Anxiety, Depression and Interpersonal Neurobiology 2.0 - NT · Anxiety, Depression and...

Anxiety,Depressionand

InterpersonalNeurobiology2.0

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Anxiety,DepressionandInterpersonalNeurobiology2.0

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Presentersfor:

Anxiety,Depressionand

InterpersonalNeurobiology2.0


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PresenterBiographiesLindaMintle,Ph.D.,isChair,DivisionofBehavioralHealth,DepartmentofPrimaryCare,CollegeofOsteopathicMedicineatLibertyUniversityinLynchburg,VA.SheisaLicensedMarriageandFamilyTherapistandLicensedClinicalSocialWorker.Dr.MintleisanApprovedSupervisorwiththeAmericanAssociationofMarriageandFamilyTherapist(AAMFT)andcompletedafour-yearpost-graduateexternshipinMarriageandFamilywithEasternVirginiaMedicalSchoolandtheFamilyTherapyPracticeCenterinGeorgetown.Shehasauthored15booksandhascontributednumerouschaptersandarticlestovarioustextbooksonthetreatmentofeatingdisorders.Dr.Mintleisalsoanationalnewscontributor,speakerandhostsherownradioprogram.MarriedtoNorm,theDeanoftheSchoolofCommunicationandCreativeArtsatLibertyUniversity,theyhavetwochildrenwhobringmuchjoytotheirlives.Paul Meier, M.A., M.D., received his Masters of Science in Cardiovascular Physiology fromMichiganStateUniversity,aMedicalDegree(M.D.)fromtheUniversityofArkansasCollegeofMedicineandcompletedhispsychiatric residencyatDukeUniversity.Dr.Meier isa LicensedPsychiatrist and ordained minister, as well as the founder of a national chain of non-profitChristianpsychiatryclinics, theMeierClinics.Hehasauthoredorco-authoredover80books,includingLoveisaChoiceandHappiness isaChoice.Hehastraveledtocountriesallovertheworldtotrainbothprofessionalandlaycounselors,aswellasmissionariesandpastors,inthefieldofChristiancounselingandpsychiatry.Dr.Meiertaughtfull-timefortwelveyearsatDallasTheological Seminary in Dallas, TX, where he spent time discipling students including TonyEvans,JohnTrent,JohnTownsend,andHenryCloud.CurtThompson,M.D.,isapsychiatristinprivatepracticeinFallsChurch,VirginiaandfounderofBeingKnown,whichdevelops teachingprograms, seminarsandresourcematerials tohelppeople explore the connection between interpersonal neurobiology and Christian spiritualitythat leads togenuinechangeandtransformation.Dr.Thompson is theauthorofAnatomyofthe Soul, which demonstrates how insights from interpersonal neurobiology resonate withbiblical truths about God and creation—validating the deep human need for meaningfulrelationships as a key to a life of hope and fulfillment. He has also produced a video seriesentitledKnowingandBeingKnown:TheTransformingPowerofRelationships,whichprovidesadetailed journey throughDr. Thompson’s discoveries on these themes. Thompson graduatedfromWright State University School ofMedicine and completed his psychiatric residency atTemple University Hospital. He is board certified by the American Board of Psychiatry andNeurology.


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Anxiety,DepressionandInterpersonalNeurobiology2.0TableofContents:

TAD101:ExposureTreatmentsandTechniquesforAnxietyDisorders...................................11LindaMintle,Ph.D.

TAD102:BipolarandSpectrumMoodDisorders:DiagnosisandTreatmentStrategies..........26PaulMeier,M.D.TAD103:InterpersonalNeurobiology:TheNineDomainsofIntegration...............................34CurtThompson,M.D.


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TAD101:

ExposureTreatmentsandTechniquesfor

AnxietyDisorders

LindaMintle,Ph.D.


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Abstract

This session will introduce a general discussion about emotional disorders and the DSM-5.

Anxiety will be defined and variousmodels and theories will be explored in determining its

originsandcorrection.Specifically,treatmentforanxietyshouldentailevidence-basedpractice,

and the twomostwidely implemented approaches include cognitive behavioral therapy and

exposuretherapy.Exposuretreatmentsshouldbethefirstlineoftreatmentformentalhealth

providersbecauseitmosteffectivelyhelpsclientsbyencouragingsystematicconfrontationof

thefearedstimuli.

LearningObjectives

1. ParticipantswillunderstandDSM-5changesinmooddisorders.

2. Participants will investigate models and theories of anxiety, its origins and its

corrections.

3. Participantswillbeabletoidentifyexposuretechniques.


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I. Introduction

A. EmotionalDisorders

1. Mooddisordersandanxietydisordersoftenco-occur.

• Theyaffectmillionsofpeopleinanygivenyear.

• About29%ofAmericanswillexperienceananxietydisorderatleastonceintheir

life.Mooddisordersareatabout21%.1

2. With the changes in theDSM-5, OCD and PTSD are no longer in the category of

anxietydisorders.

3. The biggest change for agoraphobia, specific phobia and social anxiety is that the

persondoesnothavetorecognizethathisorheranxietyisexcessive.

4. Thedurationofthesedisordershastobeforsixmonthsforallages.

5. Panicdoesnothavea lotofchanges,except that it is in twocategories:expected

andunexpectedpanic.

• Panicandagoraphobiaarenolongernecessarilylinkedtogether.

6. Selective mutism is now in the anxiety disorders category along with separation

anxietydisorder.

B. Definition

1. Barlow says that it is a future oriented emotion; it is a basic response to the

perceivedunpredictabilityofor lackof controloverupcomingpotentiallynegative

ordangerousevents.


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2. Italsosignalstheneedforpeopletobevigilanttoreduceanactivitythattheyare

doing because of the fear or anxiety that they are feeling, and it refocuses the

attentiononpossiblesourcesofharmorfuturethreats.

3. Whenwefeelanxiousourbodiesandourmindsalsoreacttothatanxiety.

• Feeling

• Thinking

• Behavior

C. Beck’sModel

1. Attheverytopofthecirclearetheassumptionsthatwehaveaboutlifeandwhat

webelievetobetrue.

2. Thoseassumptionsfuelautomaticthoughts.

3. Automaticthoughtsthenfuelanemotion.

4. Theemotionsaffectbehaviors,whichaffectperception.

5. Itbecomesacircularprocess.

• Youcaninterveneinanyofthoseplacesandmakechanges.

• Exposurecaninterveneonthefeelinglevel.

D. Symptoms

1. People with anxiety disorders experience negative affect more than the average

person.

• Theyfeelitmorefrequentlyandmoreintensely.


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2. Theyviewexperiencesasmoreaversive.

3. Theyhavedifficultyregulatingtheemotionalexperience,whichresultsinonetrying

todampentheemotion(escapeandavoidance).

II. Treatment

A. Evidence-BasedApproach

1. Lookatthethingsthatwork.

2. Twoofthemostusedapproachesare:

• Cognitivebehavioraltherapy

• Exposure

3. All the treatments with anxiety look at some kind of measure of a person’s

avoidance.

4. Inallthetreatments,thereistypicallysomeresponseprevention.

5. Allof themethodsalso lookat thesafetycuesandoverprotectivebehaviors that

peopleuse.

B. ExposureTechniques

1. It usually requires the patient to be exposed to the situations, thoughts or

sensationsthattriggertheirfear.

2. Interoceptivecuesentail the fearofexperiencing thephysical symptomsnormally

associatedwiththephysicalarousalthataccompaniesanxiety.


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3. Cognitivecues:beliefs,expectationsandassumptions(theyoperateinsocialphobia

andspecificphobiaprettyintensely).

4. Panic and generalized anxiety disorders also employ a cognitive restructuring

process.

5. Exposure-based treatments arewell established in their effectiveness. Yet, only a

small percentage of clients actually get exposure techniques and treatment for

anxietydisorders.

• Researchsayslessthan30%.

• Surveysandstudiesfindthatonlyabout12%ofprofessionalsarewelltrainedin

howtodeliverexposuretechniquesandtreatments.

6. Professionalsthinkthattheseprocedureswillexacerbatethesymptoms.

7. Exposure techniques teach people that through the exposure the symptoms

improve.

8. Theseshouldbethefirstlineoftreatment.

• About75%ofpeoplegetbetterjustwithexposuretechniques.

9. Exposure treatment is defined as any treatment that encourages systematic

confrontationofthefearedstimuli,whichcanbeinternalorexternal.

10. Thegoalistoreducetheperson’sfearfulresponsetothestimuli.

11. TheAmericanPsychologicalAssociationsaysthatexposuretechniquesusuallytake

about8-10sessions.


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III. Theories

A. Habituation

1. Habituationisthenaturalreductioninrespondingwithrepeatedexposure.

2. Inrepeatedexposure,peoplegraduallygetusedtothesituationthattheyareinand

itreducesthefearresponse.

3. You go toward the discomfort and you trust the idea that going toward the

discomfortisgoingtobegood.

“EventhoughIwalkthroughthevalleyoftheshadowofdeath,Ifearnoevil,forYou

arewithme;YourrodandYourstaff,theycomfortme.”—Psalm23:4

4. Habituation requires people to have frequent,prolonged exposure to the fear in

ordertoreducethethreat.

B. Extinction

1. Youareoverridingthepreviouslylearnedfearassociations.

2. Thinkabouttheclassicalconditioningmodel.

3. Exposure therapyweakens the conditioned response through repeatedly exposing

thepersontotheconditionedstimuli.

C. EmotionalProcessingTheory

1. Help the client develop new interpretations and new meanings for the feared

stimuliandthefearedresponses.


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2. Fear is stored in ourmemory as a network of stimuli response andmeaning. The

faultymeaningisassignedtothestimulianditincreasesfeartowardthatstimuli.

3. Exposuretothefearedstimuliresultsinanewwaytoprocesstheinformationandit

correctsthefaultyfearstructure.

D. Self-EfficacyTheory

1. This is when you are increasing perceptions that you are capable of tolerating

fearfulstimuliandresponse.

2. You face the fear. It increases your skills and mastery over a situation or

performance.

3. Youbuildonthesuccessofovercomingthefearedstimuli.

4. Thereisaresiliencythatbeginstobuildinaperson.

5. Then, you aremore willing to face the difficult situations. As a treatment effect,

thereisgeneralization.

IV. BehavioralandCognitive

A. TherapeuticAlliance

1. Itisacommonfactor.

• It has a lot to dowith the varianceof change in people that are successful at

makingchange.

2. Developacollaborativeapproachwithclients.


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3. Developandshareguidelineswiththeclientaboutwhatwearedoing.

B. ExposureHierarchy

1. Brainstormthestimuli.

2. Asyoubuildtheladder,youassignvaluestoit(systematicunitofdistressscale).

3. Conduct the exposures in a graduatedmanner by having them practice the steps

thattheyhaveassigned.

4. Eliminatethesafetybehaviors.

5. Challengethecognitivedistortionsalongtheway.

6. Safetybehaviorsunderminethework.

C. CognitiveRestructuring

1. Itcanbeusedasanadjuncttoexposuretherapy.

2. Byusingthisyouhelpclientstoidentifytheircognitivedistortions.

3. Techniques:

• Examiningtheevidence

• Rehearsal

• Realisticthinking

4. Cognitiveerrors:


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• Catastrophizing

• Minimizing

• Maximizing

5. Intermsofautomaticthoughtsandbeliefs,acognitivebehavioralapproachteaches

themthattheiranxietystemsfromexaggeratedappraisalsofanevent.

V. PanicAttacksandAnxiety

A. Examples

1. Someoneingoodhealthfeelsterrible.

2. Apersonwithsocialanxietymayfeelembarrassed.

B. Anxiety

1. Changethethinkingandfeelingandthenchangethebehavior.

2. Thegoal is fortheclienttofindanewwaytorelatetotheiruncertaintyandtheir

discomfort.

3. Wearelookingatspecificthingsintheanxietydisorder,butwearealsolookingat

thebiggerpictureofhowthepersonrelatestothestress.

• Thebigkeyhereisnottofightit.

• Themoreanxious theclient isandthemoreone fightsagainst them,thenthe

moreintensethosefeelingsbecome.

4. Insteadofcalmingtheanxietydown,youwanttoallowclientstofeelit.Sometimes

youevenwanttoinduceitbyputtingtheminthesituation.


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5. Challengethecatastrophicordistortedbelieftobecomesomethingmorerealisticso

thattheycancontrolthepanicoranxietyratherthaneliminateit.

6. Confrontthefearevent,enterintoitandremaininit.

“IcandoallthingsthroughHimwhostrengthensme.”—Philippians4:13

7. Clientsneedtolearntotoleratethosefeelings.

8. Provokethedoubtanddiscomfortthatisfearedbuttodoso,makesurethatyour

clientsunderstandwhatyouaredoing.

9. Distressingthoughtsandfeelingswillcertainlycomeasyouaredoingexposure.

10. Checkwithclientstoseeiftheyaregettingashiftinthinking.Theyhavetotrustyou

intheprocess.Itisacollaborativeprocessoritdoesn'twork.

C. CreatingProtocol

1. As you are creating the protocol, they have to be working with you on the

instruction.Theyareactuallycreatingtheprotocol.

2. Gotowardswhatisfrighteningandchangetherelationshipwiththefear.

3. Mostofthetimetheexposureisgradualandgradedbaseduponthehierarchy.

4. Therearesometimeswhentherapistusewhatiscalledflooding.

• Youthrowthepersonintothesituation.

• Youhavetobecarefulwiththat.


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• Ithasethicalissues.

5. Youcandoinvivoexposure(intherealsituation)orimaginativeexposure.

6. Withpanic,youwanttoidentifythespecificfearwithinthepanic.

7. Exposethemtothesituationinwhichtriggersthosethoughts.

D. InteroceptiveExposure

1. Inducethefearsensations.

2. Usuallybeginwiththepracticesessionsinthetherapist’soffice,andasktheclients

topracticeathome.

3. Addthephysicalsymptomsthatnaturallyproducedthefearsensations.

4. Ifthereispanicwithagoraphobia,thengobacktothesituation.

E. SpecificPhobia

1. Whenwearedealingwithspecificphobia,mostofthetimeweusegradedexposure

orinvivo.

2. Withsocialphobia,weuseexposurepluscognitiverestructuring.Thecombination

oftheseseemstobebetteratpreventingreoccurrence.

• Thedifficultywithsocialphobiaisthatyoucan’tpredicttheseverywell.

• Socialexchangesarebrief,andtheprolongedpracticeofthatiskindofdifficult

toworkwith.


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3. Withagoraphobia,youuseinvivopractice.

• Whentheypracticewithaspouseorafriend,theydobetter.

F. UnifiedApproach

1. Barlowusesaunifiedapproach.Itisanintegrationapproach.

2. Heseesthatthesedifferentbehavioral,anxietyandmooddisordershaveacommon

latentstructure.

3. Thereisageneralizedbiologicalandpsychologicalvulnerabilityaswellasaspecific

psychologicalvulnerabilitythatalotoftheemotionaldisordersshare.

4. Itusesemotion-focusedandcognitivebehavioraltreatments.

5. It isappliedacrossanxietyanddepression,andit isdevelopedfromtheemotional

regulationliterature,cognitiveneuroscienceandlearningtheory.

6. It targets antecedent cognitive appraisals (thinking), reduces and prevents

avoidancethroughderegulatedemotions(feeling)andencouragesactionsthatare

inconsistentwithdisorderedemotionalstates(behavior).

7. He works on modifying the processes of internal experiences rather than the

externalcues.

8. The unified protocol is designed to help clients confront and experience

uncomfortableemotionsandrespondtotheminamoreadaptiveway.

9. Sevenmodulartreatments:


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• Psychoeducation

• Collaborativenature

• Emotionalawareness

• Cognitiveappraisals

• Emotiondrivenbehaviorsandemotionalavoidance

• Interoceptiveandsituationalexposures

• Responseprevention

G. Conclusion

1. Evidence-based treatments for anxiety disorders put exposure treatments at the

top.

2. Exposure treatments should be your first line of treatment. They work, they are

effectiveandpeopleseeresultswiththesetreatments!

3. Gettrainedinthesetreatments.


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Endnotes1R.C.Kessler,W.T.Chiu,O.Demler,K.R.Merikangas,andE.E.Walters,“Prevalence,Severity,andComorbidityof12-MonthDisordersintheNationalComorbiditySurveyReplication,”ArchivesofGeneralPsychiatry62(7)(2005).


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TAD102:

BipolarandSpectrumMoodDisorders:

DiagnosisandTreatmentStrategies

PaulMeier,M.D.


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AbstractMood disorders can reflect a person’s aversion of anymood. The causes ofmood disorders

vary: emotional, spiritual, medical, and genetic. As a predominating mood disorder, bipolar

spectrumdisorder isoverviewedinthissessionalongwithvariousformsofthedisordersuch

as: schizoaffective disorder and cyclothymia. To correct these disorders, there are multiple

medication related approaches one could take. In conclusion, this session encourages

counselorstolookatangerinaclient’slife,medicationrecommendationsandgenetics.

LearningObjectives

1. Participantswilllookatunderlyingcausesofmooddisorders.

2. Participantswilloverviewmedicationrecommendationsforthosewithbipolardisorder

anditsrelateddisorders.

3. Participants will be able to identify major symptoms of mood disorders, specifically

bipolardisorders.


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I. MoodDisorders

A. Overview

1. Anymoodthatyoudonotlikeisamooddisorder.

2. Whenpeoplethinkofmooddisorderstheyusuallythinkofdepression.

• Thatistheprimaryoneseeninpractice.

B. Causes

1. Thereareemotionalandspiritualcausesofmostmooddisorders.

• Mostpeoplearedepressedforemotionalorspiritualreasons.

• Itishardtodifferentiatebetweentheemotionalandthespiritualbecausethey

areinterrelated.

2. The main emotional and spiritual cause of depression is anger turned inward or

towardsothers.

• Angeristheleadingcauseofdeath.

“Beangry,andyetdonotsin;donotletthesungodownonyouranger,anddonot

givethedevilanopportunity.”—Ephesians4:26-27

“Nevertakeyourownrevenge,beloved,butleaveroomforthewrathofGod,foritis

written,‘VengeanceisMine,Iwillrepay,’saystheLord.”—Romans12:19

“Afatherofthefatherlessandajudgeforthewidows,isGodinHisholyhabitation.

Godmakesahomeforthelonely;Heleadsouttheprisonersintoprosperity,onlythe

rebelliousdwellinaparchedland.”—Psalm68:5-6

3. Therecanbemedicalcausesofmooddisorders.


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• Hastheirthyroidbeenchecked?

Ø Dryskin

Ø Hairloss

Ø Constipation

Ø Weightgain

Ø Cold

Ø Sluggish

Ø Depressed

• Sleepapnea

• Substanceabuse

• Chronicpain

• PMS

• Fibromyalgia

4. Therecanbegeneticcausesofmooddisorders.

• About20%inheritdepression.

• Threethingsthatdeterminehowoneturnsout:

Ø Genes

Ø Environment

Ø Choices

II. Disorders

A. BipolarSpectrumDisorder

1. Itreallyinvolvesgeneticdepression.

2. Somepeopleinheritdysthymia.

• Itisnotreallybipolardisorder,butthespectruminvolvesallkindsofmoodsthat

aregenetic.


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• Itisusuallycausedbyserotoninlevelsbeinglow.

• Youneedtryptophaninyourdiet(bananas).B6transportsthemfromthegutto

thebrain.Yourbrainthenturnsitintoserotonin.

3. Thereareotherchemicalsthatinfluencethewayyoufeelaswell.

• Dopamine

• GABA

• Norepinephrine

4. Therearedifferentnutrientsthatbuildthesechemicals.

• Tryptophan

• Phenylalanine

• Tyrosine

• Choline

• B6

B. SchizoaffectiveDisorder

1. ItisacombinationofBipolarIandschizophrenia.

2. Oneoutofevery33peoplewillgetpsychoticatsomepointintheirlife!

3. Bleuler’sfiveA’sthatoftenhappenbeforethebreakwithreality:

• Affectivedisorder:flataffect

• Associativedisorder:looseassociations

• Ambivalence

• Autisticdisorder

• Anhedonia:inabilitytohavefunorfeelpleasure


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4. Moreseveresymptoms:

• Paranoidandgrandiosedelusions

• Hallucinations

5. Bipolar I involves big mood swings, usually every three of four months (it varies

greatly).

• Thereareseveralchemicalsthatcanbeinvolved.

• Theyarenormalmostofthetime.

• Bipolarisalwaysinherited.

• Theybecomepsychoticforafewdaysorafewweeks.

• Theymanicphaseiswhentheyhavepressureofspeech.

• Themost importantsymptomtoremember issevere insomniawithoutgetting

tired.

6. There are three things that Bipolar I does when an individual looses touch with

reality:

• Sex

• Superspirituality

• Spending

C. BipolarII

1. WithbipolarII,thepersondoesnotbecomepsychotic.

2. Theyhavethefollowingsymptoms:

• Talkingfast

• Irritability

• Reallyhappy

• Madatthosewhodisagreewiththem


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• Intouchwithreality

D. Cyclothymia

1. Mildmoodswingsareinherited.

2. Ifyougetdepressed,youdon’tjusttakeanantidepressant.

• If you have a first degree relative that has bipolar disorder and you are

depressed,anantidepressantalonewithnotresultincompletehealth.

• IfyoutakeGABAwithit,thentheantidepressantwillworkgreat.

E. Medication

1. Ifapersonlosestouchwithreality,thentheonlymedicationthatwillhelpthemget

realitybackisdopaminemedication.

• BupropionXL

• WellbutrinXL

• Aplonzin

2. Ifapersonisbipolarandnotpsychotic,thenusuallytheGABAmedicationsarethe

best.

• Lamictal

• Trileptal

• Topamax

3. Thenumberoneantidepressantrecommendedisnotaserotoninmedication.

4. If youhavebipolar disorder and take a serotoninmedicationby itself, then itwill

makeyoumanic.


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5. The number one medication for people with bipolar disorder is bupropion

(Wellbutrin).

6. Thebestantidepressantforbipolardisorderisamixtureofbupropionalongwitha

GABAmedicine.

F. Summary

1. Most people,when they are dealingwith depression, are dealingwith it because

theyareangry.

• Ascounselors,helpthemwiththeirself-talk.

2. Depressioncouldalsobearesultofprolongedgrief,medicalcauses,etc.

• 80% of people who go through various mood disorders do not need any

medicationatall.TheyneedChristiancounseling.

• 20%ofpeopleneedmedication.

3. Therearesuchthingsasgeneticdisorders.


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TAD103:

InterpersonalNeurobiology:TheNine

DomainsofIntegration

CurtThompson,M.D.


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AbstractHumanity yearns for a world of goodness and beauty, and throughout the past decade,

neuroscienceresearchhas increasingly reflected this innatehumandesire. Italsoaffirmsand

energizes theexperienceof faith. Throughout thedata, one key feature is theexperienceof

beingknown.Intheprocessofbeingknown,thebraininitsmanyfunctionaldomains,comes

togetherinanintegralway.Whenworkingwithpeople,wemustunderstandthatthemindand

all of its components represent a process that is characterized as embodied, embrained and

relational.Therefore,mentalhealthresultsfromtheunionofsuchcharacteristicsinthemind.

Thissessionseekstoidentifyninemajorcomponentsof integratingneurologicalprocesses.In

conclusion,participantsareencouragedtorealizetheimportanceofcommunityinfluenceand

abiblicalnarrativeofthemind.

LearningObjectives

1. Participantswillbeexposedtothecomponentsofthemind.

2. Participantswillbeabletoidentifythoughtprocesses.

3. Participantswillinvestigatethemajorcomponentsofintegratingneurobiology.


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I. Introduction

A. AnatomyoftheSoul1

1. Wealldesire,hungerandthirstforaworldofgoodnessandbeauty.

2. Thatworldofgoodnessandbeautyisbeingreflectedintheemergingneuroscience

thathasbeencomingintoourawareness,particularlyoverthepasttenyears.

3. Theneurosciencedataincludesresearchofthebrainandthebrain’sinteractionsin

human relationships. It looks at physics, art and sociology. All of that research

combinedpointstotheworldofgoodnessandbeauty.Italsoaffirmsandenergizes

ourfaithexperience(abiblicalperspectiveoftheworld).

4. A key feature of all of the data (interpersonal neurobiology) is theexperience of

beingknown.

• The experience of being known is an avenue into the discovery and

implementationofmuchoftheneurosciencethatistalkedaboutinthefieldof

neurobiology.Itisasignificantthemethroughoutthebiblicalnarrative.

“Ifanyonesupposesthatheknowsanything,hehasnotyetknownasheoughtto

know;butifanyonelovesGod,heisknownbyHim.”—1Corinthians8:2-3

5. Although we live in a culture that is interested in personal growth and personal

welfare, this work (neuroscience and the process of being known) is not simply

aboutpersonalgrowth.Italsospeakstoourvocationalcallings.

• Intheprocessofbeingknown,thebrain in itsmanyfunctionaldomainscomes

together in an integral way. In that process of integration, we reduce our

capacityforanxietyandweincreaseourcapacityforcreativity.

• InthiswayweservethefunctionofwhatbiblicalnarrativedescribesinGenesis

1.


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• Ourmissioninlifeistocreateoutofawellspringofjoy.

• Oneofthemainquestionsthatweneedtoaddressinanyendeavorinlifeis,“To

whatdegreearewejoyfullycreatinginanymomentofendeavor?”

• Ascounselors,whatdoesthismeanforusintermsofhowweareenablingour

counselees/patientstohavelivesthatarecreated.

“ThenGodsaid,‘LetUsmakemaninOurimage,accordingtoOurlikeness;andlet

themruleoverthefishoftheseaandoverthebirdsoftheskyandoverthecattle

andoveralltheearth,andovereverycreepingthingthatcreepsontheearth.’God

createdmaninHisownimage,intheimageofGodHecreatedhim;maleandfemale

Hecreatedthem.”—Genesis1:26-27

B. Integration

1. Whatisthemind?

2. Ifwe are going to be in the helping profession (counseling), thenwe are actually

goingtobeaddressingpeople’sminds.

3. Ifweareworkingwithpeople’sminds,thenwhatisitthatweareworkingwith?

4. Whatdefinesahealthymind?

5. AccordingtoDanSiegel,aprofessorofpsychiatryatUCLA,themindisaprocessthat

emerges both in an embodied way and a relational way whose purpose is to

regulatetheflowofenergyandinformation.

• Themindisembodiedandnotsimplyembrained.


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“Or do you not know that your body is a temple of theHoly Spiritwho is in you,

whomyouhavefromGod,andthatyouarenotyourown?”—1Corinthians6:19

6. TothedegreethatGodwantstocommunicatewithus(withourminds),andtothe

degree thatwe loveGodwithallofourminds…thatmustnecessarily includehow

weloveGodwithourbodies.

7. Themindisnotjustembodied,butitisalsorelational.

• Agreatdealofourmindisalsofocusedoninteractinginotherrelationships.

• Weneedotherpeopletosurvive,letalonetothrive.

• In thisway, themind isnot simply tobeunderstoodas limited to “one’sown

person.”

• Somuchofthemindsactivity isconsumedwithwhatone isthinking,picturing

andwonderingaboutintermsofotherpeople.

8. Themindisaprocess.Itisnotstagnantorstatic.

9. Itisimportanttoknowthatthehumanbodyisnevercompletelyatrest.

• In thissameway,ourmindsarealwaysmoving. Itmirrors theanthropologyof

the Bible.God is aGodwho ismoving, and the only thing that changes is his

pace.

• Ourminds are constantly moving in a direction that is toward or away from

health,healingandwholeness.

• Inwhatdirectionareyoumovingatanygiventime?

10. Theseelementsof themind (embodied, relational and aprocess) are intended to

regulatetheflowofenergyandinformation.


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• Energy: the neurochemical or the electrochemical energy that we find that

coursesthroughoutallofourneuralnetworksthatexistnotonly inourbrains,

butthroughouttheextendednervoussysteminourbodies.

• The neural correlates always have subjective experiences to which they are

connected. The neural correlates and their subjective informational ideas are

always being constantly regulated by ourmind as it exists in relationshipwith

otherpeople.

• Thequestionis,“Towhatdegreearewepayingattentiontothecorrelates?”

• The degree inwhich the parts (embodied, relational, energy and information)

areworkingtogetherinconcertpointstotheideaofmentalhealth.

11. The concept of integration is another way of describing how these parts come

together.

• Integrationisaboutthedifferentiationofthedifferentaspectsofthefunctions

ofthemindandthatthoseaspectsarelinkedtogethersothatyouhaveasystem

thatfunctionsinawaythatisflexible,adaptive,coherent,energizedandstable

(FACES).

• To what degree is your life, at this moment, flexible, adaptive, coherent,

energizedorstable?

• Tothedegreethattheyareabletolinkthoseideasandbringthemtogetherisa

reflectionofthedegreetowhichintegrationormentalhealthistakingplacein

theirmindatthattime.

C. BiblicalCorrelate

“TeachmeYourway,OLord; Iwillwalk inYour truth;unitemyheart to fearYour

name.”—Psalm86:11


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II. DomainsofIntegration

A. Consciousness

1. Whenweareworkingwith someone,we firstneed toknow that theyareawake,

alertandattuned.

2. Therefore,consciousnessisprimarilyaboutattention.

3. Attentionistheengineofthemind.Itpullseverythingelsebehindit.

• Nothingchangesinthehumanexperience,intermsofourintentionalandmost

ofourautomaticbehavior,withoutashiftinattention.

4. Howwellareyoupayingattentiontowhatyouarepayingattentionto?

• Youcangivepeopleassignmentstodothisonaregularbasis.

• 1or2timesaday,take30secondsandreflectonwhathasbeenpaidattention

to.

5. Emotion:

• Donald Nathanson, an international leader in the study of human emotion,

pointsoutthatattentionisprimarilyafunctionofemotion.

• We shift our attention to those things that draw our curiosity, even if the

curiosityisautomatic.

• The necessary proposition: Emotion is the energy around which the brain

organizesitself.Nothingwedoiswithoutemotion.

• Ifwetakeemotionoutofthehumancondition,humanbeingswillstopmoving.

B. Vertical

1. Firstofall,itistheanatomicconditionofthecentralnervoussystem.


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2. The brain stem is the part of the anatomy that is largely responsible for life

movement.

3. Emergingoutofthebrainstem,wehaveneuralnetworksthatrepresentthelimbic

circuitry.

• Thiscircuitryislargelyresponsiblefortheprimaryemergenceofemotioninthe

humancondition.

4. Developing later in the course of an infant’s intrauterine development is the

neocortex.

• Althoughtheneocortexand inparticular,theprefrontalcortex,makesusmost

human, much of the activity that takes place in our brain is the activity that

representswhatwehaveincommonwithreptilesandlowermammals.

• The activity of the prefrontal cortex is responsible for helping to restrain and

regulateagreatdealoftherestofwhatourbrainactivityisabout.

C. Horizontal

1. Wehaverightandlefthemispheres.Thesedevelopatdifferentrates.

2. Thingsthattakeplaceintherighthemisphere(developquickly):

• Nonverbalcues

• Emotionalemergence

• Visual-spatialorientation

3. Thelefthemispheredealswithlanguage,thelogical,linearandliteralexpressions.

4. Overtime,the leftbrainworksreallyhardatmakingsenseofwhattherightbrain

sends.


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5. Inthiscase,weseeanotherexampleofadomaininwhichintegrationisimportant.

6. Howwellistherightbrainincommunicationwiththeleftbrain?

7. Theverticalandhorizontaldomainsdevelopbottomtotopandrighttoleft.

• Howwellarewepayingattention(atanytime)totheactivityofthosedomains?

D. Memory

1. Itisnotlargelyjustaboutthepast,butitismostlyaboutthefuture.

• Werememberthingsnotjustbecausewewanttobeabletorecallthem.

• Werecalltheminorderforustoknowwhatwecandoinourfuture.

2. In that regard, memory is not just something that stores information about

something thathashappened, it is something thathasanongoing influenceatall

timesinthemind’soverallexperience.

3. Itisinfluencingthebottomtotopandtherighttoleftdevelopment.Itisinfluencing

concentrationandfocus.

4. Memory is one of the major linking points. The way that we remember things

determineswhatwewill anticipate about our future.What one anticipates about

thefutureaffectsthewayonelivesinthepresentmoment.

5. Memory is typicallydivided into twodifferent realms.The first is implicitmemory

thatisrepresentedbyneuralnetworksformedbeforebirth.Itdoesnotrequireany

focusedattentioninorderforustoencodeorretrieveinformation.

• Implicitmemoryhappensallthetime.


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• Arewepayingattentiontoitandareweawarethatitisshapingandformingthe

anticipatedfuture?

6. Anotherformofmemoryisexplicitmemory.

• Ittypicallybeginstodevelopbetween18-24monthsofage.

• Itishighlycorrelatedwiththedevelopmentoflanguage.

• This form of memory is often significant from the standpoint that it is

disconnectedordisintegratedfromimplicitmemory.

• Howwelldoyoureallyremembernot justevents,buttheemotionalqualityof

thoseevents?

• One way to help them do this is to get them to handwrite their personal

autobiography.

E. Narrative

1. Humansaretheonlyonestotellstories.Wenarrateourlives.

2. Whatisthestoryinwhichyoubelieveyouareliving?

3. Importantinshapingthisdomainisattachment.

4. Whoisit inyourlifethatisresponsibleforbeginningtotellyourstorylongbefore

youwereborn?

5. Whatarethosenonverbalelementsofthestorythatyoutell?

6. Whoarethepeopleinyourlifecurrentlywhoareassistingyouintellingyourstory?

7. Wetellournarrativeinorderforittobeheard.


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F. State

1. Inwhatstateareyouliving?

2. Throughout the course of our day, we are moving through different interactive

statestodifferentinteractivestates.

• Foreachofthesestates,therearecorrelatingbrainpatterns.

3. How aware are you about the states in which you exist and into which you are

transitioning?

4. Muchoflife’stroublescomebecausewearenotawarethatweareactuallymoving

fromonestatetoanother.Thattransitionisoftenfraughtwithperil.

5. Invitepatientstobegintomakealistofdifferentstates.

G. Interpersonal

1. Fromastandpointofinterpersonalneurobiology,innaturethereisnosuchthingas

anindividualhumanbrain.

2. Weareconstantlyinteractingwithotherpeople’sbrains.

3. Thisdomainofmymindisnotsimplymine.

• Imustrecognizethatmymindisconstantlygoingtobeaffectedbythemultiple

differentdomainsofotherpeople’smindswithwhomIamliving.


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“ThenGodsaid, ‘LetUsmakemaninOurimage,accordingtoOurlikeness;andlet

themruleoverthefishoftheseaandoverthebirdsoftheskyandoverthecattle

andoveralltheearth,andovereverycreepingthingthatcreepsontheearth.’”

—Genesis1:26

H. Temporal

1. Wearetemporalcreatures.

2. Notonlyareweabletobeawareofapastandafuture,butwealsoreflectonit.

3. Wefindourselvesbeingdeeplyawareofthelong-termoutcomesoftime.

• Weareawarethatwewilldie,whichleadstoeschatology.

4. Whatwebelieveourfutureholdscomesbacktoaffectwhereweliveinthepresent

moment.

5. Oursenseofthefutureisdeeplyaffectedbyoursenseandawarenessofthepast,

butnotsimplythepastintermsofeventsthathavehappened.Itisintermsofwhat

happenedintheverybeginning.

6. Thereareveryfewofuswhodon’tlivewithadeepanthropologicalconnectionto

ourhumanorigins.Wewonderwherewecamefrom.

• TheChristiannarrativepurposesthatwecomefromaGodwhohasdeeplygood

intentionsforus.

• Wehavebeenbornintoaworldthattriestotellusaverydifferentstory.


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7. Itisimportantforusasclinicianstobeaskingpeopleonaregularbasis,“Whatisit

thatyoubelievetobetrueaboutyourpastintermsofwhereyoubelieveyoucome

fromandyourfutureintermsofwhereyoubelievethatyouaregoing?”

8. Ouranthropologyandeschatologyareconstantlyshapingthenatureofourneural

networks,butneveroutsideofhowitisbeingaffectedthroughrelationships.

I. Transpirational

1. Transpiration is a reflection of our awareness and attunement to the other eight

domains.

2. Thework at paying attention towhatwearepaying attention to and to all these

other domains effectively leads to an integrated life and a whole, healthy and

healedmind,butneveroutsidetheboundaryofcommunity.

J. Conclusion

1. Itiscruciallyimportantforustorecognizethatanyofthesethingsareelementsof

themindthatarealwaysbeingexperiencedincommunitywhetherwewantthem

tobeornot.

• A crucial question is the degree towhichwe are being intentional in creating

communitiesthatenablethistohappeneffectively.

• Whoaretheothertwoorthreepeopleinlifewithwhomrelationshipsarebeing

builtinwhichyouandallofyourmultipledomainsarebecomingfullyknown?

2. Neuroscienceisstillinitsascendency.

• Weliveinaculturethatfindsitcruciallyimportant.

“Lifeisdifficult.”—ScottPeck


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• We live in a world in which the primary way of understanding the world is

through amodernist scientific lens. A plausibility structure that does not first

beginwithGodorabiblicalnarrative.

• Itbeginswithastory inwhichwearealone in theuniverseandwearesimply

tryingtodothebestwecan.

• Althoughneuroscience ishugely important, it is tobeunderstood through the

lensofthestoryofthebiblicalnarrative.

• Tothedegreethatwedothat,wenotonlyliveintegratedlivestogetherbutare

alsopeople,clinicians,professionalsandcommunitiesthatbringtheveryscience

ofinterpersonalneurobiologyalongwiththerestoflifeintothekingdomofGod.


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Endnote1CurtThompson,AnatomyoftheSoul:SurprisingConnectionsbetweenNeuroscienceandSpiritualPracticesThatCanTransformYourLifeandRelationships(CarolStream,Illinois:TyndaleHousePublishers,2010).


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Copyright2014LightUniversity

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Nopartofthispublicationmaybereproducedinanyformwithouttheexpressedwritten

permissionofLightUniversityortheAmericanAssociationofChristianCounselors.

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