Psychotherapy and the Mind-Body Connection: Integrating Principles of Psychoneuroimmunology, Epigenetics, Nutrition and Neurobiology in the Treatment of Trauma, Anxiety and Depression
Objectives
1. Evaluate the role of diet and health related behaviors on genetic expression and neurological health.
2. Explain the relationship between adverse childhood experiences on health, behavior and mental disorders.
3. Structure lifestyle interventions that improve the expression of health-based psychiatric symptoms.
4. Differentiate between implicit and explicit memory and their roles in therapy.
5. Contrast the fast and slow tracks to the amygdala and the role they play in anxiety disorders and therapy for individuals with anxiety disorders.
6. Apply evidence-based health and behavioral approaches to promote neuroplasticity and adaptive brain growth.
7. Articulate the role that attachment plays in the development of affect regulation and mood disorders.
8. Individualize therapeutic interventions to specifically target brain functions affected by adverse experiences and stress.
9. Contrast cognitive-behavioral and metacognitive models of anxiety treatment.
10. Effectively communicate a comprehensive approach to treatment to individuals with OCD.
11. Evaluate the role of medications, substances and physical status in the experience of depression.
12. Explain how mindfulness meditation affects the brain and is used in the treatment of anxiety
disorders and depression.
Outline
Session 1 - The integrative approach—no more need for the “schools” of psychotherapy
Necessary elements of a comprehensive client view
Historical perspectives on therapy – search for common factors
Psychotherapy and the brain – Brain-Based Psychotherapy
Mind/Brain causality – interaction of multidimensional feedback loops
Results from the ACE study – health, behavioral and psychic impacts of adverse experiences
Mind-Brain-Gene feedback loops
Epigenetics in gene expression – effect of nurturance on stress tolerance
Early experience – neurological responses and neurochemical risk factors
Cell-DNA interactions – highlighters, erasers and decoders
Intergenerational Transmission – passing on the effects of trauma
Gene expression - cell aging and telomeres
Factors that impair DNA and cells – interventions to minimize telomere shrinkage
Components of the immune system
Pro-inflammatory Cytokines - relation to emotional symptoms and physical disease
Short term stress can suppress the immune system
The brain controls the stress pathways – involved neurological systems
Communication in the immune system happens via chemicals
Role of chronic brain inflammation
Obesity pandemic – relationship to early death and psychological vulnerability
Obesity, chronic adipose tissue inflammation and diabetes
Diabetes, stress and psychological disorders
Diet, inflammation and pre-diabetes
Cardio-metabolic syndrome – cognitive fog and mood disorders
Depression has a relationship to chronic inflammation - “sickness behavior”
Hypocortisol vs Hypercortisol activity – maintaining appropriate balance
Immune dysregulation and hopelessness
Inflammation and dementia
Peripheral nerve involvement
Enteric nervous system – the “gut brain”
Microbiome – good and bad microflora
Lifetime psychiatric disorders associated with irritable bowel syndrome
“Leaky gut” syndrome – consequences of stress and inflammation
Dysbiosis and microbial diversity – the importance of balance
Session 2 - Self-regulatory interventions – self-care behaviors “SEEDS”
Movement is an evolutionary imperative – role of beta-endorphin
Exercise increases neurotransmitters, reduces inflammation, improves mood and sleep
Cardiovascular exercise and cortical plasticity – improving cognitive clarity
Exercise induced myokines and anti-inflammatory effects
Working and long-term memory - implications for psychotherapy engagement
Implicit vs explicit long-term memory processes
Role of amygdala and hippocampus in memory function
Case example – H.M. and removal of hippocampus
Threat appraisal – amygdala vs cortical circuits
The dynamics of fear- negative memories and narrowed focus of attention
Positive emotions and expanded focus of attention
Client education - memory improvement
Diet and cognitive function
Perils of the Western diet – impact on dopamine receptors and experience of pleasure
Priming appetite and obesity
Cognitive effects of B vitamins deficiency and elevated glycemic load
Effects of Omega-3 and Omega-6 Fatty acids
Glycation and impact of excess glucose and fructose in diet
Trans-fatty acids and alteration of neurotransmitter synthesis
Protecting the brain from pre-diabetes and Metabolic Syndrome
Client education essentials
Sleep and circadian rhythms
Synchronizing circadian rhythms and sleep patterns
Negative effects of computer use and light spectrum exposure
Medical conditions contributing to sleep disruption
Normal and pathologic sleep architectures
Slow wave sleep deprivation
Sleep changes over the life cycle
Brain clearing – the “glymphatic” system
Sleep deprivation impairs memory – sleep hygiene interventions
Session 3 - Habit and motivation - brain reward pathways
Role of dopamine, nucleus accumbens and ventral tegmental area in habit formation
Drugs associated with neurotransmitters
Effects of acute alcohol on neural circuits – downregulation of neurotransmitters
Brain recovery from alcoholism – persisting cognitive dysfunction
Long term effect of alcohol – brain atrophy, cognitive impairments
Client education - alcohol, mood and sleep
Dopamine firing patterns – response to expected and unexpected rewards
Establishment of habits – wanting vs liking
The “white knuckle” paradox – counterproductive nature of “just say no” approach
The Middle Path – dopamine recycling
Neuroplasticity – increases in synaptic efficiency and receptor density
Growth of dendrite spines and synapses
Client education – “rewiring” the brain
Habits as entrenched neural pathways
Examples of neuroplasticity – growth in hippocampus and grey matter
Bidirectional mind/brain causality
Yerkes Dodson arousal curve – problematic levels of arousal
Client education – acting outside of comfort zone for increased neuroplasticity
Brain Derived Neurotropic Factor – impact on neural growth
Factors that increase and decrease neurogenesis
Client education – relationship of diet and exercise to brain health
Iceland Project – results from international research into health behaviors in youth
Session 4 – The social self
The role of social engagement in the development of self
Hunter-gatherer adaptation boosted the social brain
Regulatory networks of the social brain
Developmental programming of stress responses
The effects of social medicine
Cell aging: shrinking telomeres
The cost of loneliness – vulnerability to depression and cognitive impairments
Effects of deprived social brain networks – Romanian orphanage research results
Child abuse and neuropathology
Effects of maternal separation
Amygdala activation: expression in adults vs children
Gender differences
Intergenerational transmission of depression – facilitating caregiver self-care
“Good-enough” parenting and frustration tolerance
The neuroscience of attachment – balancing the branches of the autonomic nervous system
Longitudinal effects of insecure attachment – alienation leading to depression and helplessness
Client education – rebuilding the stress thermostat
Correspondence between child and adult attachment categories
Epigenetics and neuroscience of early experience
Role of oxytocin and the Vagus nerve system
Regulatory actions of cingulate cortex, fusiform gyrus
Neural structures associated with social engagement
Insula and empathy – response to touch
Mirror neurons – anticipation of goal directed behavior
Contralateral facial muscles and nerves – D-smiles and feedforward expressions
Effects of smiling and humor – reduction of cardiovascular arousal, improvement of mood
Cultural framing – race and ethnicity
Maximizing the placebo effect to facilitate positive outcomes
Session 5 – Self organization
Capacity of complex adaptive systems to achieve higher levels of organization
Mind as a product of interactive systems – continuity and change
The Mind’s operating networks – salience, default mode, central executive
Balancing the mental networks – interplay and coordination
Salience network – physiological feedback, desire and emotion
Vagus nerve system – heart rate variability and modulation of sympathetic arousal
Default mode network – reflection vs rumination
Central executive network – working memory and planning
Dorsolateral prefrontal cortex – development and function
Effects of underdevelopment and underactivity in the executive network
Mental networks and long term memory systems – integrating explicit and implicit memory systems
Affect asymmetry – hemispheric differentiation and balance, associated pathology
Client education – focus on incremental change
Hemispheric differences related to neurotransmitters
Placebo effect – impact of positive expectations
Allostasis and allostatic load – role in anxiety
Medical and drug related factors that mimic anxiety
Stress - bottom up and top down approaches
Client education – developing durability
Sympathetic autonomic nervous and neuroendocrine systems – stress responses
Cytokines and inflammation regulation
Hypocortisol vs hypercortisol activity
Suicidality and anxiety disorders – physiology of generalized anxiety
Balancing the autonomic nervous system – breathing and overbreathing
Activating the parasympathetic nervous system
Case example Jane – breathing and anxiety
The worry loop – worry as cognitive avoidance
CBT vs metacognitive models of anxiety treatment
Client education – accepting uncertainty
REAL acronym for anxiety accommodation – Relaxation, Exposure, Acceptance, Labeling
Neurodynamics of anxiety
Fast and slow tracks to the amygdala – maintaining functional allostasis
Interventions for automatic thoughts, assumptions and core beliefs
Shifting perspective to speed up the slow track
Avoidance – oversensitizing the amygdala
Complex exposure techniques – duration and role of neurotransmitters
Critical aspects of exposure therapy
Exercise and anxiety
Client education – accurate somatic interpretation and tolerance of sensations
Interceptive feedback loop – exposure and acceptance
Body based therapy and Panic Disorder
BEAT panic – Body, Exposure, Amygdala and Thinking
Session 6 – Brain Based Therapy for OCD
Brain structures and neurochemistry involved with OCD
The habit brain and OCD – cues and behavioral routines
Orbital prefrontal cortex flooded with nuisance information
OCD as failure of top down control
Pulling out of the OCD circuit – strengthened pathways and improved gating
Client education - ORDER acronym
Observation - disrupts habitual, automatic behaviors
Remind – reframing thoughts as from the disorder rather than actual threat
Doing – establish new behaviors
Exposure – developing habituation
Response prevention – strengthening the inhibitory circuits
Case example Penelope – modulating cleanliness obsessions
Post-traumatic Stress Disorder
The spectrum of trauma – chronic, severe, inescapable
Worldwide incidence of PTSD
Risk factors for PTSD
Sequential development of PTSD symptoms
Phylogenetic responses to stress – neurodynamic aspects of PTSD
Most common acute post-traumatic stress responses
Multidimensional nature of neuropsychological disorders
Common comorbidity of PTSD and Depression
Non-combat trauma associated with PTSD
Lifetime prevalence of common psychological disorders
Trauma responses are autonomically driven – hippocampal atrophy
Client education – restoring memory function, understanding necessity of social engagement
Neurochemical vulnerability and disordered fear regulation in PTSD
Prevalence of trauma and probability of PTSD - role of avoidance in chronic PTSD
Suicidality and PTSD – risk and prevalence
Role of implicit memory in trauma – disrupted integration with other memory systems
PTSD treatment outcome research results – limitations of current approaches, future directions
Primacy of exposure and CPT approaches – addressing impaired information processing
Signs of implicit trauma memories – physiological and mood changes
Dual processing theory – integrating implicit and explicit memories
Client education – explaining exposure, step by step structure of integration
Converting traumatic memories into meaning
Explicit and implicit memory integration
Continuum of detachment – absorption, dissociation, catatonia
Affective regulation of conditioned emotional response – skills and actions
Implementing exposure and counterconditioning – start low, go slow
Client education – purpose of delay and affective tolerance
Activation of conditioned emotional responses and dissociative experiences
“Identity training” from dissociation – developing continuity and coherence
Goals of PTSD treatment – rebuilding feedback loops
Orienting response, REM and memory – common denominators in trauma therapies
Orienting and recoding – novel experience facilitates integration of memory systems
Shifts in attention and asymmetry – tapping techniques
Brain Based Therapy and PTSD – first aid, memory integration and posttraumatic growth
SAFE acronym – Stabilization, Acceptance of events, Future hope, Exposure to triggers
Session 7 – Depression
Conceptualization of depression within Mind-Brain feedback loops
Illness and depression – multiple vulnerabilities and interactions
Role of medications, drugs and alcohol
Biologically plausible mechanisms linking depression with chronic heart disease
Combining bottom up and top down interventions – Antidepressants vs cognitive behavioral approaches
Pro-inflammatory cytokines – relationship with stress and “sickness behavior”
Damage to the anterior cingulate and amygdala and exacerbation of depression and anxiety
Symptoms of sickness behavior
Bidirectional depression systems – disruption of mood, cognition, motor deficits and circadian rhythm
Gender differences in depression – expression of symptoms, suicidality
Assessment of risk factors
Stress induced depression – effects on neurotransmitters and blood flow
Re-balancing hemispheric asymmetry
Client education - effort-driven reward circuitry and behavioral activation
Impaired hippocampus and over-generalizing – black and white perceptions
Exercise and depression – one of the most effective interventions for depression
Dysregulated mental networks in depression
Client education – dealing with rumination, accepting negative thoughts
Mindfulness and depression – cultivation of awareness and novelty
Meta-awareness – decentering and intentionality
Therapy: Mind-brain-gene feedback loops – upregulation of positive engagements
Client education - TEAM acronym, Thinking, Effort, Accepting, Mindfulness
Research on meditation – brain changes related to practice of mindfulness
Seven principles common to prayer, meditation, relaxation and hypnosis
Balancing the mental operating networks – activity and synchronization
Sustaining positive habits
Transcendent awareness – compassion, acceptance, contemplation
Target Audience
Addiction Counselors, Case Managers, Counselors, Marriage & Family Therapists, Nurses, Occupational Therapists & Occupational Therapy Assistants, and other Mental Health Professionals
Copyright : 05/16/2019