Saint Mary's College
Catherine M. Pittman, Ph.D. HSPP, has a background in cognitive behavioral therapy, neuropsychology, fear-conditioning research, and treated anxiety-based disorders in clinical practice for over 25 years. Her experience makes her uniquely qualified to provide a clear understanding of neuroscience and how that informs the selection and application of successful anxiety treatment strategies.
Dr. Pittman is the author of the popular book, Rewire Your Anxious Brain: How to Use the Neuroscience of Fear to End Anxiety Panic, and Worry (New Harbinger Publications). Her new book, Taming Your Amygdala, will be published in Spring 2022 (PESI Publishing & Media). Dr. Pittman is a professor of Psychology at Saint Mary's College, Notre Dame, IN. She regularly presents workshops at national conferences and national webinars on anxiety treatment and is an active member of the Public Education Committee of the Anxiety and Depression Association of America.
Financial: Catherine Pittman is an associate professor at Saint Mary’s College. She is an author for New Harbinger and receives royalties. Dr. Pittman receives a speaking honorarium from PESI, Inc.
Non-financial: Catherine Pittman is a member of the Anxiety and Depression Association of America.
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- Analyze 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.
- Demonstrate strategies for calming and training the amygdala in order to alleviate symptoms of anxiety.
- Develop 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
- 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
- Social Workers
- Marriage and Family Therapists
- Case Managers
- Addiction Counselors
- Speech-Language Pathologists
- Occupational Therapists
- Other Mental Health Professionals
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