Dr. Janene Donarski – Rewire the Anxious Brain: Neuroscience-Informed Treatment of Anxiety, Panic and Worry

Outline

Use Neuroscience in the Treatment of AnxietyUse Neuroscience in the Treatment of Anxiety

• Positives:Positives:
  • We know more about anxiety-based disorders than any other disordersWe know more about anxiety-based disorders than any other disorders
  • Science gives explanations, evidence, authority, destigmatizes difficultiesScience gives explanations, evidence, authority, destigmatizes difficulties
• Concerns:Concerns:
  • It can be difficult to explain, answer questionsIt can be difficult to explain, answer questions
  • Clients may feel a lack of responsibilityClients may feel a lack of responsibility
  • Oversimplification is inevitableOversimplification is inevitable

Enhancing Engagement in TreatmentEnhancing Engagement in Treatment

• Don’t neglect the therapeutic relationship!Don’t neglect the therapeutic relationship!
• Address the challenges of anxious clientsAddress the challenges of anxious clients
• Remember that strategies are effortfulRemember that strategies are effortful
• Guide the process using client’s goalsGuide the process using client’s goals
• Maintain motivationMaintain motivation

NeuroplasticityNeuroplasticity

• Define Neuroplasticity in everyday languageDefine Neuroplasticity in everyday language
• Therapy is about creating a new selfTherapy is about creating a new self
• ”Rewiring” as an accessible concept for change”Rewiring” as an accessible concept for change
• Re-consolidation: the modification of emotional memoriesRe-consolidation: the modification of emotional memories

Identify Two Neural Pathways to AnxietyIdentify Two Neural Pathways to Anxiety

• Amygdala – bottom-up triggering of emotion, physicality of anxietyAmygdala – bottom-up triggering of emotion, physicality of anxiety
• Cortex – top-down emotion generation based in cognitionCortex – top-down emotion generation based in cognition
• Explain the two pathways to clientsExplain the two pathways to clients
• How anxiety is initiated in each pathway and how pathways influence each otherHow anxiety is initiated in each pathway and how pathways influence each other

Client Friendly ExplanationsClient Friendly Explanations

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

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

• Sleep and the amygdalaSleep and the amygdala
• The influence of exerciseThe influence of exercise
• Breathing techniques to reduce activationBreathing techniques to reduce activation
• Relaxation, meditation, and yoga to modify responsesRelaxation, meditation, and yoga to modify responses
• Exposure as opportunities for the amygdala to learnExposure as opportunities for the amygdala to learn
• Combatting avoidanceCombatting avoidance
• When anxiety indicates that the amygdala can learn new responsesWhen anxiety indicates that the amygdala can learn new responses
• Push through anxiety to change the amygdalaPush through anxiety to change the amygdala

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

• ”Survival of the busiest” principle – strengthen or weaken specific circuitry”Survival of the busiest” principle – strengthen or weaken specific circuitry
• The healthy (adaptive) use of worry in the cortexThe healthy (adaptive) use of worry in the cortex
• ”You can’t erase: You must replace””You can’t erase: You must replace”
• Recognize and modify the impact of uncertaintyRecognize and modify the impact of uncertainty
• Training correct uses of distractionTraining correct uses of distraction
• Left hemisphere techniques – cognitive defusion, coping thoughts, fighting anticipationLeft hemisphere techniques – cognitive defusion, coping thoughts, fighting anticipation
• Right hemisphere techniques – imagery, musicRight hemisphere techniques – imagery, music
• Mindfulness and anxiety resistancesMindfulness and anxiety resistances

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

• Medication’s effects in the rewiring processMedication’s effects in the rewiring process
• The myth of the chemical imbalanceThe myth of the chemical imbalance
• The danger of sedating the brain with benzodiazepinesThe danger of sedating the brain with benzodiazepines
• Promoting neuroplasticity with SSRIs, SNRIsPromoting neuroplasticity with SSRIs, SNRIs
• The effectiveness of CBT and medsThe effectiveness of CBT and meds

Moving Beyond Diagnostic Categories to Focus on Anxiety Pathways Moving Beyond Diagnostic Categories to Focus on Anxiety Pathways

• Anxiety is a component of many diagnoses (depression, substance abuse, etc.)Anxiety is a component of many diagnoses (depression, substance abuse, etc.)
• Amygdala – and cortex-based techniques help in other disordersAmygdala – and cortex-based techniques help in other disorders
• Targeting brain-based symptoms rather than disordersTargeting brain-based symptoms rather than disorders
• Worry, obsessions, rumination respond to similar cortex-based techniquesWorry, obsessions, rumination respond to similar cortex-based techniques
• Panic, phobic responses, and compulsions respond to amygdala-based techniquesPanic, phobic responses, and compulsions respond to amygdala-based techniques

Research, Risks and LimitationsResearch, Risks and Limitations

• Empirical versus clinical and anecdotal evidenceEmpirical versus clinical and anecdotal evidence
• Clinical considerations for specific clients and settingsClinical considerations for specific clients and settings
• Efficacy of particular interventions may varyEfficacy of particular interventions may vary