What Path is right for me?
Healing is a deeply personal journey, and no one’s path will look the same. That being said, there are some things to keep in mind when treating trauma. Many different therapeutic approaches fall under the bottom-up or the top-down framework.
Bottom-up therapies (like somatic experiencing or EMDR) focus on the body and nervous system first, helping regulate sensations and emotions before processing thoughts. Top-down therapies (like CBT or talk therapy) start with the mind, using cognition and insight to influence emotions and behaviors. For trauma, bottom-up approaches are often more effective because traumatic memory is stored in the body and nervous system, making regulation and safety essential before cognitive processing can take hold. This can be especially helpful for those with a tendency to intellectualize their emotions, or feel stagnated in traditional therapy.
Below, you can find a list of different modalities, briefly explaining what they are and some advantages and disadvantages accompanying each. Additionally, you can find a button where you can learn more, as well as a link to a corresponding subreddit—a great place to read up on others’ experiences, share your own and ask questions. Don’t be discouraged if the first path you try isn’t working the way you hoped—processing trauma involves and lot of trial and error, and it’s completely normal if that first therapy session doesn’t click.
Bottom-Up Approaches
Eye Movement Desensitization & Reprocessing
Eye Movement Desensitization and Reprocessing (EMDR) therapy is an extensively studied psychotherapy that has proven highly effective at helping individuals recover from post-traumatic stress and other conditions such as dissociative, obsessive-compulsive, and eating disorders. Unlike other forms of therapy, it does not involve talking about distressing experiences. Instead, it is designed to help the brain resolve unprocessed memories and emotions through guided instructions and bilateral (back and forth) eye movements. This process allows the brain to resume its natural healing process and repair the injury left by trauma.
Advantages
- Many studies have proven it effective
- Does not involve talking about painful memories
- Often works more quickly than other forms of therapy
Disadvantages
- Relatively new form of therapy (developed in the 1980s)
- Only works with conditions related to trauma. Disorders caused by genetics or physical brain injuries may not be resolved with EMDR
Brainspotting
Brainspotting is a trauma therapy that uses eye position to access unprocessed memories and emotions stored deep in the brain. A therapist helps the client identify “brainspots” — eye positions connected to internal experiences — and then guides them in maintaining focus while allowing emotions and body sensations to surface and resolve. Brainspotting works with the body’s natural healing mechanisms and is often used for trauma, anxiety, chronic pain, and performance enhancement.
Advantages
- Accesses deeply stored trauma without requiring detailed verbal descriptions
- Can lead to profound emotional release and healing
- Effective for a wide range of trauma-related conditions
Disadvantages
- Relatively new, so fewer large-scale studies compared to CBT or EMDR
- Requires a highly trained practitioner for best results
- May bring up intense emotions during sessions
Somatic Experiencing
Somatic Experiencing is a body-focused therapeutic approach developed by Dr. Peter Levine. It helps individuals process trauma by tuning into bodily sensations, allowing the nervous system to release stored trauma. SE works by gradually building awareness of how emotions are experienced in the body, helping to regulate and complete the fight-or-flight responses that were interrupted during trauma.
Advantages
- Focuses on the body’s sensations to help release trauma stored in the nervous system, promoting healing without re-traumatization.
- Helps improve emotional regulation by restoring balance to the autonomic nervous system.
- Effective for a wide range of trauma, including physical, sexual, and emotional trauma.
Disadvantages
- May not be suitable for individuals who struggle with body awareness or have severe dissociation.
- Can be intense for individuals who are not ready to process bodily sensations tied to trauma.
- Requires a trained therapist to be most effective, making access difficult in some areas.
Deep Brain Reorienting
Deep Brain Reorienting (DBR) is a relatively new trauma therapy that focuses on the brainstem — the part of the brain responsible for survival responses. DBR works by gently guiding clients to access the body’s original responses to overwhelming events, starting with the initial orienting reflex before the traumatic reaction (such as freeze or collapse) took hold. By slowing down and revisiting these early responses, the therapy helps the nervous system “reset” and resolve trauma at its root.
Advantages
- Targets the body’s earliest, automatic trauma responses
- Can reduce chronic symptoms like hypervigilance, anxiety, and emotional overwhelm
- Does not require talking in detail about traumatic memories
Disadvantages
- Still emerging, with limited research compared to older therapies
- Few trained practitioners available worldwide
- May feel very unfamiliar to clients used to more traditional therapy
Internal Family Systems
Developed by psychologist Richard Schwartz, IFS is a therapeutic approach that views the mind as a system of different “parts,” each with its own emotions, beliefs, and roles. These parts develop as coping mechanisms, often in response to trauma, and can include protective, wounded, or exiled aspects of the self. The goal of IFS is to cultivate a compassionate “Self” that can help heal and integrate these parts, fostering emotional balance and inner harmony.
Advantages
- Research suggests IFS is effective for trauma, PTSD, and emotional regulation, with some studies indicating lasting improvements in self-compassion and emotional balance.
- It provides a non-pathologizing approach, viewing symptoms as adaptive parts rather than disorders, which can reduce stigma.
- Can be used independently or with a therapist
Disadvantages
- IFS has gained recognition in trauma therapy, but large-scale studies are still limited compared to CBT or EMDR.
- The introspective nature of IFS may be challenging for individuals in acute distress who need structured coping strategies.
- Some people may struggle to engage with IFS without guidance from a trained therapist.
Art Therapy
Art therapy uses a combination of psychotherapy and the creative art-making process to foster self-awareness, cultivate emotional resilience and reduce distress. This is achieved by engaging both the mind and body in various art forms such as drawing, painting, photography, or sculpture. These forms of self-expression can communicate feelings and experiences that may be difficult to put into words.
Advantages
- Works well in combination with other therapy methods
- Studies have shown that less than an hour of creativity can reduce stress
- There is a wide range of mediums and creative forms that can be used
Disadvantages
- Research is mixed about its effectiveness for more impairing conditions
- Some art therapy sessions take place in groups which may not be preferable for all patients
- Time constraints for sessions may put pressure on the creative process
Top-Down Approaches
Cognitive Behavioral THERAPY
Cognitive Behavioral Therapy (CBT) is founded on the idea that our thoughts shape the way we feel and behave. The aim of CBT is to lessen distress and impairment in everyday functioning by targeting thought and behavior patterns. Specific CBT goals may include learning to recognize distorted perceptions, strengthening problem-solving skills, practicing facing fears and exercising calming abilities. Unlike therapies that utilize psychoanalysis, CBT does not deal with processing and understanding the past. Its focus lies in gaining the skills to solve present-day problems and lessen conditions such as depression, anxiety, additions, and obsessive-compulsive disorders.
Advantages
- Research has shown CBT to be as effective as medication in lessening symptoms of many mental health disorders
- Highly structured with clear guidance on how to improve everyday functioning
- The skills you learn can serve you long after treatment has finished
Disadvantages
- Benefits rely on your own willingness to commit to the process, which can at times be a lot of hard work
- Methods that involve confronting your own emotions and fears can temporarily cause a worsening of anxiety and depression
- Since it is present-focused, CBT alone does not address underlying traumas from the past
Cognitive Processing THERAPY
Cognitive Processing Therapy (CPT) is a form of cognitive behavioral therapy that has been shown to be effective at reducing symptoms of post-traumatic stress. CPT involves learning about the thoughts, emotions, and other symptoms associated with PTSD and then identifying the specific ways they have impacted your own life. The goal of treatment is then to learn a set of strategies to overcome these barriers to everyday functioning. Treatment may also involve writing out specific events relating to the traumatic experience with the aim of recognizing how thought patterns surrounding the trauma have developed.
Advantages
- As with broader CBT, the skills you learn can be used in everyday life
- Encourages self-awareness and understanding of PTSD and its symptoms
Disadvantages
- Focus more on altering and strengthening the logic center of the brain rather than the nervous system where trauma is stored
- Can be retraumatizing for some as it involves pinpointing specific areas of distress relating to trauma
- Often involves a lot of writing and homework, strong literary skills are needed
Dialectical Behavior Therapy
Dialectical Behavior Therapy (DBT) was developed to help individuals struggling with intense emotions, self-harm, and unstable relationships. It combines cognitive-behavioral techniques with mindfulness, focusing on four core skill areas: emotion regulation, distress tolerance, interpersonal effectiveness, and mindfulness. DBT is highly structured and skill-based, often delivered through both individual therapy and group sessions.
Advantages
- Provides practical, real-life skills for managing emotions
- Strong evidence base for borderline personality disorder and self-harm behaviors
- Helps build resilience and stability in daily life
Disadvantages
- Can be time-intensive and demanding (often requires group and individual work)
- May feel rigid or structured for clients who prefer flexibility
- Focuses more on skill-building than on directly processing trauma memories
Talk Therapy
Talk therapy is one of the most common therapeutic approaches. Through conversation with a therapist, individuals explore their thoughts, feelings, relationships, and personal history. The goal is often to gain insight into unconscious patterns, make sense of experiences, and build self-understanding. While not trauma-specific, talk therapy can provide a supportive space for healing.
Advantages
- Widely available and familiar to most people
- Builds self-awareness and insight into patterns of behavior
- Can foster a strong therapeutic relationship, which supports healing
Disadvantages
- Progress may be slower compared to trauma-specific approaches
- May not fully address trauma stored in the body
- Relies heavily on verbal expressio
Exposure THERAPY
Exposure therapy is used to treat PTSD and phobias by reducing reactions to feared stimuli, including objects, places, activities, and situations. This therapy works to break habits of avoidance through exposure to the feared stimulus in a controlled environment. This process may involve unlearning negative associations, building more realistic beliefs around a fear, and strengthening confidence that overcoming fear is possible. Exposures may involve vivid imagination of the feared stimulus or real-life or virtual reality interactions.
Advantages
- Studies show it is highly effective for treating phobias and other fear-based responses
- Can be used for a range of conditions involving anxieties and even panic responses
- Calming techniques learned can serve you in many life situations
- Increases emotional resilience and self-efficacy
Disadvantages
- Long-term form of therapy, may take more time than other methods
- It can be very difficult and distressing to work through intense fears, especially those associated with trauma
- For those with more severe PTSD, more intensive treatment may be needed
- Simulated situations may not reflect those that arise in reality
“‘There’s a light at each end of this tunnel’ you shout
‘Cause you’re just as far in as you’ll ever be out.’”
“Breathe (2 AM)”, Anna Nalick
Project Paper Birds 