STRESS. EBT Clinical Services. EBT History. Emotional Brain Training. Emotional Brain Training: Neuroscience Concept #1: It s not us. It s our wiring.

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1 Emotional Brain Training DIFM The Integrative RDs July 6, 0 STRESS Emotional Brain Training: Self-directed positive emotional plasticity to rewire self-regulation Stress Physiology Neuroplasticity Attachment Theory + + EBT Clinical Services Ø Certified EBT Providers Exceptional clinicians (mental health, nutrition, medicine, nursing, addiction) complete personal and professional training in EBT, distance learning, hours/week for year Ø EBT Groups and Coaching Brief courses: Stress, Common Excesses Long-term groups: Reset the emotional brain for joy Qualities: educators, groups, embody joy, emotionally expressive with excellent counseling skills Receive: CE Credit and Certified EBT Provider EBT History Ø 979 UCSF: pediatric obesity SHAPEDOWN Ø 987 UCSF: adult obesity The Solution Ø 999 Neuroplasticity: All stress symptoms Neuroscience Concept #: It s not us It s our wiring Ø 00 Physiology: Reward & Addiction Ø 009 EBT: Brain-based integrative medicine

2 Homeostatic Circuit Allostatic Circuit Effective processing Encode reasonable expectations and adaptive responses - Negative feedback loop Natural shut-off Ineffective processing Encode unreasonable expectations and maladaptive responses - Positive feedback loop No natural shut-off Mitrovic, I, et al (0) Rewiring the Stress Response: A New Paradigm in Health Care Hypothesis Mitrovic, I, et al (0) Rewiring the Stress Response: A New Paradigm in Health Care Hypothesis Stress Dominant Area Neuroscience Concept #: Wiring triggers brain states Perry, BD (999) Memories of Fear: How the Brain Stores and Retrieves Physiolgical States, Feelings, Behaviors and Thoughts from Traumatic Events The Child Trauma Academy, - 9 Stress Dominant Area Brain State-specific Characteristics State (#) Cognitive - great! Abstract Joyous Intimate - good Concrete Balanced Companionable Healthy - little stressed Rigid Mixed Social - stressed Unbalanced Needy/Distant Unhealthy Reactive - stressed out Irrational Emotional Terrified Relational Merged/ Behavioral Optimal Moderate Addictive Disengaged Perry, BD (999) Memories of Fear: How the Brain Stores and Retrieves Physiolgical States, Feelings, Behaviors and Thoughts from Traumatic Events The Child Trauma Academy, - 9 Mitrovic, I, et al (0) Rewiring the Stress Response: A New Paradigm in Health Care Hypothesis

3 Brain State-specific Rewards State (#) In stressed states, the brain defaults to hedonic rewards - great! Sanctuary Authenticity Vibrancy Integrity Intimacy Spirituality Freedom - good - little stressed - stressed - stressed out Overeating BED ETOH Smoking Drugs Anorexia Rx Misuse Neuroscience Concept #: Brain states become persistent Mitrovic, I, et al (0) Rewiring the Stress Response: A New Paradigm in Health Care Hypothesis Repeated episodes of stress cause wear and tear (allostatic load) Reward centers become dysregulated Emotional set point decreases McEwen, B S Protective and Damaging Effects of Stress Mediators New England Journal of Medicine 8: 7-79, 998 Koob, G Alcoholism: Allostasis and Beyond Alcoholism: Clinical & Experimental Research Vol 7, No (00): - Chronic stress may cannibalize protective brain structures The brain adopts a fixed allostatic state McEwen, B S Protective and Damaging Effects of Stress Mediators New England Journal of Medicine 8: 7-79, 998 McEwen, B S Protective and Damaging Effects of Stress Mediators New England Journal of Medicine 8: 7-79, 998

4 EBT Process Ø Repeatedly attune to state, and accept or actively change state Neuroscience Concept #: We can create new wiring Ø Use cortical explicit memory to change the circuits stored in sub-cortical implicit memory Ø Emergent effect - adaptive self-regulatory circuits convert to long-term procedural memory in the basal ganglia Rewire Stress Circuits Dyadic Attunement and Regulation Ø Stress is a moment of opportunity to rewire circuits Ø Stress reactivates the circuit and makes synapses fluid Without emotional arousal, circuits do open* Many times throughout the day: Ø Compassionately observe/stay attuned Ø Use Cycle Tool during reconsolidation window Ø Appraise emotional state ( to scale) Vivid awareness of two opposing expectations ( juxtapposition ) The brain spontaneously erases one of the circuits Ø Accept or change state -- to get to Brain State *D Schiller et al Nature 6, -,00 Self-Attunement and Self-Regulation: Check In Tool Many times throughout the day: Ø Compassionately observe/stay attuned Ø What number am I? Ø Accept or change state to get to Brain State

5 Dyadic-Regulation Tools of Self-Regulation Loving connection Feelings? Needs? Express Feelings Feelings/Expectations Reassurance Sanctuary Tool Feelings Check Tool Emotional Housecleaning Feelings/Expectations Reassurance

6 Tool for selfdirected rewiring of allostatic circuits State-specific memory PW, Baxter LR Jr, Martin KM, Phelps ME Arch Gen Psychiatry 996 Feb; ():09- Ecker B, Toomey R J Construct Psych 008;:87-0 Rewire Brain State Circuits Circuits are stored in brain area that was dominant when the experience occurred and retrieved easily ( on line ) when in that brain state again false associations ( Survival Circuits ) I get my safety (x) from (y) I get my safety from food Survival Circuits Schwartz JM, Stoessel I get my safety from thinking I get my safety from distancing Rewire Brain State Circuits: false generalizations Examples: I am bad I cannot love 6

7 Improve the brain s set point State (#) Cognitive Emotional Relational Behavioral - great! Abstract Joyous Intimate Optimal - good Concrete Balanced Companionable Healthy - little stressed Rigid Mixed Social Moderate - stressed Reactive Unbalanced Needy/Distant Unhealthy - stressed out Irrational Terrified Merged/ Addictive Disengaged Mitrovic, I, et al (0) Rewiring the Stress Response: A New Paradigm in Health Care Hypothesis Summary Ø Advances in neuroscience suggest the possibility of a new paradigm in health care based on rewiring selfregulation Ø Addressing the root cause of a range of stressrelated disorders through education and therapeutic training is delivered by Certified EBT Providers More information: Come to Annual Meeting Personal courses and professional certification: wwwebtorg Contact: Laurel Mellin laurelmellin@ucsfedu