Digital Commons @ SPU

A systematic review of bottom-up and top-down psychotherapy methods for the treatment of posttraumatic stress disorder (PTSD)

While numerous studies have investigated the efficacy of either Top-Down or Bottom-Up modalities in reducing PTSD symptoms, there is a paucity of research focused on comparing differences in treatment effects of Bottom-Up and Top-Down therapies. Top-Down interventions are built on an individual’s ability to become conscious of their thoughts and their subsequent capacity to change those thoughts, while Bottom-Up interventions rely on an individual’s body sensations an/or movements to access and process trauma. We investigated this gap by conducting a systematic review of Top-down and Bottom-up treatments for PTSD. To be included in the review, studies needed to examine adults meeting DSM -5 diagnostic criteria for PTSD and represent a Randomized Controlled Trial comparing a psychotherapy intervention to an inactive control (e.g., placebo, no treatment, standard care, or a waitlisting control). Search methods were developed in conjunction with a librarian experienced in conducting systematic reviews. Initial search criteria produced 5,262 articles, of these 64 met full inclusion criteria for the study. Factors such as PTSD symptoms, attrition rates, and patient satisfaction with treatment were compared across the two models. Implications for treatment recommendations for PTSD are discussed.