Module 5: Exposure Strategies for Teaching the Amygdala

Credits

Speaker

Catherine Pittman, PhD, HSPP Related seminars and products

Saint Mary's College

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Catherine M. Pittman, PhD, HSPP, has a background in cognitive behavioral therapy, neuropsychology, fear-conditioning research, and treated anxiety-based disorders in clinical practice for over 25 years. Her experience makes her uniquely qualified to provide a clear understanding of neuroscience and how that informs the selection and application of successful anxiety treatment strategies.

Dr. Pittman is the author of the popular book, Rewire Your Anxious Brain: How to Use the Neuroscience of Fear to End Anxiety Panic, and Worry (New Harbinger Publications). Her new book, Taming Your Amygdala, will be published in Spring 2022 (PESI Publishing & Media). Dr. Pittman is a professor of Psychology at Saint Mary's College, Notre Dame, IN. She regularly presents workshops at national conferences and national webinars on anxiety treatment and is an active member of the Public Education Committee of the Anxiety and Depression Association of America.
 

Speaker Disclosures:
Financial: Dr. Catherine Pittman maintains a private practice and has an employment relationship with Saint Mary's College. She receives royalties as a published author. Dr. Pittman receives a speaking honorarium, recording, and book royalties from Psychotherapy Networker and PESI, Inc. She has no relevant financial relationships with ineligible organizations.
Non-financial: Dr. Catherine Pittman is a member of the Anxiety and Depression Association of America.

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Target Audience

Objectives

1. Demonstrate to clients the neurological processes underlying anxiety in a clearly understandable manner that enhances client motivation.
2. Incorporate personalized goals to increase client engagement and focus client efforts on making lasting changes in the brain.
3. Characterize the differences between amygdala-based and cortex-based anxiety symptoms in order to select the most effective treatment interventions.
4. Individualize practical and evidence-based methods to resist anxiety and improve symptom management in clients.
5. Demonstrate strategies for calming the amygdala without use of medication to improve client level of functioning.
6. Recommend exposure-based strategies that change the amygdala responses to triggers to reduce anxiety symptoms.
7. 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.
8. 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.
9. Analyze the clinical implications of how SSRIs and SNRIs promote the process of treating anxiety.
10. Determine detrimental effects of benzodiazepines as it relates to anxiety treatment outcomes.
11. Differentiate between rebound anxiety and relapse symptoms to inform the clinician’s choice of treatment interventions.
12. Breakdown the key elements of mindfulness practices in managing symptoms of anxiety.
13. Present client education exercises that can be utilized in session to train clients in the use of mindfulness techniques.
14. Appraise common reactions to aversion and utilize clinical strategies to replace them with mindfulness.
15. Reframe exposure as an opportunity to teach the amygdala new responses in order to improve client engagement and treatment compliance.
16. Utilize clinical strategies for exposure that reduce avoidance and train clients to push through anxiety.
17. Employ effective strategies for reducing anxiety symptoms utilizing imaginal and in vivo exposure, including use of SUDS and attention to interceptive triggers.
18. Provide clinical strategies for managing comorbid depression that reduce worry, rumination, and common cognitive errors while promoting positive thinking and social interaction.
19. 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.
20. Implement interventions in a clinical setting that use a reconsolidation approach to reactivate a symptom-producing memory and disconfirm it.

Outline

Module 5: Exposure Strategies for Teaching the Amygdala

• 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

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