By Ashley Siebrasse MS | May 2, 2025
Discover a whole-person approach to anxiety treatment in Spearfish, SD. Learn how top-down and bottom-up anxiety affect your mind and body—and how Ensō Mental Health can help.
Anxiety is one of the most common mental health challenges people face, yet it remains deeply misunderstood. Too often, it’s dismissed as simple overthinking or excessive worry. In reality, anxiety is a full-body experience involving both the brain and the nervous system. At Ensō Mental Health, we believe in treating anxiety through a holistic lens—addressing both the mind and body to promote lasting healing.
What Is Anxiety, Really?
At its core, anxiety is a survival response. It’s your body’s way of preparing for potential danger. This response is incredibly useful in short bursts—like when you need to brake quickly to avoid a car accident. But when your system starts reacting to everyday stressors as if they’re life-threatening, anxiety has the potential to take over your life.
Understanding the roots of your anxiety helps you regain control. At Ensō, we help clients explore both top-down and bottom-up pathways—two distinct but interconnected ways anxiety manifests.
Top-Down Anxiety: When the Mind Leads
Top-down anxiety begins in the brain’s cognitive centers, particularly the prefrontal cortex which is responsible for thoughts, planning, and interpretation. This is the kind of anxiety that starts with a thought:
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“What if I mess up during my presentation?”
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“Did I say something wrong?”
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“I’ll probably fail anyway, so why try?”
These thoughts create a ripple effect throughout the body, leading to symptoms like a tight chest, rapid heartbeat, and shortness of breath. This kind of anxiety is thought-driven—your interpretation of a situation triggers the physical response.
Bottom-Up Anxiety: When the Body Speaks First
Bottom-up anxiety originates in the body—specifically the autonomic nervous system, which controls your fight-or-flight response. This kind of anxiety may seem to come “out of nowhere.” You might suddenly feel tense, panicked, or jittery without any conscious thought triggering it.
This form of anxiety often stems from past trauma, chronic stress, or dysregulation in the nervous system. The brain reads the body’s physical state as dangerous and creates anxious thoughts to match.
A Whole-Person Approach to Healing
Top-down and bottom-up anxiety often work together in a loop—a stressful thought creates body tension, which fuels more anxious thinking. That’s why a holistic treatment approach is so important. At Ensō Mental Health, we address anxiety from all angles:
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For top-down anxiety: we use evidence-based therapies like Cognitive Behavioral Therapy (CBT) to reshape thought patterns.
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For bottom-up anxiety: we incorporate somatic therapies and nervous system regulation techniques to help the body feel safe again.
This flexible approach allows us to personalize care and meet each client exactly where they are in their healing journey.
You’re Not Broken—Your Body Is Trying to Protect You
Perhaps the most powerful shift in healing anxiety is recognizing that your symptoms are not signs of failure—they’re signs that your system is working overtime to protect you. With compassion and the right support, you can retrain your nervous system and reclaim your sense of peace.
If you’re ready to explore a deeper, more holistic approach to anxiety, our team is here to help.
Learn more about Anxiety Treatment Services at Ensō Mental Health
Schedule an appointment with Ensō Mental Health today to get help understanding your anxiety and explore how we can support you.
