The bottom-up processing protocol



Different experiential, psychophysiological, and neurobiological responses to traumatic symptom provocation in post-traumatic stress disorder (PTSD) have been reported in the literature. Two subtypes of trauma response have been hypothesized, one characterized predominantly by hyperarousal and the other primarily dissociative, each one representing unique pathways to chronic stress-related psychopathology. Dissociative responses to trauma, particularly depersonalization and out-of-body experiences, often pose a significant treatment challenge. While the Standard EMDR Protocol includes a significant focus on the body, this can sometimes be insufficient for clients to continue effective processing in cases of significant depersonalization. The term bottom-up processing is used in sensorimotor psychotherapy, a somatic (body) approach to facilitate processing of unassimilated sensorimotor reactions to trauma. Lanius (2000) found this approach useful in dealing with dissociative symptoms and adapted it to be used in conjunction with bilateral stimulation (BLS), as part of a comprehensive treatment approach for individuals with complex PTSD and dissociative symptoms. This chapter discusses how bottom-up protocol differs from standard EMDR protocol; affect and the body: the importance of subcortical processes; sensory fragments and the subcortical bridge; and the bottom-up processing protocol script notes.


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Ulrich Lanius



“The bottom-up processing protocol,” Francine Shapiro Library, accessed September 17, 2021,

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