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Anxiety,Depressionand
InterpersonalNeurobiology2.0
P.O.Box739•Forest,VA24551•1-800-526-8673•www.AACC.net
Anxiety,DepressionandInterpersonalNeurobiology2.0
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WelcometoLightUniversityandthe“Anxiety,DepressionandInterpersonalNeurobiology2.0”programofstudy.Our prayer is that you will be blessed by your studies and increase your effectiveness inreaching out to others. We believe you will find this program to be academically sound,clinicallyexcellentandbiblically-based.Our faculty represents some of the best in their field – including professors, counselors andministers who provide students with current, practical instruction relevant to the needs oftoday’sgenerations.We have alsoworked hard to provide youwith a program that is convenient and flexible –givingyoutheadvantageof“classroominstruction”onlineandallowingyoutocompleteyourtrainingonyourowntimeandscheduleinthecomfortofyourhomeoroffice.Thetestmaterialcanbefoundatwww.lightuniversity.comandmaybetakenopenbook.Onceyouhavesuccessfullycompletedthetest,whichcoverstheunitswithinthiscourse,youwillbeawardedacertificateofcompletionsignifyingyouhavecompletedthisprogramofstudy.Thank you for your interest in this program of study. Our prayer is that you will grow inknowledge,discernment,andpeople-skillsthroughoutthiscourseofstudy.Sincerely,
RonHawkinsDean,LightUniversity
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TheAmericanAssociationofChristianCounselors
• Represents the largestorganizedmembership (nearly50,000)ofChristian counselorsandcaregiversintheworld,havingjustcelebratedits25thanniversaryin2011.
• Known for its top-tier publications (Christian Counseling Today, the Christian CounselingConnectionandChristianCoachingToday),professionalcredentialingopportunitiesofferedthroughtheInternationalBoardofChristianCare(IBCC),excellenceinChristiancounselingeducation, an arrayof broad-based conferences and live training events, radioprograms,regulatoryandadvocacyeffortsonbehalfofChristianprofessionals,apeer-reviewedEthicsCode, and collaborative partnerships such as Compassion International, the NationalHispanic Christian Leadership Conference and Care Net (to name a few), the AACC hasbecomethefaceofChristiancounselingtoday.
• With the needed vision and practical support necessary, the AACC helped launch the
International Christian Coaching Association (ICCA) in 2011, which now represents thelargest Christian life coaching organization in the world with over 2,000 members andgrowing.
OurMission
The AACC is committed to assisting Christian counselors, the entire “community of care,”licensedprofessionals,pastors,and laychurchmemberswith littleorno formal training. It isourintentiontoequipclinical,pastoral,andlaycaregiverswithbiblicaltruthandpsychosocialinsights that minister to hurting persons and helps them move to personal wholeness,interpersonalcompetence,mentalstability,andspiritualmaturity.
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OurVision
TheAACC’svisionhastwocriticaldimensions:First,wedesiretoservetheworldwideChristianChurch by helping foster maturity in Christ. Secondly, we aim to serve, educate, and equip1,000,000 professional clinicians, pastoral counselors, and lay helpers throughout the nextdecade.WearecommittedtohelpingtheChurchequipGod’speopletoloveandcareforoneanother.We recognize Christian counseling as a unique form of Christian discipleship, assisting thechurch in its call to bring believers to maturity in the lifelong process of sanctification—ofgrowingtomaturityinChristandexperiencingabundantlife.Werecognizesomearegiftedtodosointhecontextofaclinical,professionaland/orpastoralmanner.Wealsobelieveselected laypeoplearecalledtocareforothersandthattheyneedtheappropriatetrainingandmentoringtodoso.WebelievetheroleofthehelpingministryintheChurchmustbesupportedbythreestrongcords:thepastor,thelayhelper,andtheclinicalprofessional.ItistothesethreerolesthattheAACCisdedicatedtoserve(Ephesians4:11-13).
OurCoreValues
InthenameofChrist,theAmericanAssociationofChristianCounselorsabidesbythefollowingvalues:
VALUE1:OURSOURCEWearecommittedtohonorJesusChristandglorifyGod,remainingflexibleandresponsivetotheHolySpiritinallthatHehascalledustobeanddo.VALUE2:OURSTRENGTHWearecommittedtobiblicaltruths,andtoclinicalexcellenceandunityinthedeliveryofallourresources,services,trainingandbenefits.VALUE3:OURSERVICEWeare committed toeffectivelyandcompetently serve the communityof careworldwide—bothourmembership and the churchat large—withexcellenceand timeliness, andbyover-deliveryonourpromises.VALUE4:OURSTAFFWearecommittedtovalueandinvestinourpeopleaspartnersinourmissiontohelpotherseffectivelyprovideChrist-centeredcounselingandsoulcareforhurtingpeople.VALUE5:OURSTEWARDSHIPWe are committed to profitably steward the resourcesGod gives to us in order to continueservingtheneedsofhurtingpeople.
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LightUniversity• Establishedin1999undertheleadershipofDr.TimClinton—hasnowseennearly200,000
students from around the world (including lay caregivers, pastors and chaplains, crisisresponders,lifecoaches,andlicensedmentalhealthpractitioners)enrollincoursesthataredelivered via multiple formats (live conference and webinar presentations, video-basedcertificationtraining,andastate-of-theartonlinedistanceteachingplatform).
• Thesepresentations,courses,andcertificateanddiplomaprograms,offeroneofthemostcomprehensive orientations to Christian counseling anywhere. The strength of LightUniversity is partially determined by its world-class faculty—over 150 of the leadingChristianeducators,authors,mentalhealthcliniciansandlifecoachingexpertsintheUnitedStates. This core groupof facultymembers represents a literal “Who’sWho” inChristiancounseling. No other university in the world has pulled together such a diverse andcomprehensivegroupofprofessionals.
• Educational and training materials cover over 40 relevant core areas in Christian—
counseling, lifecoaching,mediation,andcrisis response—equippingcompetentcaregiversand ministry leaders who are making a difference in their churches, communities, andorganizations.
OurMissionStatement
TotrainonemillionBiblicalCounselors,ChristianLifeCoaches,andChristianCrisisRespondersbyeducating,equipping,andservingtoday’sChristianleaders.
AcademicallySound•ClinicallyExcellent•DistinctivelyChristian
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Video-basedCurriculum
• UtilizesDVDpresentations that incorporateover 150 of the leading Christian educators,authors,mentalhealthclinicians,andlifecoachingexpertsintheUnitedStates.
• Eachpresentationisapproximately50-60minutesinlengthandmostareaccompaniedbyacorrespondingtext(inoutlineformat)anda10-questionexaminationtomeasurelearningoutcomes.Therearenearly1,000uniquepresentationsthatareavailableandorganizedinvariouscourseofferings.
• Learning is self-directed and pacing is determined according to the individual time
parameters/scheduleofeachparticipant.• With the successful completion of each program course, participants receive an official
Certificate of Completion. In addition to the normal Certificate of Completion that eachparticipant receives, Regular and Advanced Diplomas in Biblical Counseling are alsoavailable.
Ø TheRegularDiploma isawardedbytakingCaringForPeopleGod’sWay,BreakingFreeandoneadditionalElectiveamongtheavailableCoreCourses.
Ø TheAdvancedDiplomaisawardedbytakingCaringForPeopleGod’sWay,BreakingFree,andanythreeElectivesamongtheavailableCoreCourses.
Credentialing
• LightUniversitycourses,programs,certificatesanddiplomasarerecognizedandendorsedbytheInternationalBoardofChristianCare(IBCC)anditsthreeaffiliateBoards:theBoardofChristianProfessional&PastoralCounselors(BCPPC);theBoardofChristianLifeCoaching(BCLC);andtheBoardofChristianCrisis&TraumaResponse(BCCTR).
• Credentialing is a separateprocess from certificate or diploma completion.However, theIBCC accepts Light University and Light University Online programs as meeting theacademic requirements for credentialing purposes. Graduates are eligible to apply forcredentialinginmostcases.
Ø Credentialinginvolvesanapplication,attestation,andpersonalreferences.
Ø CredentialrenewalsincludeContinuingEducationrequirements,re-attestation,andoccureitherannuallyorbienniallydependingonthespecificBoard.
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OnlineTesting
TheURLfortakingallquizzesforthiscourseis:http://www.lightuniversity.com/my-account/.
• TOLOGINTOYOURACCOUNT
Ø You should have received an email upon checkout that included your username,password,andalinktologintoyouraccountonline.
• MYDASHBOARDPAGE
Ø Once registered, youwill see theMyDVD Course Dashboard link by placing yourmousepointerovertheMyAccountmenuinthetopbarofthewebsite.Thispagewill include studentPROFILE informationand theREGISTEREDCOURSES forwhichyouareregistered.TheLOG-OUTandMYDASHBOARDtabswillbeinthetoprightofeachscreen.Clickingonthe>nexttothecoursewilltakeyoutothecoursepagecontainingthequizzes.
• QUIZZES
Ø Simplyclickonthefirstquiztobegin.• PRINTCERTIFICATE
Afterallquizzesaresuccessfullycompleted,a“PrintYourCertificate”buttonwillappearnearthetopofthecoursepage.YouwillnowbeabletoprintoutaCertificateofCompletion.Yournameandthecourseinformationarepre-populated.ContinuingEducationThe AACC is approved by the American Psychological Association (APA) to offer continuingeducationforpsychologists.TheAACCisaco-sponsorofthistrainingcurriculumandaNationalBoard of Certified Counselors (NBCC)ApprovedContinuing Education Provider (ACEPTM). TheAACC may award NBCC approved clock hours for events or programs that meet NBCCrequirements.TheAACCmaintainsresponsibilityforthecontentofthistrainingcurriculum.TheAACCalsoofferscontinuingeducationcreditforplaytherapiststhroughtheAssociationforPlayTherapy (APT Approved Provider #14-373), so long as the training element is specificallyapplicabletothepracticeofplaytherapy.It remains the responsibility of each individual to be aware of his/her state licensure andContinuing Education requirements. A letter certifying participation will be mailed to thoseindividuals who submit a Continuing Education request and have successfully completed allcourserequirements.
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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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