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6 Hours 06 Minutes
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06 May, 2020
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Hannah Smith, MA, LMHC, CGP, is the founder of Potential Finders and is the group therapy program coordinator in a top partial-hospital rehabilitation treatment center in the Seattle area. She holds Masters degrees in both special education and counseling psychology and has nearly 20 years of experience both in the US and abroad. Her educational work has been with disorders of cognition and communication, where the role of the brain in learning and memory were primary areas of focus. Clinically, her practice is primarily devoted to the treatment of people recovering from trauma and anxiety disorders. Her experience, both personally and professionally, has allowed her to develop an expertise in incorporating neuroscience into therapeutic interventions in innovative ways. Hannah guest lectures in academic and clinical settings on a variety of topics related to neuroscience and the treatment of anxiety, trauma, and emotion regulation. She is an engaging presenter whose passion is to educate clinicians on practical, whole-person approaches and applications in therapy.
Financial: Hannah Smith is the clinical supervisor at The Center; A Place of Hope. She receives a speaking honorarium from PESI, Inc.
Non-financial: Hannah Smith has no relevant non-financial relationship to disclose.
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- Ascertain the underlying neurological processes that impact anxious symptoms for clients.
- Develop client engagement in treatment using personalized goals and attending to the therapeutic relationship.
- Evaluate the differences between amygdala-based and cortex-based anxiety symptoms and identify how these symptoms inform treatment interventions.
- Communicate strategies for calming and training the amygdala in order to alleviate symptoms of anxiety.
- Implement methods for teaching clients to retrain the cortex so that anxiety is resisted rather than exacerbated.
- Analyze how psychotropic medication impacts neuroplasticity in the brain; identify related treatment implications.
Use Neuroscience in the Treatment of Anxiety
- We know more about anxiety-based disorders than any other disorders
- Science gives explanations, evidence, authority, destigmatizes difficulties
Enhancing Engagement in Treatment
- It can be difficult to explain, answer questions
- Clients may feel a lack of responsibility
- Oversimplification is inevitable
- Don’t neglect the therapeutic relationship!
- Address the challenges of anxious clients
- Remember that strategies are effortful
- Guide the process using client’s goals
- Maintain motivation
Identify Two Neural Pathways to Anxiety
- Define Neuroplasticity in everyday language
- Therapy is about creating a new self
- ”Rewiring” as an accessible concept for change
- Re-consolidation: the modification of emotional memories
Client Friendly Explanations
- Amygdala – bottom-up triggering of emotion, physicality of anxiety
- Cortex – top-down emotion generation based in cognition
- Explain the two pathways to clients
- How anxiety is initiated in each pathway and how pathways influence each other
Neuroplasticity in the Amygdala (Essential for all Anxiety Disorders, PTSD, OCD, Depression)
- 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 to anxiety
Neuroplasticity in the Cortex (Essential for GAD, SAD, OCD, PTSD, 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
- Combatting avoidance
- When anxiety indicates that the amygdala can learn new responses
- Push through anxiety to change the amygdala
Neuroplasticity and Medications for Anxiety Disorders, 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
Moving Beyond Diagnostic Categories to Focus on Anxiety Pathways
- Medication’s effects in the rewiring process
- The myth of the chemical imbalance
- The danger of sedating the brain with benzodiazepines
- Promoting neuroplasticity with SSRIs, SNRIs
- The effectiveness of CBT and meds
Research, Risks and Limitations
- Anxiety is a component of many diagnoses (depression, substance abuse, etc.)
- Amygdala – and cortex-based techniques help in other disorders
- Targeting brain-based symptoms rather than disorders
- Worry, obsessions, rumination respond to similar cortex-based techniques
- Panic, phobic responses, and compulsions respond to amygdala-based techniques
- Empirical versus clinical and anecdotal evidence
- Clinical considerations for specific clients and settings
- Efficacy of particular interventions may vary
- Social Workers
- Occupational Therapists
- Marriage and Family Therapists
- Case Managers
- Addiction Counselors
- Speech-Language Pathologists
- Other Mental Health Professionals
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