Marwa Azab – Rewire the Anxious Brain: Neuroscience-Informed Treatment of Anxiety, Panic and Worry

Outline

Use 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: It can be difficult to explain, answer questions
• Clients may feel a lack of responsibility
• Oversimplification is inevitable

Enhancing Engagement in Treatment

• 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

Neuroplasticity

• 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

Identify Two Neural Pathways to Anxiety

• 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

Client Friendly Explanations

• 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 Amygdala (Essential for all Anxiety Disorders, PTSD, OCD, 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 in the Cortex (Essential for GAD, SAD, 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

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

• 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

Move Beyond Diagnostic Categories to Focus on Anxiety Pathways

• 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

Research, Risks and Limitations

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