Anxiety is a common, yet deeply personal experience that can manifest in various forms—from a slight unease to a debilitating sense of dread. As a holistic psychologist, I believe that addressing anxiety requires an approach that honours the complexity of our minds, bodies, and spirits. Two powerful strategies that can be employed in this process are the top-down and bottom-up approaches. Understanding how these approaches work, and when to use them, can be instrumental in effectively managing anxiety.
The Top-Down Approach: Engaging the Mind to Heal the Body
The top-down approach begins with the mind, working to shift our thoughts, beliefs, and perceptions to alleviate anxiety. In this context, Acceptance and Commitment Therapy (ACT) offers valuable tools to help us navigate our internal experiences without becoming overwhelmed by them.
Rather than focusing solely on changing anxious thoughts, ACT encourages us to accept them as part of our human experience while committing to actions aligned with our values. This approach helps us build psychological flexibility—the ability to stay present and open, even when facing difficult emotions.
In a top-down approach rooted in ACT, we might explore:
- Mindful Awareness: Noticing anxious thoughts and feelings without judgement, allowing them to come and go like passing clouds. This practice helps us detach from the grip of anxiety and creates space for more intentional responses.
- Cognitive Defusion: Learning to see thoughts as just thoughts, rather than absolute truths. By practising cognitive defusion techniques, such as repeating a thought with a playful tone or visualising it as text on a screen, we can reduce the power these thoughts have over us.
- Values Clarification: Identifying what truly matters to us and using those values as a compass to guide our actions. By staying connected to our values, we can take meaningful steps forward, even in the presence of anxiety.
- Committed Action: Taking small, purposeful actions that align with our values, despite the presence of anxiety. This helps us move towards a life that feels fulfilling and authentic, rather than allowing anxiety to dictate our choices.
These ACT-based tools offer a compassionate and empowering way to engage with anxiety, helping us to shift our relationship with it rather than trying to eliminate it entirely.
The Bottom-Up Approach: Healing the Body to Calm the Mind
The bottom-up approach begins with the body, recognising that our physical state has a profound impact on our mental and emotional well-being. This approach is particularly useful for managing the physiological aspects of anxiety, such as a racing heart, shallow breathing, or muscle tension.
Tier 1: Calming the Body Through Movement
One particularly effective bottom-up technique involves the use of vigorous movement to calm the stress response. When we experience anxiety, our body releases stress hormones like adrenaline and cortisol, preparing us for fight or flight. This influx of hormones primes our large muscles for action. Engaging in activities such as brisk walking, running, dancing, or any form of vigorous exercise can help to “flush out” these stress hormones, providing an outlet for the energy that anxiety creates.
By incorporating movement into our routine, we can:
- Release built-up tension and stress in the body.
- Engage our muscles, which have been primed for action by the stress response.
- Help our nervous system return to a state of equilibrium, promoting a sense of calm and relaxation.
Tier 2: Soothing the Body and Senses
Once the body has been calmed through movement, the next step in the bottom-up approach involves engaging in practices that further soothe the nervous system and create a sense of safety.
When using this tier of the bottom-up approach, consider:
How is your body reacting to anxiety?
- Tune into physical sensations like tension, tightness, or rapid heartbeat.
- Awareness is the first step to addressing these symptoms.
- Allow the feelings to move through you and ask your body what it feels like doing to help the energy flow.
Can you engage in deep breathing, grounding exercises, or mindful movement to soothe these physical responses?
- Deep breathing techniques, such as diaphragmatic breathing, can activate the parasympathetic nervous system, which helps calm the body.
- Grounding exercises, like feeling your feet on the floor or holding a comforting object, can bring you back to the present moment and reduce anxiety.
- Gentle, mindful movement such as yoga or tai chi can help release remaining tension and promote relaxation.
What can you do to create a sense of safety in your body?
- Sensory soothing techniques, such as wrapping yourself in a soft blanket, listening to calming music, or using essential oils, can help create a comforting environment.
- Visualisations of safe, peaceful places can also help to evoke a sense of safety and calm within.
- Being with other people or pets can take the focus away from internal thoughts. Sometimes, people are not available but you can visualise them or a memory of them that is soothing or comforting to bring the felt sense of that loved one into your body.
- This tier is particularly effective after vigorous movement or when you feel the need to further ground and calm yourself after an anxiety spike. Sensory soothing helps to reinforce the body’s sense of safety and can be a powerful way to maintain a state of calm throughout the day.
Nature is the most soothing aesthetic available to us. Try spending more time outdoors.
Creativity can also be calming and healing. Engage in something that takes you into the calm zone.
Integrating Top-Down and Bottom-Up Approaches
In my practice, I find that the most effective way to manage anxiety is to integrate both top-down and bottom-up approaches. This holistic method ensures that we are addressing anxiety from multiple angles, acknowledging the interconnectedness of our minds and bodies.
For example, a client might begin a session with a grounding exercise (bottom-up) to calm their nervous system before engaging in ACT-based cognitive work (top-down) to explore their thoughts and values. Alternatively, after clarifying their values and committing to action (top-down), they might engage in yoga, deep breathing, or vigorous movement followed by sensory soothing to further soothe their body’s stress response (bottom-up).
A Holistic Path to Anxiety Management
Anxiety is a multifaceted experience, and there is no one-size-fits-all solution. By understanding and utilising both top-down and bottom-up approaches, we can create a personalised and holistic plan for managing anxiety that honours the unique ways it manifests in each individual.
As we learn to balance the mind and body, we open the door to a more grounded, present, and peaceful existence. In this process, we become more attuned to our inner world, allowing us to not only manage anxiety but also to grow, heal, and thrive.
As a holistic psychologist, I integrate these approaches into my work, helping clients navigate their journey with anxiety. By blending ACT tools with body-based practices, including vigorous movement and sensory soothing, we can address anxiety in a way that feels compassionate, empowering, and deeply supportive.
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