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

CPD

Planning Committee Disclosure - No relevant relationships

All members of the PESI, Inc. planning committee have provided disclosures of financial relationships with ineligible organizations and any relevant non-financial relationships prior to planning content for this activity. None of the committee members had relevant financial relationships with ineligible companies or other potentially biasing relationships to disclose to learners.  For speaker disclosures, please see the faculty biography.

Handouts

Faculty

Marwa Azab, PhD Related seminars and products

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Marwa Azab, PhD, teaches for the psychology department at Cal State University, Long Beach, (CSULB) and has also taught for the biology department at the University of California, Irvine (UCI). Recently, she has developed and taught curriculums on anxiety disorders and their treatments, The Tug War: Pain & Pleasure & the Science of Emotions for the Stanford University Continuing Studies Program (CSP). Marwa studied psychology for many years and completed a master’s in counseling psychology. She has facilitated many groups such as anger management, stress management, interpersonal communication, and many others for patients suffering from a variety of mental disorders. After many years of addressing human behaviors from a psychological perspective, Marwa realized that there were blind spots that needed to be satiated from complementary fields. Thus, she completed a PhD in biological sciences with emphasis on neuroscience. Dr. Azab started life coaching utilizing an interdisciplinary approach that intersects psychology, biology and genetics.

Marwa is a sought after international public speaker who is invited to speak on a variety of interdisciplinary topics, including five TEDx talks, translated to multiple languages. Her first textbook, An Update on Anxiety Disorders: Etiological, Cognitive & Neuroscientific Aspects (Springer Nature) was published in 2022. Dr. Azab has a Psychology Today blog called “Neuroscience in Everyday Life” and has been featured on ABC, NBC, and BBC News; NPR, KPCC, and KGO Radio; and in Vogue Magazine, VICE, Long Beach Post, Psychology Today, The Daily Mail, LAist, and others. She has also been elected 5x by a government agency in Southern California to be the Chair of planning a mental health conference to promote and destigmatize mental health discussions. You can connect with her on LinkedIn or her Instagram account @DrMarwaAzab.

 

Speaker Disclosures:
Financial: Dr. Marwa Azab has an employment relationship with California State University and receives royalties as a published author. She receives a speaking honorarium and recording royalties from Psychotherapy Networker and PESI, Inc. She has no relevant financial relationships with ineligible organizations.
Non-financial: Dr. Marwa Azab writes a blog for Psychology Today called "Neuroscience in Everyday Life."

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Objectives

1. Ascertain the underlying neurological processes that impact anxious symptoms for clients.
2. Develop client engagement in treatment using personalized goals and attending to the therapeutic relationship.
3. Evaluate the differences between amygdala-based and cortex-based anxiety symptoms and identify how these symptoms inform treatment interventions.
4. Communicate strategies for calming and training the amygdala in order to alleviate symptoms of anxiety.
5. Implement methods for teaching clients to retrain the cortex so that anxiety is resisted rather than exacerbated.
6. Analyze how psychotropic medication impacts neuroplasticity in the brain; identify related treatment implications.

Outline

• 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

• 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

• 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

• 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

• 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

• 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

• ”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

• 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

• 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

Target Audience

• Social Workers
• Psychologists
• Psychiatrists
• Counsellors
• Case Managers
• Marriage and Family Therapists
• Occupational Therapists
• Occupational Therapy Assistants
• Speech Language Pathologists
• Addiction Counsellors
• Therapists
• Nurses
• Physicians
• Other Mental Health Professionals