic exercises like placing your hands on your heart and taking slow, deep breaths can create a feeling of warmth and connection to yourself.

4. It Helps You Rewrite Shame’s Narrative

When your body feels safe and regulated, it becomes easier to challenge the thoughts that come with shame. By starting with the body, bottom-up therapy lays the groundwork for changing the way you think about yourself.

• Example: Once your nervous system is calm, you might find it easier to reframe thoughts like, “I’m not good enough” to “I am learning, growing, and worthy of love as I am.”

Why the Body Holds the Key to Healing

Shame thrives on disconnection—from yourself, from others, and from your body. A bottom-up approach reconnects you to your body’s wisdom, showing you that healing isn’t about “fixing” yourself—it’s about creating safety, compassion, and space for your emotions to flow.

When you heal shame from the ground up, you’re not just thinking differently—you’re feeling differently. And that’s where true transformation happens.

Ready to Try a Bottom-Up Approach?

If you’ve been stuck in cycles of shame, wondering why nothing seems to shift, it might be time to explore a bottom-up approach to therapy. By addressing the body and nervous system alongside the mind, you can create a deeper, more lasting sense of self-worth and emotional freedom.

You don’t have to carry shame forever. Healing is possible—from the inside out. And you are so worthy of that healing.