Full Course Description
Rewire the Anxious Brain: Applied Neuroscience for Treating Anxiety, Panic and Worry
- Explain to clients the neurological processes underlying anxiety in a clearly understandable manner that enhances client motivation.
- Incorporate personalized goals to increase client engagement and focus client efforts on making lasting changes in the brain.
- Characterize the differences between amygdala-based and cortex-based anxiety symptoms in order to select the most effective treatment interventions.
- Individualize practical and evidence-based methods to resist anxiety and improve symptom management in clients.
- Teach strategies for calming the amygdala without use of medication to improve client level of functioning.
- Recommend exposure-based strategies that change the amygdala responses to triggers to reduce anxiety symptoms.
- Employ a variety of strategies to improve clinical outcomes utilizing evidence-based strategies that target cortex-based responding, including cognitive restructuring, psychoeducation, cognitive defusion, distraction, and mindfulness.
- Differentiate symptom-producing cognitions characteristic of specific disorders, including Obsessive Compulsive Disorder, Generalized Anxiety Disorder, Social Anxiety Disorder, and Post-Traumatic Stress Disorder as it relates to case conceptualization.
- Relate the clinical implications of how SSRIs and SNRIs promote the process of treating anxiety.
- Identify detrimental effects of benzodiazepines as it relates to anxiety treatment outcomes.
- Differentiate between rebound anxiety and relapse symptoms to inform the clinician’s choice of treatment interventions.
- Breakdown the key elements of mindfulness practices in managing symptoms of anxiety.
- Present client education exercises that can be utilized in session to train clients in the use of mindfulness techniques.
- Recognize common reactions to aversion and utilize clinical strategies to replace them with mindfulness.
- Reframe exposure as an opportunity to teach the amygdala new responses in order to improve client engagement and treatment compliance.
- Utilize clinical strategies for exposure that reduce avoidance and train clients to push through anxiety.
- Employ effective strategies for reducing anxiety symptoms utilizing imaginal and in vivo exposure, including use of SUDS and attention to interceptive triggers.
- Provide clinical strategies for managing comorbid depression that reduce worry, rumination, and common cognitive errors while promoting positive thinking and social interaction.
- Use cognitive restructuring and cognitive strategies for managing symptoms of OCD and GAD that focus on scheduling obsession/worries and promote client acceptance of uncertainty.
- Implement interventions in a clinical setting that use a reconsolidation approach to reactivate a symptom-producing memory and disconfirm it.
Module 1: Using Neuroscience in the Treatment of Anxiety
Module 2: Working with the Amygdala
- Using Neuroscience in the Treatment of Anxiety
- Positives: We know more about anxiety-based disorders than any other disorders
- Science gives explanations, evidence, authority, destigmatizes difficulties
- Concerns: How to effectively explain neuroscience and answer questions
- Clients may feel a lack of responsibility
- Oversimplification is inevitable - The proper level of detail is essential
- Enhancing the Engagement of Anxious or Avoidant Clients in Treatment
- Don’t neglect therapeutic relationship!
- Empathy before explanations
- Addressing the challenges of anxious, worried, obsessive, and avoidant clients
- Assist anxious clients in understanding their own symptoms, feelings, interpretations, beliefs
- Treatment strategies for anxiety are effortful and produce anxiety
- Use the goal of changing the brain rather than the goal of reducing anxiety
- Focus on client’s personalized goals in guiding the process
- Agreement on goals between therapist and client is predictive of improvement
- Case Example
- The Promise of Neuroplasticity
- Defining Neuroplasticity in everyday language
- Therapy is about creating a new self
- Focusing on neuroplasticity makes the brain more resistant to anxiety
- Clients are more willing to undergo anxiety when they expect it will create improved circuitry
- Explaining re-consolidation: the modification of emotional memories
- Identifying Two Neural Pathways to Anxiety
- Amygdala - Bottom-up triggering of emotion, physicality of anxiety
- Cortex - Top-down emotion generation based in cognition
- Simplified techniques for explaining the two pathways and their differences to clients
- How anxiety is initiated in each pathway and how pathways influence each other
- Different pathways respond to different types of treatment
Module 3: Managing the Cortex
- Explaining the Amygdala’s Role in Anxiety
- The protective, evolutionary role of the amygdala
- The amygdala and the stress/fear/anxiety response
- The role of the amygdala in forming emotional memories
- Explaining the Fight/Flight/Freeze response to clients
- Teaching the amygdala
- The language of the amygdala - communicating alarms and relying on pairings
- Why the amygdala needs experience to learn
- How “Triggers” are created in the amygdala
- Managing the Amygdala
- Essential for all Anxiety Disorders, PTSD, OCD, Depression
- Symptomatic behavior is often a response to amygdala activation
- Interventions that impact the amygdala
- The Vagus nerve’s role in recovery from the activation of the sympathetic nervous system
- Interventions that reduce activation in the amygdala over time
- Communicating with your client to enhance treatment compliance
- Exposure: activating the fear circuitry created in the amygdala to generate new connections
- Tips for effective exposure strategies
- Exposure with response prevention is essential when treating OCD
- Limitations and Risks in Neuroscience-Informed Treatment of Anxiety
- The efficacy of evidence based treatments differ by individual and context
- Research is constantly evolving
- Using analogies and other psychoeducation communication
- Medication information and interaction with interventions
- More studies needed to support some observed clinical outcomes
Module 4: Medications in the Treatment of Anxiety
- Explaining the Cortex’s Role in Anxiety
- How the cortex constructs reality for us
- Describing the cortex and its functions in understandable terms
- The fear/anxiety response comes from the amygdala, but the cortex can initiate the response
- Using the concept “Don’t scare your amygdala”
- Understanding and resisting the detrimental effects of anticipation
- Teaching the appropriate use of worry to minimize its detrimental effects
- Managing the Cortex
- Cortex management is essential for GAD, SAD, OCD, PTSD, and Depression
- Identifying specific cognitions, beliefs, attitudes, associated with specific anxiety disorders
- “Survival of the busiest” - understanding how to modify the cortex
- Changes in cortex responses can occur through education, logic, argument, and experience
- “You can’t erase: You must replace.”
- Modifying interpretations and using coping thoughts to manage anxiety
- The appropriate use of distraction
- Right vs. left hemisphere interventions
- Cognitive Therapy - modifying the cognitions mediating emotional responses
- Cognitive fusion - recognizing the problem and how to use cognitive defusion
- CBT cognitive restructuring approaches for targeting cortex-based processes
- Mindfulness approaches to reducing anxiety, and their effect on the cortex
- A cognitive model for approaching OCD
Module 5: Exposure Strategies for Teaching the Amygdala
- Medications Overview
- The role of therapists regarding medications
- Anxiety management, not anxiety elimination, is the goal
- Beneficial effects of Medications
- Assessing and addressing medication during the initial intake
- Respecting the relationship between the prescriber and client
- Educating clients about the role of medication in treating anxiety
- What are the approved Medications for treating anxiety?
- Medications and Anxiety Treatments
- SSRIs and SNRIs
- The impact of benzodiazepines on therapeutic interventions
- The problem of rebound from benzodiazepine use
- Beta blockers
- Choosing the right medication for specific anxiety disorders
- Mechanisms of Action: How these drugs work
- Explaining the effects to clients
- Benefits, disadvantages, and risks of medications
- Factors that influence the usefulness of medications
- Monitoring therapeutic effects
- CBT vs. Medications: Comparing effectiveness and durability
Module 6: Mindfulness in the Anxious Brain
- Teaching the Amygdala
- Exposure interventions allow new emotional learning
- Emotional learning is based on associations or pairings
- The amygdala is not always “correct” - it needs experience to learn new reactions
- Training clients in exposure strategies can change client relationship with anxiety
- Clients are motivated by idea that they are “teaching the amygdala”
- Learning to reduce avoidance and push through anxiety
- Preparation for exposure: psychoeducation, breathing training, cognitive restructuring
- Exposure Strategies
- In vivo vs. imaginal exposure approaches
- Interoceptive triggers and methods for exposure
- Training client for independent exposures
- Use of the term “trigger” and providing examples for client
- Understanding the brain changes underlying successful exposure experiences
- Use of Subjective Units of Distress/Discomfort Scale (SUDS)
- Examining advantages of graphing SUDS ratings
- Concerns associated with safety signals, medications, distraction
- Tips for constructing hierarchies
- Therapist’s role in exposure
- Troubleshooting problems
- Case Examples
Module 7: Neuropsychologically Informed CBT
- Introducing mindfulness to clients
- Defining basic emotional reactions: Attachment, Aversion, Indifference
- Key elements to mindfulness: Being aware, present, and focused
- The detrimental effect of judgment and how to practice self-acceptance
- Exploring thoughts, sensations, and emotional reactions
- Using breath in connecting to the present moment
- Learning how to savor the moment
- Incorporating mindfulness as a tool in treatment
- The neuroscience of mindfulness: Examining the evidence
- Teaching clients to focus more deliberately
- Mindfulness as training to determine focus
- Using the power of intention to focus thoughts in new directions
- Coping with common reactions to aversion using mindfulness
- “Mind wandering” is not failed experience!
- The role of practice and evidence for brain change
- Helpful hints in mindfulness training
- Mindfulness exercises for the anxious brain
- Focus on the breath
- Train the brain to focus
- Mindfulness of sound and thoughts
- Fingers Exercise
- GLAD technique to resist depressive thinking
- Becoming Embodied: The experience of the body
Module 8: Treating Comorbid Depression
- Neuropsychologically Informed CBT approaches
- CBT strategies used to effectively treat anxiety
- Advantages of the strategic use of neuroscience in CBT
- Focus on expectancy of client has benefits in CBT
- Evidence supports CBT and neurological knowledge can strengthen client engagement
- Not all assumptions of CBT are consistent with current neurological knowledge
- Focusing on logic and disputing has limits - some circuitry is not logical
- Emotional centers of the brain are not mediated by cognitive processes
- Skills based approaches in CBT provides the brain experiences to learn
- Neurology of anxiety supports many CBT tenets:
- Focus on the present
- Exposure techniques
- Importance of going beyond talk to experience
- Treating Comorbid Depression
- The link between chronic anxiety and depression
- How the hippocampus impacts negative thinking
- Exercises to help clients focus on the positive
- Addressing worry, rumination, and common cognitive errors in depression
- Benefits of goal setting and behavioral activation
- Key role of social support and social interaction
- Benefits of adequate sleep and regular exercise
Module 9: Cognitive Restructuring Interventions
- Cognitive Restructuring: Interventions for OCD and GAD
- Steps in cognitive restructuring:
- Guided discovery
- Exploring the relationship between thoughts and amygdala activation
- How to challenge distorted cognitions
- Tools for generating alternative perspectives
- Identify and stop anxiety-igniting thoughts common in OCD and GAD
- Strategies for embracing uncertainty
- Making OCD or worry the adversary: Don’t be bullied!
- Scheduling obsessions or worries to bring them under control
- Strategies to avoid counter transference
- Mindfulness tools for OCD and GAD
- Myths about working with anxious thoughts
Module 10: Using Reconsolidation Approaches
- Using Reconsolidation Approaches
- Explaining implicit emotional learning and identifying examples
- Reconsolidation: Deleting/modifying unwanted memories
- How to lay the groundwork for reconsolidation:
- Guided discovery
- Assisting the client to experience the memory structure in the present moment
- Promoting client’s experiential learning of emotional truth
- Disconfirming the emotional memory with “mismatching” information that invalidates it
- Case Example
Telehealth for Mental Health Professionals: Distance Therapy Training
- Appraise the legal and ethical challenges posed by telehealth for mental health professionals in a clinical setting.
- Analyze the evidence supporting the effectiveness of telemental health as it relates to clinical treatment.
- Inspect the unique policies and procedures considerations for telehealth and the clinical implications.
- Evaluate adaptions with telemental health for various populations to improve clinical outcomes.
- Investigate the privacy, security and confidentiality concerns related to technology use in clinical practice.
- Differentiate how client expectations differ for telehealth as compared to in-person therapy and what that means for clinical treatment.
- Distinguish unique boundary issues that arise in a telemental health setting.
- Utilize specific adaptations that are recommended for various disorders and modalities to improve clinical outcomes.
- Appraise text messaging and email complications as it relates to privacy in a clinical setting.
- Apply best ethical practices regarding referrals and advertising concerns as it relates to clinical practice.
- Articulate the legalities of practicing across state lines via telemental health sessions.
- Specify the HIPAA compliance challenges associated with telemental health and its clinical implications.
Telehealth for Mental Health Professionals: What You Need to Know Before You Get Started
Legal & Ethical Issues
- The Types of Telehealth
- Synchronous Format – Live Interaction via Video
- Asynchronous Format – Transfers of Information Electronically
- Evidence Supporting the Effectiveness of Telehealth for Clients and Various Populations
- The Benefits and Risk for Telehealth
- Recent Trends in Telehealth
How to Start Your Mental Health Telepractice
- Following a Code of Ethics
- Legal Implications of Practicing Across State Lines
- Privacy & Security
- HIPAA Compliance Concerns
- Documentation & Paperwork Issues
- Ensure Data Protection & Avoid Unintended Access/Disclosure
- The Client’s Perception of Privacy via Videoconferencing
- Boundary Issues More Likely to Arise in Telehealth
- Multicultural Issues in Telehealth
- Technology Competence of the Clinician and Client
Important Business Aspects to Consider
- Offering Your Telehealth Services – Where to Begin?
- How to Introduce the Concept to Clients
- Who is a Good Fit for Telehealth? Who is Not?
- Administrative Responsibilities
- Policies & Procedures Consideration – Protect Yourself and Your License
- Informed Consent – Unique Concerns & Best Practices
- Intake Process – Tips You Need to Know
- Emergency Plan for Telehealth
- Client Interviewing & Assessment Techniques
- Videoconferencing vs. Telephone
- Best Practices for Professionalism
- Camera Placement, Background, Proximity & Dress Attire
- Handling Technical Issues
Choosing a Platform – What Technology is Right for You and Your Clients?
- Marketing Concerns with Telehealth Practice
- Billing & Reimbursement Strategies – Is This Covered Under My Client’s Insurance Policy?
- Payment Fee Structure Considerations
- Communication of Payment Structure to Client
- Professional Liability Insurance – Telehealth Covered?
- Client Expectations & How They Differ Versus In-Person Therapy
- Financial, Accounting & Tax Concerns
- Giving and Getting Referrals – Issues for Telepractice
Demonstrations of Telehealth in Practice
- An Overview of the Various Platforms Available
- Demonstrations of Key Features
- How to Assess What Features are Important for You
- Cost Comparisons
- What Legal Assurances Do I Need from A Platform Provider?
- Client Considerations When Choosing a Platform
- What Technology is My Client Using & Where From?
Additional Technology Considerations
- A Guided Tour of How to Begin a Telehealth Videoconferencing Session
- What Videoconferencing Looks Like in Practice
- Key Techniques to Enhance the Telehealth In-Session Experience
- Presentation Skills & Tips
Treatment Adaptations to Consider for Telehealth
- Text Message & Email Telehealth – Security, Privacy & Expectations
- Cloud Storage – What are the legal issues?
- Virtual Reality – What You Need to Know
Case Studies of Telehealth Successes & Failures
- Discuss Key Adjustments Recommended for Practicing Telehealth for Different Disorders
- Evidence & Best Practices for Tailoring Telehealth to a Variety of Clients
- Important Adaptations for Groups or Couples
- Which Modalities Most Easily Apply to Telehealth & Which Could Use Adaptions
The Future of Telehealth for Mental Health Professionals
- Examples of the Do’s and Don’ts That Can Make or Break Your Telepractice
- Possible Future New Rules & Regulations
- Up & Coming Technology Trends to Be Aware Of
- What Distance Therapy Might Look Like in 10 years