Session 1: Psychotherapy and the Mind-Body Connection

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John B Arden, PhD Related seminars and products

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John Arden, PhD, served as Kaiser Permanente’s Northern California Regional Director of Training where he developed one of the largest mental health training programs in the United States. In this capacity, he oversaw more than 150 interns and postdoctoral psychology residents in 24 medical centers. Prior to this, he served as Chief Psychologist for KP.
 

Dr. Arden believes that the evolution of psychotherapy in the 21st Century demands integration. Instead of choosing from the blizzard of modalities and schools of the past, therapists must move toward finding common denominators among them. Similarly, today’s psychotherapy necessitates the integration of the mind and body, not the past practice of compartmentalization of mental health and physical health. John’s study of neuropsychology has inspired him to integrate neuroscience and psychotherapy, synthesizing the biological and psychological into a new vision for psychotherapy: Brain-Based Therapy. His work incorporates what is currently known about the brain and its capacities, including neuroplasticity and neurogenesis, with psychotherapy research, mindfulness, nutritional neuroscience and social intelligence. He conducts seminars on Brain-Based Therapy throughout the United States and the world.
 

John is the author of 15 books including his newest book, Mind-Brain-Gene (W. W. Norton & Company, 2019). John is lead author along with Lloyd Linford of the books Brain-Based Therapy with Adults (Wiley, 2008) and Brain-Based Therapy with Children and Adolescents (Wiley, 2008). His first book, Consciousness, Dreams, and Self (Psychosocial Pr, 1996), was awarded the 1997 Outstanding Academic Book Award by Choice, a publication of the American Library Association. An international panel of jurists nominated his second book, Science, Theology, and Consciousness (Praeger, 1998), for the CTS award funded by the Templeton Foundation. His book America’s Meltdowns: Creating the Lowest Common Denominator Society (Praeger, 2003) explored the degradation of the fabric of American society.

 

Speaker Disclosures:
Financial: John Arden receives compensation as a national speaker. He receives royalties as a published author. He receives a speaking honorarium, book royalties, and recording royalties from PESI, Inc. He has no relevant financial relationships with ineligible organizations.
Non-financial: John Arden has no relevant non-financial relationships.

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Objectives

1.  Evaluate the role of diet and health related behaviors on genetic expression and neurological health.

2.  Explain the relationship between adverse childhood experiences on health, behavior and mental disorders.

3.  Structure lifestyle interventions that improve the expression of health-based psychiatric symptoms.

4.  Differentiate between implicit and explicit memory and their roles in therapy.

5.  Contrast the fast and slow tracks to the amygdala and the role they play in anxiety disorders and therapy for individuals with anxiety disorders.

6.  Apply evidence-based health and behavioral approaches to promote neuroplasticity and adaptive brain growth.

7.  Articulate the role that attachment plays in the development of affect regulation and mood disorders.

8.  Individualize therapeutic interventions to specifically target brain functions affected by adverse experiences and stress.

9.  Contrast cognitive-behavioral and metacognitive models of anxiety treatment.

10.  Effectively communicate a comprehensive approach to treatment to individuals with OCD.

11.  Evaluate the role of medications, substances and physical status in the experience of depression.

12. Explain how mindfulness meditation affects the brain and is used in the treatment of anxiety

disorders and depression.

Outline

Session 1 - The integrative approach—no more need for the “schools” of psychotherapy

                Necessary elements of a comprehensive client view

                Historical perspectives on therapy – search for common factors

Psychotherapy and the brain – Brain-Based Psychotherapy

                Mind/Brain causality – interaction of multidimensional feedback loops

                Results from the ACE study – health, behavioral and psychic impacts of adverse experiences

Mind-Brain-Gene feedback loops

                Epigenetics in gene expression – effect of nurturance on stress tolerance

                Early experience – neurological responses and neurochemical risk factors

                Cell-DNA interactions – highlighters, erasers and decoders

                Intergenerational Transmission – passing on the effects of trauma

Gene expression - cell aging and telomeres

                Factors that impair DNA and cells – interventions to minimize telomere shrinkage

Components of the immune system

                Pro-inflammatory Cytokines - relation to emotional symptoms and physical disease

                Short term stress can suppress the immune system

                The brain controls the stress pathways – involved neurological systems

                Communication in the immune system happens via chemicals

                Role of chronic brain inflammation

Obesity pandemic – relationship to early death and psychological vulnerability

                Obesity, chronic adipose tissue inflammation and diabetes

                Diabetes, stress and psychological disorders

                Diet, inflammation and pre-diabetes

                Cardio-metabolic syndrome – cognitive fog and mood disorders

                Depression has a relationship to chronic inflammation - “sickness behavior”

Hypocortisol vs Hypercortisol activity – maintaining appropriate balance

                Immune dysregulation and hopelessness

                Inflammation and dementia

                Peripheral nerve involvement

Enteric nervous system – the “gut brain”

                Microbiome – good and bad microflora

                Lifetime psychiatric disorders associated with irritable bowel syndrome

                “Leaky gut” syndrome – consequences of stress and inflammation

                Dysbiosis and microbial diversity – the importance of balance

Session 2 - Self-regulatory interventions – self-care behaviors “SEEDS”

Movement is an evolutionary imperative – role of beta-endorphin

                Exercise increases neurotransmitters, reduces inflammation, improves mood and sleep

                Cardiovascular exercise and cortical plasticity – improving cognitive clarity

                Exercise induced myokines and anti-inflammatory effects

Working and long-term memory - implications for psychotherapy engagement

                Implicit vs explicit long-term memory processes

                Role of amygdala and hippocampus in memory function

                Case example – H.M. and removal of hippocampus

Threat appraisal – amygdala vs cortical circuits

                The dynamics of fear- negative memories and narrowed focus of attention

                Positive emotions and expanded focus of attention

                Client education - memory improvement

Diet and cognitive function

                Perils of the Western diet – impact on dopamine receptors and experience of pleasure

                Priming appetite and obesity

                Cognitive effects of B vitamins deficiency and elevated glycemic load

                Effects of Omega-3 and Omega-6 Fatty acids

                Glycation and impact of excess glucose and fructose in diet

                Trans-fatty acids and alteration of neurotransmitter synthesis

                Protecting the brain from pre-diabetes and Metabolic Syndrome

                Client education essentials

Sleep and circadian rhythms

                Synchronizing circadian rhythms and sleep patterns

                Negative effects of computer use and light spectrum exposure

                Medical conditions contributing to sleep disruption

                Normal and pathologic sleep architectures

                Slow wave sleep deprivation

                Sleep changes over the life cycle

                Brain clearing – the “glymphatic” system

                Sleep deprivation impairs memory – sleep hygiene interventions

Session 3 - Habit and motivation - brain reward pathways

Role of dopamine, nucleus accumbens and ventral tegmental area in habit formation

                Drugs associated with neurotransmitters

Effects of acute alcohol on neural circuits – downregulation of neurotransmitters

                Brain recovery from alcoholism – persisting cognitive dysfunction

                Long term effect of alcohol – brain atrophy, cognitive impairments

                Client education - alcohol, mood and sleep

Dopamine firing patterns – response to expected and unexpected rewards

                Establishment of habits – wanting vs liking

                The “white knuckle” paradox – counterproductive nature of “just say no” approach

                The Middle Path – dopamine recycling

Neuroplasticity – increases in synaptic efficiency and receptor density

                Growth of dendrite spines and synapses

                Client education – “rewiring” the brain

                Habits as entrenched neural pathways

                Examples of neuroplasticity – growth in hippocampus and grey matter

                Bidirectional mind/brain causality

Yerkes Dodson arousal curve – problematic levels of arousal

                Client education – acting outside of comfort zone for increased neuroplasticity

Brain Derived Neurotropic Factor – impact on neural growth

                Factors that increase and decrease neurogenesis

                Client education – relationship of diet and exercise to brain health

                Iceland Project – results from international research into health behaviors in youth

Session 4 – The social self

The role of social engagement in the development of self

                Hunter-gatherer adaptation boosted the social brain

                Regulatory networks of the social brain

                Developmental programming of stress responses

                The effects of social medicine

Cell aging: shrinking telomeres

The cost of loneliness – vulnerability to depression and cognitive impairments

                Effects of deprived social brain networks – Romanian orphanage research results

Child abuse and neuropathology

                Effects of maternal separation

                Amygdala activation:  expression in adults vs children

                Gender differences

                Intergenerational transmission of depression – facilitating caregiver self-care

                “Good-enough” parenting and frustration tolerance

The neuroscience of attachment – balancing the branches of the autonomic nervous system

                Longitudinal effects of insecure attachment – alienation leading to depression and helplessness

                Client education – rebuilding the stress thermostat

Correspondence between child and adult attachment categories

Epigenetics and neuroscience of early experience

                Role of oxytocin and the Vagus nerve system

                Regulatory actions of cingulate cortex, fusiform gyrus

Neural structures associated with social engagement

                Insula and empathy – response to touch

                Mirror neurons – anticipation of goal directed behavior

                Contralateral facial muscles and nerves – D-smiles and feedforward expressions

                Effects of smiling and humor – reduction of cardiovascular arousal, improvement of mood

Cultural framing – race and ethnicity

Maximizing the placebo effect to facilitate positive outcomes

Session 5 – Self organization

Capacity of complex adaptive systems to achieve higher levels of organization

                Mind as a product of interactive systems – continuity and change

The Mind’s operating networks – salience, default mode, central executive

                Balancing the mental networks – interplay and coordination

                Salience network – physiological feedback, desire and emotion

                Vagus nerve system – heart rate variability  and modulation of sympathetic arousal

                Default mode network – reflection vs rumination

                Central executive network – working memory and planning

                                Dorsolateral prefrontal cortex – development and function

                                Effects of underdevelopment and underactivity in the executive network

Mental networks and long term memory systems – integrating explicit and implicit memory systems

Affect asymmetry – hemispheric differentiation and balance, associated pathology

                Client education – focus on incremental change

                Hemispheric differences related to neurotransmitters

Placebo effect – impact of positive expectations

Allostasis and allostatic load – role in anxiety

                Medical and drug related factors that mimic anxiety

                Stress - bottom up and top down approaches

                Client education – developing durability

Sympathetic autonomic nervous and neuroendocrine systems – stress responses

                Cytokines and inflammation regulation

                Hypocortisol vs hypercortisol activity

                Suicidality and anxiety disorders – physiology of generalized anxiety 

                Balancing the autonomic nervous system – breathing and overbreathing

Activating the parasympathetic nervous system

                Case example Jane – breathing and anxiety

The worry loop – worry as cognitive avoidance

                CBT vs metacognitive models of anxiety treatment

                Client education – accepting uncertainty

                REAL acronym for anxiety accommodation – Relaxation, Exposure, Acceptance, Labeling

Neurodynamics of anxiety

                Fast and slow tracks to the amygdala – maintaining functional allostasis

                Interventions for automatic thoughts, assumptions and core beliefs

                Shifting perspective to speed up the slow track

                Avoidance – oversensitizing the amygdala

Complex exposure techniques – duration and role of neurotransmitters

                Critical aspects of exposure therapy

Exercise and anxiety

                Client education – accurate somatic interpretation and tolerance of sensations

                Interceptive feedback loop – exposure and acceptance

Body based therapy and Panic Disorder

                BEAT panic – Body, Exposure, Amygdala and Thinking

Session 6 – Brain Based Therapy for OCD

Brain structures and neurochemistry involved with OCD

                The habit brain and OCD – cues and behavioral routines

                Orbital prefrontal cortex flooded with nuisance information

                OCD as failure of top down control

                Pulling out of the OCD circuit – strengthened pathways and improved gating

                Client education - ORDER acronym

                                Observation - disrupts habitual, automatic behaviors

                                Remind – reframing thoughts as from the disorder rather than actual threat

                                Doing – establish new behaviors

                                Exposure – developing habituation

                                Response prevention – strengthening the inhibitory circuits

                Case example Penelope – modulating cleanliness obsessions

Post-traumatic Stress Disorder

                The spectrum of trauma – chronic, severe, inescapable

                Worldwide incidence of PTSD

                Risk factors for PTSD

                Sequential development of PTSD symptoms

                Phylogenetic responses to stress – neurodynamic aspects of PTSD

                Most common acute post-traumatic stress responses

                Multidimensional nature of neuropsychological disorders

                Common comorbidity of PTSD and Depression

                Non-combat trauma associated with PTSD

Lifetime prevalence of common psychological disorders

Trauma responses are autonomically driven – hippocampal atrophy

                Client education – restoring memory function, understanding necessity of social engagement

                Neurochemical vulnerability and disordered fear regulation in PTSD

                Prevalence of trauma and probability of PTSD - role of avoidance in chronic PTSD

Suicidality and PTSD – risk and prevalence

Role of implicit memory in trauma – disrupted integration with other memory systems

PTSD treatment outcome research results – limitations of current approaches, future directions

                Primacy of exposure and CPT approaches – addressing impaired information processing

Signs of implicit trauma memories – physiological and mood changes

                Dual processing theory – integrating implicit and explicit memories

                Client education – explaining exposure, step by step structure of integration

Converting traumatic memories into meaning

Explicit and implicit memory integration

Continuum of detachment – absorption, dissociation, catatonia

Affective regulation of conditioned emotional response – skills and actions

                Implementing exposure and counterconditioning – start low, go slow

                Client education – purpose of delay and affective tolerance

                Activation of conditioned emotional responses and dissociative experiences

“Identity training” from dissociation – developing continuity and coherence

Goals of PTSD treatment – rebuilding feedback loops

Orienting response, REM and memory – common denominators in trauma therapies

                Orienting and recoding – novel experience facilitates integration of memory systems

                Shifts in attention and asymmetry – tapping techniques

Brain Based Therapy and PTSD – first aid, memory integration and posttraumatic growth

                SAFE acronym – Stabilization, Acceptance of events, Future hope, Exposure to triggers

Session 7 – Depression

Conceptualization of depression within Mind-Brain feedback loops

Illness and depression – multiple vulnerabilities and interactions

                Role of medications, drugs and alcohol

                Biologically plausible mechanisms linking depression with chronic heart disease

Combining bottom up and top down interventions – Antidepressants vs cognitive behavioral approaches

Pro-inflammatory cytokines – relationship with stress and “sickness behavior”

                Damage to the anterior cingulate and amygdala and exacerbation of depression and anxiety

                Symptoms of sickness behavior

Bidirectional depression systems – disruption of mood, cognition, motor deficits and circadian rhythm

Gender differences in depression – expression of symptoms, suicidality

                Assessment of risk factors

Stress induced depression – effects on neurotransmitters and blood flow

Re-balancing hemispheric asymmetry

                Client education - effort-driven reward circuitry and behavioral activation

Impaired hippocampus and over-generalizing – black and white perceptions

Exercise and depression – one of the most effective interventions for depression

Dysregulated mental networks in depression

                Client education – dealing with rumination, accepting negative thoughts

Mindfulness and depression – cultivation of awareness and novelty

                Meta-awareness – decentering and intentionality

Therapy:  Mind-brain-gene feedback loops – upregulation of positive engagements

                Client education - TEAM acronym, Thinking, Effort, Accepting, Mindfulness

                Research on meditation – brain changes related to practice of mindfulness

                Seven principles common to prayer, meditation, relaxation and hypnosis

Balancing the mental operating networks – activity and synchronization

                Sustaining positive habits

Transcendent awareness – compassion, acceptance, contemplation

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