Outline

Using Neuroscience in the Treatment of Anxiety

• Positives:
  • Causes and treatments known
  • Can explain the neurological symptoms
  • Science provides evidence, authority
  • De-stigmatizes disorders
• Clinician concerns:
  • You don’t have to be a neuroscientist
  • Oversimplification is inevitable
  • Finding the right level of explanation is essential

Enhancing Engagement in Treatment

• Don’t neglect the therapeutic relationship
• Focus on personalized goals
• Address the challenges of anxious clients
• Remember that strategies are effortful
• Guide the process using client’s goals
• Maintain motivation

Neuroplasticity

• Defined in everyday language
• Neurologically informed therapy goal
  • ”Change the brain” in desired ways
  • Make the brain more resistant to anxiety
  • Create a new self
• Re-consolidation: The modification of emotional memories

Neuropsychologically Informed CBT

• Strategies can be used to effectively “rewire” the brain
• Long history of evidence supporting efficacy
• Skills-based approach
• Strong focus on the present
• Psychoeducation is essential

Identify the Two Neural Pathways to Anxiety

• Amygdala – bottom-up triggering of emotion, physicality of anxiety
• Cortex – top-down emotion generation based in cognition
• How to explain the pathways to clients
• How anxiety is initiated in each pathway
• The pathways influence each other

Client Friendly Explanations

• Use illustrations to create concrete understanding
• Fight/flight/freeze responses
• The “language of the amygdala”
• Anxiety and the cortex
• Help clients recognize the two pathways

Neuroplasticity in the Amygdala Essential for all Anxiety Disorders, PTSD, OCD, Depression

• Sleep and the amygdala
• The influence of exercise
• Breathing techniques to reduce activation
• Relaxation, meditation, and yoga to modify responses
• Exposure as opportunities for the amygdala to learn
• Combating avoidance
• Indications that the amygdala can learn new responses
• Push through anxiety to change the amygdala

Neuroplasticity in the Cortex Essential for GAD, SAD, OCD, PTSD, Depression

• ”Survival of the busiest” principle
• Strengthen or weaken specific circuitry
• The healthy (adaptive) use of worry in the cortex
• ”You can’t erase: You must replace”
• Recognize and modify the impact of uncertainty
• Training correct uses of distraction
• Left hemisphere techniques
  • Cognitive defusion
  • Coping thoughts
  • Fighting anticipation
• Right hemisphere techniques
  • Imagery
  • Music
• Mindfulness and anxiety resistances

Neuroplasticity and Medications for Anxiety Disorders, OCD, PTSD, Depression

• Medication’s effects in the rewiring process
• The myth of the chemical imbalance
• The danger of sedating the brain with benzodiazepines
• Promote neuroplasticity with SSRIs, SNRIs
• The effectiveness of CBT and meds

Moving Beyond Diagnostic Categories to Focus on Anxiety Pathways

• Address anxiety as a component of many diagnoses
  • Depression, substance abuse, etc.
• Amygdala and cortex-based techniques that can help in other disorders
• Target brain-based symptoms rather than disorders
• Worry, obsessions, rumination respond to similar cortex-based techniques
• Panic, phobic responses, compulsions respond to amygdala-based techniques

Research, Risks and Limitations