EMDR as Top-Down + Bottom-Up Trauma Therapy

By Susie Morgan, LMFT - April 21, 2026

In a lot of ways, EMDR was ahead of its time. It came about during the heyday of cognitive behavioral therapy, long before the somatic therapies had their zeitgeist in psychological circles. And yet, even then, EMDR was already incorporating the body into the way we treat trauma.

EMDR is uniquely powerful as both a top-down and a bottom-up trauma therapy. It addresses the meaning the brain has made of a trauma, and the way that trauma is still held in the body - simultaneously, in the same protocol, in the same session.

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EMDR as Top-Down Therapy: Treating Clients as Meaning-Makers

It is not just about what happened. It is about the meaning the brain assigned to it.

When we are addressing a trauma memory in EMDR, we are working with a learning experience. There is a core negative meaning the brain has assigned to that experience, and that meaning is what is still shaping the client's life.

At its core, I think of EMDR as a learning-oriented modality. What it does, and does extraordinarily well, is address the meaning the brain made of the experience.

Traumatic experiences are encoded in full living color and embodied emotional intensity because the brain is wired to prioritize survival above all else.  The brain automatically “learns” from anything it perceives as a threat to safety, in order to predict and prevent anything like it in the future.

For humans, safety threats come in two primary forms. The first is a threat to physical safety — the life-threatening, "blood and fire," big-T traumas we traditionally identify as trauma. The second is a threat to attachment safety, which is every bit as much a safety issue, because we are primarily relational beings. We are attachment-oriented in order to survive.

When we are little tiny humans — infants, or even small children — we cannot survive without our caregivers. Attachment at that age is a biological, physical safety issue, and if a caregiver is not a reliable source of care, the child is not safe.

But, the critical nature of attachment does not end when we are little. As adults, we still need each other to survive. If we are alone in the wild, without another human there to help us, we are at risk of a lot of trouble.

We live and function in concentric circles of attachment: a partner if we have one, a family of origin, a family of creation in our friends and the biological family we may create, a community around us, and the cities and towns and government structures beyond that.  Whatever our feelings may be about those larger structures, they are still the concentric circles of human attachment that allow us to come together when disaster strikes in order to protect and care for one another.  

Attachment is a human safety concern, regardless of age.

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From Core Meaning to Symptom - and Back

Meaning organized the symptom. Meaning is how we unwind it.

When physical or attachment safety is threatened, a heightened level of importance is placed on learning from that experience — and adopting a strategy to manage this sort of threat should it occur in the future.

EMDR facilitates the identification of the core negative belief about the self that is developed to make sense of the experience - the meaning assigned to the traumatic event - such as: I am worthless. I am powerless. I am not safe. I don’t belong.

Strategies instinctually develop out of those core negative meanings, to manage safety, to keep attachment relationships from rupturing. Over time, those strategies become the symptoms that bring clients into treatment.

A person believing I am worthless, who learned to placate and please, may stay in attachment relationships that are harmful, or in work situations where they are being taken advantage of.

Another whose I am worthless turned into a strategy of if I try, I will fail or if I reach I will be disappointed may find their repeated instinct to withdraw and shut down has developed into a depressive state.

Our work with EMDR is to decode those symptoms back down to the core meanings organizing them. Meaning is what the brain uses to organize what it has learned from (and to do in response to) traumatic experiences, so it makes sense to use meaning to guide how we strategically reprocess the key learning experiences driving our client’s difficulties.

At Precision EMDR, we map this systematically. We map the line between the present-day trigger, the symptom being expressed, and the historical learning experience underneath. We map the entire memory network that serves as the supporting evidence of the core negative belief. And because there is rarely just one, we map any other trauma memory networks a client may be carrying, along with whatever cluster of symptoms may be related.

Reprocessing with EMDR unwinds the prior learning, loosens the grip of the previous meaning assigned to traumatic experiences, and enables the mind to consider alternatives based on a fuller, more updated, and reality-based perspective.

This opens up a wider range of options for how to respond - allowing clients freedom to choose their responses to the stressors and challenges they face.

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EMDR as Bottom-Up Therapy: Treating Clients as Embodied Nervous Systems

The body is ignition. Memory reconsolidation depends on activation. Activation lives in the body.

It is not enough to address the head when the nervous system is still holding what happened. If all we are doing is treating cognitions - addressing the memory from a top-down method - it is not enough. Humans are embodied nervous systems. EMDR simultaneously treats both, and the bottom-up work is woven into the protocol from the very start.

When we light up a target memory for reprocessing, we use TICES - target, image, cognition, emotion, sensation. We choose the target memory, identify the image of the worst part, and identify the negative cognition we are starting with alongside the positive cognition we are moving toward. We measure how disturbing the whole thing is. And then, as the final question before we begin, we ask our client to deepen into the sensations. Where do you feel it in your body?

That is not a checklist. That is ignition.

One of the places I most consistently see EMDR training miss the point is right here. The assessment phase often gets presented as if we check the boxes about the target memory, gather the baseline data, and move on. But baseline data is not the whole purpose. The deeper purpose of TICES is to lift off — to facilitate activation into the range where memory reconsolidation can actually occur.

Activation is critical for memory reconsolidation. Bruce Ecker has spoken to this. Ad de Jongh has spoken to this.

And the body is the key to that final piece of full activation.

For that reason, training the assessment phase as if it is a checklist carries the risk of nechanical data-gathering that slides into something closer to free association, instead of effective reprocessing.

Equally important, it carries the risk of clinicians treating the assessment phase as innocuous - just a procedure to complete in preparation for the next session when there will be time for reprocessing - and underestimating the degree to which the TICES questions may be lighting up trauma memory within the client.

Completing the assessment phase at the end of a session and telling the client to use their resources to contain the memory - that was just activated - creates predictable difficulties. While unintended, it is a sort of cruelty. The meaning is lit up. The sights and sounds of the memory are lit up. The body is lit up. And then the client goes home to likely manage intrusions and disturbance for a week.

Understanding the purpose of TICES - particularly the role the body has in deepening activation - makes it clear that the assessment phase should be completed only when reprocessing immediately follows.

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The Body as the Way Through

Deeper in the body. Further through the memory.

Once reprocessing is underway, the memory needs to stay sufficiently activated for reprocessing to continue effectively.

Sometimes a client stops following their brain and starts to direct their thoughts or think about what should happen. Sometimes the associations begin to feel difficult, and the instinct to retreat to intellectualizing automatically takes over.

The simplest interweave in those moments is often the most effective: Where do you feel it in your body?

It is the slightest little intervention, but it moves the client deeper into the activation - and that activation is what makes EMDR efficient and effective. The goal is not to prolong the pain. The goal is to move the client through it.

Staying up in the head while dipping a toe in slows the work.  While sometimes that is necessary because of the severity of affect phobia, much of the time, the client needs us to nudge them to deepen in so they can move through more rapidly. The body is the key to that.

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Where the Body Finishes What It Could Not

The movement the nervous system could not make then, it can finally make now.

The body is also where some of the most powerful movement in EMDR happens.

During reprocessing, clients often spontaneously move into speaking the words they were not able to speak at the time - words that could have put them in danger or risked severe punishment.

Or they imagine fighting back in a way that was absolutely impossible in the original situation, when the wisdom of  their body at the time was freeze, shut down, or placate because of the severity of the danger.

PTSD develops, in part, because of a thwarted survival response. A nervous system that needed to flee, needed to fight, and because it could not, had to freeze, had to shut down, had to placate. According to Peter Levine, that response then gets locked in the body. Much of what somatic therapies do is help the body complete the action it could not complete at the time.

What is remarkable with EMDR is that so much of this can happen imaginally. We can ask the client what their body feels like it needs to do in the memory and simply imagine doing it — and that alone can move the client through a full arc of release.

This is especially powerful with complex developmental trauma, where there were unmet developmental needs for a little one. Imaginally bringing the adult self in to have the little one's back allows the little one to finally say the words they could not say, do the things they could not do, and fight back in the way they needed to.

Or - sometimes even more importantly - to watch as the adult self speaks and acts protectively on their behalf, in the ways they always needed.

All of it imaginally. All of it releasing through the nervous system.

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Why EMDR Holds: Top-Down and Bottom-Up Together

The client is both. The therapy has to be both too.

EMDR reaches beyond what cognitive therapy or somatic therapy can reach on its own, because it is the synergy of both - with memory reconsolidation as the mechanism that makes the change possible.

There are practitioners who have braided somatics into EMDR in beautiful ways, and those integrations are worth learning. But even on its own, the power of EMDR, and of imagination as an interweave within it, is extraordinary.

This is what lets us treat the whole client, meaning-maker and embodied nervous system at once. It is what lets us unwind the trauma they are carrying, so that the nervous system itself shifts, and with it, the automatic responses trauma learning had locked in place.

We cannot bubble wrap our clients from life. But we can change what they meet it with - in the way they think, and in the way their body responds.

That is both the work and its outcome.

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Resources:

• Develop and Deepen Your EMDR Skills:
  • Precision EMDR Basic Training: CLICK HERE
  • Precision EMDR Refresher Course: CLICK HERE

References:

Ecker, B., Ticic, R., & Hulley, L. (2023). Unlocking the emotional brain: Eliminating symptoms at their roots using memory reconsolidation (2nd ed.). Routledge. https://doi.org/10.4324/9781003200653.

Levine, Peter A. Waking the Tiger: Healing Trauma. Berkeley, CA: North Atlantic Books, 1997.

Matthijssen, S. J. M. A., Brouwers, L., van Beerschoten, M., & de Jongh, A. (2021). EMDR 2.0: An integrative and strategic approach to EMDR therapy. Journal of EMDR Practice and Research, 15(1), 22–35. https://doi.org/10.1891/EMDR-D-20-00035

Shapiro, F. (2018). Eye movement desensitization and reprocessing (EMDR) therapy: Basic principles, protocols, and procedures (3rd ed.). Guilford Press.

Siegel, D. J. (1999). The developing mind: Toward a neurobiology of interpersonal experience. Guilford Press.