Melanie Greenberg – 2-Day Comprehensive Training: Applied Neuroscience for Brain Change in the Treatment of Trauma, Anxiety and Stress Disorders

Outline

Using Neuroscience in Treatment of Stress and Trauma

• Positives:
  • Science gives authority, evidence, de-stigmatizes mental health problems
  • Increased motivation and hope for change
• Concerns:
  • Oversimplification, unrealistic expectations, changing state of science, see self as damaged or different

The Promise of Neuroplasticity

• Describe neuroplasticity in everyday language
• Therapy is about creating a new, more resilient brain
• We are changing beings – don’t have to be stuck in rigid views of self
• Teach brain to be less reactive to stress and triggers
• “Rewiring” as a metaphor for change
• Changing “raw,” unprocessed memories to organized narratives

The Brain’s Stress Response

• Historical view – Hans Selye
• The brain’s stress response “fight, flight, freeze”
• The triune brain – reptilian, mammalian, human
• The amygdala and the prefrontal cortex
• How the amygdala “hijacks” the brain into emergency mode

How the Stress Response is Spread Throughout the Body

• Neurotransmitters – Epinephrine, norepinephrine and cortisol
• The HPA axis and role of cortisol
• The sympathetic and parasympathetic nervous systems
• The dorsovagal “freeze” response to unavoidable threat

The Upside and Downside of Stress

• Increased motivation and engagement – “flow”state
• Can create mental toughness and resilience to future stressors
• Inflammatory response to chronic stress
• Stress and health risk behaviors (excess alcohol use, smoking, overeating etc)
• Stress and cellular aging (telomeres)

Traumas – Effects on the Brain

• Cortisol attacks the hippocampus – center of narrative memory
• Amygdala response increases in strength
• Impaired anterior cingulate cortex (ACC) and prefrontal cortical function
• Cortisol halts production of BDNF – fewer new brain cells formed
• Link to depression, anxiety disorders, PTSD
• Cognitive rigidity and inability to take in new information
• Changes in sense of self and dissociation

Long-Term Impact of Adverse Childhood Experiences (ACEs)

• The ACE Study (Kaiser and the CDC)
• Addictive and unhealthy ways of managing anxiety & negative emotions
• Disease, mental health issues, behavioral problems, PTSD

Explaining Neuroscience Concepts to Clients

• Use drawings and images
• Individualize to the type of difficulty (e.g., disengaged vs reactive – different brain areas)
• Redirect vs eliminate
• Help client label & recognize when happening (e.g., freeze, flooding, negative thinking, rigidity, impulsivity)
• Find coping strategies for each type of brain difficulty

Stress-Proofing the Brain – Overview

• Calming the amygdala – Grounding, mindfulness, self-compassion, perceiving control
• Moving forward with the prefrontal cortex – Cognitive reappraisal, priming positive mindsets and, growth focus, health psychology tools

Grounding Strategies for Clients with Trauma or Attachment Injuries

• Yoga, relaxation, breathing, present-moment focus, soothing with the senses, pets, drawing, gardening, walking
• Mental imagery – safe place, boundaries, energetic, times they felt strong/competent
• Left-brain strategies – task focus and engagement

Mindfulness Strategies

• Qualities of mindfulness states – open, nonjudgmental, fluid, deliberate,
• Observing and accepting inner experience (thoughts, feelings, sensations)
• Using the senses to self-regulate
• De-fusing from negative thoughts and self-images
• How mindfulness changes the brain
• Mindfulness practices – breathing, watching thoughts, urge surfing, open awareness
• Application to anxiety, depression, addictions, PTSD

Self-Compassion Strategies

• Self-kindness, common humanity, focus on unmet needs
• Application to depression, anxiety, stress-management, trauma, insecure attachment
• Link to Schema Therapy – healthy adult mode
• Practices – Metta meditation, soften, soothe and allow, dialogues with inner critic

Cognitive Strategies

• How stress and anxiety narrow attention, create cognitive rigidity
• Depression and negative thinking
• PTSD and internalized negative appraisals (helpless, unworthy, unsafe etc.)
• Worry and rumination cycles – link to prefrontal cortex and default mode network
• Why thought suppression doesn’t work
• De-catastrophizing and probability estimation
• Exposure and tolerating negative thoughts
• Using metaphors (monsters on the boat, bouncy ball underwater)

Creating Positive States of Mind to Counter Stress

• How our brains are wired to the negative
• Positive emotions can promote physiological recovery from anxiety and fear
• Reappraising anxiety as excitement
• Gratitude diaries
• Commitment, control, and challenge; growth mindset

Living Healthy in the Face of Stress

• Sleep disturbance – behavioral strategies
• Healthy coping strategies – exercise, meditation, yoga
• Dealing with emotional eating