Somatic Psychotherapy...Bottom-Up

When most people think about counseling, "talk therapy" usually comes to mind. Addressing thoughts to make changes in behavior. Typically Cognitive Behavioral Therapy (CBT) is widely used and this is known as a top-down approach. Using the prefrontal cortex to drive thoughts and behaviors.

I love the way Dan Siegel explains the Triune Brain in this short few minutes.

He's talking about parenting, but the hand model is important because we can get a visualization of complex brain processes that we need to understand at the basic level to be able to leverage these processes. I have talked about the vagus nerve in other posts, and honestly, I'll be surprised if there isn't a post where the vagus nerve isn't relevant. Here what I want to point out is that the vagus nerve exits the brain stem and innervates and communicates with facial nerves, trigeminal nerves, auricular nerves, pharngeals and laryngeal nerves, basically the entire face, throat, and mouth. It also travels into the torso, innervating and communicating with the heart (telling it how fast or how slow to fire), the phrenic nerve (operates the diaphragm), the entire GI system, pelvic and reproductive organs. whether the information is coming supradiaphragmatic or subdiaphragmatic (above or below the diaphragm), it is all considered the body. This is important because we know the fibers in the vagus nerve are bi-directional, meaning information comes from the body to the brain (afferent) and from the brain to the body (efferent). So, talk therapies like CBT are using the efferent pathway. That's fine, however, we know that only 20% of these vagal fibers are efferent. So it's like sands in an hourglass. The other 80% are afferent, which means all of the information coming from the body to inform the brain is like dumping a bucket of sand into that glass container, no bottleneck.

Somatic psychotherapy uses a bottom-up pathway. We tune-in to the nervous system state of the body to change the narrative of the brain. By simply noticing our breath, it oftentimes becomes slower and deeper, these signals travel up the vagus nerve to the brain and then the brain thinks, "oh, we're safe". By using the body in therapy, we are leveraging that 80% pathway, using the triune brain, from brainstem (regulating breath) to limbic system (calming emotions) to prefrontal cortex (the world is safe, and I'm safe in it). It's both/and, not either/or. In fact, there is a beautiful quote by Deb Dana, a brillant LCSW who uses this information about the vagus nerve and the vagal fibers, when she says,

"Story Follows State"

Which simply means the narrative in our head, our thoughts are influenced by our nervous system state. So if we can change the state of our nervous system from flight/fight to rest/digest, then we can change our thoughts from the bottom-up. I will almost always invite you into mindfulness to notice what is happening in your body, as I slow down and tune into what is happening in my body. Let's leverage that 80% to help us in therapy!

Dana, D. (2018). The Polyvagal Theory in therapy: Engaging the rhythm of regulation. W.W. Norton &

Company.

Siegel, D. J. (2012). Mindsight : Change your brain and your life. Scribe Publications.

Van der Kolk, B. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma.

Penguin Books.