dr. christine chasek limhp, ladc, mac associate professor ... · neurocounseling: bridging the...
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Neurocounseling: Bridging the Recovery Gap
Dr. Christine Chasek LIMHP, LADC, MAC
Associate Professor
University of Nebraska at Kearney
November 8, 2017
Thomas Durham, PhD
Director of Training
NAADAC, the Association for Addiction Professionals
www.naadac.org
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Using GoToWebinar – (Live Participants Only)
Control Panel
Asking Questions
Audio (phone preferred)
Polling Questions
Dr. Christine Chasek LIMHP, LADC Associate Professor
1615 W. 24th Street
Kearney, NE 68845
Webinar Presenter
YourUniversity of Nebraska at Kearney
Behavioral Health Education Center of Nebraska
Webinar Learning Objectives
Identify the
basics of
neurocounseling
and how to
incorporate
neurocounseling
interventions
into practice.
Examine two specific
neurocounseling
recovery and relapse
prevention
interventions to use
with clients.
Be able to assess
the effectiveness of
neurocounseling
interventions used
with clients.
1 32
What is Neurocounseling?
The integration of neuroscience into counseling
practice.
How is it used?
To understand how therapy changes the brain
To understand client concerns, conceptualize
cases and plan treatment using a brain based
perspective
Another tool in the clinician’s toolbox
Basics of Neurocounseling
We have learned so much
about the brain but there is
always more to learn.
We will take a look at basic
brain structures and brain
functions that help our
understanding of substance
use disorders.
The Incredible Brain
Polling Question #1
Have you had any “brain training” in your
educational courses?
Yes or No
The brain is organized into two hemispheres
connected by the Corpus Callosum, a thick
band of nerve fibers that allows the two
hemispheres to communicate.
The brain is further divided into 4 sets of lobes,
the most important for us to understand is the
Frontal Lobe.
Becoming Brain Wise
• The Frontal Lobe is the executive command center of the brain, critical
in problem solving, decision making, moral reasoning, and emotional
regulation.
Deep inside the brain there are many important subcortical structures.
These structures are connected into systems that affect mental health and
healthy brain functioning.
The most important functional brain system in the discussion of addiction is
the Limbic System. The limbic system is primarily known for helping
people to respond to emotional cues and threats and also plays a role in
motivation, addiction, and sexual behavior.
There are several subcortical structures involved in the limbic system
however the most important ones for us to understand are the Basal
Ganglia and the Amygdala.
From Structures to Systems
The Basal Ganglia functions as
the reward and motivation
system as it has a high
concentration of dopamine
projections. The Basal Ganglia
controls the rewarding or
pleasurable effects of substance
use and are responsible for the
formation of the habitual use of
substances.
The Amygdala is involved in
responding to threats and stress.
The feelings of unease, anxiety,
and irritability as occurs with
withdrawal from substances
reside here.
Communication in the brain is
carried out via neurotransmission.
Neurotransmitters carry messages
across the millions of neurons
located in the brain.
Dopamine and the brain’s natural
occurring Opioid
Neurotransmitters are key
communicators in the brain’s reward
system. This system is hijacked in
substance use disorders.
How the Brain Communicates
The Addiction Cycle as Explained by
Neuroscience
Why do I binge on Ice Cream and not
Broccoli?
Binge/Intoxication Stage: Basal Ganglia
• Consume intoxicating substance and experiences pleasurable
effects/rewards
• Dopamine and the opioid signaling system is activated, the stimuli
associated with the use of the substances is connected with the reward;
over time the stimuli can trigger the dopamine and opioid signaling
system
• Habit circuitry of the basal ganglia contributes to compulsive substance
seeking
• The reward and habit neurocircuits explain the intense desire (craving)
for the substance and the compulsive substance seeking
The Addiction Cycle
Withdrawal/Negative Affect Stage: Amygdala
• Follows the binge/intoxication stage and sets up future binges
• Withdrawal symptoms are experienced including negative emotions
which come from the diminished activity in the reward circuitry and
activation of the brain’s stress systems in the amygdala
• Long lasting decreases in the dopamine system can occur accounting
for loss of pleasure in the substance use and other pleasurable
activities; substance use increases to try to regain pleasurable feelings
(tolerance)
• The combination of decreased dopamine and increased stress
neurochemicals reinforces the neurochemical basis driving compulsive
substance use
The Addiction Cycle
Preoccupation/Anticipation Stage: Prefrontal Cortex
• This stage occurs after a period of abstinence (can be long or short-ie.
hours) when a person seeks substances again
• A preoccupation with substances occurs; commonly called craving
• This stage engages the prefrontal cortex, the executive center which
has a Go System and a Stop System
• In individuals with substance use disorders, the prefrontal cortex Go
System is over activated driving substance seeking behavior and the
Stop System is under activated promoting impulsive and compulsive
substance seeking
The Addiction Cycle
Neurocounseling
Interventions for
Recovery
Management and
Relapse Prevention
Polling Question #2
Do you use neurocounseling interventions in
your work with clients?
Yes, No, or Maybe
Mindfulness-Based Relapse Prevention
is an emerging evidence based
program integrating mindfulness
meditation practices with traditional
cognitive-behavioral relapse
prevention.
MBRP is designed as an outpatient
aftercare program to support
maintenance of treatment gains and
foster a sustainable recovery life.
MBRP
A meta-analysis of mindfulness based treatments for substance misuse
revealed significant small to large effects of mindfulness treatments in
reducing the frequency and severity of substance misuse, intensity of
craving and severity of stress (Li, Howard, Garland, & Lazar, 2017)
Compared with treatment as usual, participants assigned to the MBRP
group reported significantly lower risk of relapse and targeted
mindfulness practices supported long-term outcomes by strengthening
the ability to monitor and cope with discomfort associated with craving
and negative affect (Bowen et al., 2014)
In a randomized clinical trial, MBRP reduced negative affect and
stimulant use in adults with mood and anxiety disorders indicating
MBRP is effective for clients with co-occurring disorders (Glasner et al.,
2017)
Research on MBRP
• MBRP combines mindfulness
meditation practices with
cognitive behavioral relapse
prevention techniques
• Clients are taught “mindfulness”
through structured activities
• MBRP is designed to engage
clients in practices of mindful
awareness to foster increased
awareness of triggers, habitual
patterns, automatic reactions,
and the range of choices
possible for them.
MBRP
If you want to use MBRP in your
practice, it is highly recommended that
you engage in your own personal
meditation program as the basis for
training and preparation.
• Group or individually
• Eight Training Sessions
• Each session starts and ends with
meditation
• Homework and home practice is
assigned each week
Topics of the sessions:
1. Automatic Pilot and Relapse
2. Awareness of Triggers and Cravings
3. Mindfulness in Daily Life
4. Mindfulness in High Risk Situations
5. Acceptance and Skillful Action
6. Seeing Thoughts as Thoughts
7. Self-Care and Lifestyle Balance
8. Social Support and Continuing
Practice
*How is MBRP done?
*Bowen, S. Chawla, N., & Marlatt, G. A. (20111).
Mindfulness-Based Relapse Prevention for Addictive
Behaviors: A Clinician’s guide
Confrontation as a
Neurocounseling
Intervention
• Neuroscience research is finding
that new learning, or
neuroplasticisty, occurs when the
two brain hemispheres synchronize
their activity (Goodwin, Lee, Puig, &
Sherrard, 2005 & 2006)
• A confrontation that points out
incongruities for the client is a way
to open them up to new ways of
thinking, forcing the two
hemispheres to work together
Confrontation Microcounseling Skill
A
word
about
GENTLE and SUPPORTIVE confrontations can
often reach underlying emotional structures which
creates the setting for new creative solutions
Assessing Neurocounseling Interventions
Polling Question #3
Are you familiar with N of 1 Research
Designs?
Yes, No, or Maybe
N of 1 research designs
are ways of measuring
interventions to determine
if they are working; if they
are “evidence based”
More objective and thus
valid way of “knowing” that
our interventions are
working
Can be a single subject, or
a single group
N of 1 Research Design
The DV is the concern or issue that is the focus
of the intervention: ie, cravings, thoughts, using
The IV is the intervention you are implementing;
ie mindfulness, meditation, homework
completion
Repeated Measures Design
Repeated measurements are used to determine the subjects “status”; the
dependent variable is measured repeatedly
Baseline Phase (A)
The time period prior to the intervention
Collect data until a pattern emerges (at least three measures)
Treatment Phase (B)
The time period in which the implementation of the treatment occurs
Measures of the dependent variable are taken repeatedly
The length of the treatment phase should be as long as the length of the
baseline phase
Foundations of Single Subject Designs
The data points between baseline and treatment are compared.
The phases of the single subject design are almost always summarized
on a graph
The y-axis is the scores of the dependent variable
The x-axis is the unit of measurement such as time, days, week, month,
etc.
Analysis Options
*Level
*Trend
*Variability
Analysis of N of 1
Level: Has the amount of the target variable changed from the
baseline to the intervention phase?
Trend: What is the direction in the pattern of the data points?
Variability: How different are the scores in the baseline and
intervention phase?
Analysis
EXAMPLE
GRAPHS TO
ANALYZE
Polling Question #4
Can you see yourself using an N of 1
Design with your clients for outcome and
treatment purposes?
Yes, No, or Maybe
Questions??? Thanks!!
Bowen, S., Chawla, N. & Marlatt, G. A. (2011). Mindfulness-based relapse prevention for addictive behaviors: A
clinician’s guide. The Guildford Press: New York.
Bowen, S., Witkiewitz, K., Clifasefi, S. L…….Larimer, M. E. (2014). Relative efficacy of mindfulness-based
relapse prevention, standard relapse prevention, and treatment as usual for substance use disorders: A
randomized trial. JAMA Psychiatry, 71(5), 547-556.
Check, J. & Schutt, R. K. (2012). Research methods in education. Sage: Los Angeles, CA.
Erickson, C. K. (2007). The Science of Addiction. W. W. Norton & Company: New York.
Field, T. A., Jones, L. K., & Russell-Chapin, L. A. (2017). Neurocounseling: Brain-based clinical approaches.
American Counseling Association: Alexandria, VA.
Glasner, S. Mooney, L. J., Ang, A…..Rawson, R. (2017). Mindfulness-based relapse prevention for stimulant
dependent adults: A pilot randomized clinical trial. Mindfulness, 8(1), 126-135.
Goodwin, L., Lee, S., Puig, A. & Sherrard, P. (2005). Guided imagery and relaxation for women with early stage
breast cancer. Journal of Creativity in Mental Health, 1(2), 260-265.
Li, W., Howard, M. O., Garland, E. L, & Lazar, M. (2017). Mindfulness treatment for substance misuse: A
systematic review and meta-analysis. Journal of Substance Abuse Treatment, 75, 62-96.
U.S. Department of Health and Human Services (HHS), Office of the Surgeon General, Facing Addiction in
America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC: HHS, November
2016.
References
Dr. Christine Chasek LIMHP, LADC Associate Professor
1615 W. 24th Street
Kearney, NE 68845
Thank You!
YourUniversity of Nebraska at Kearney
Behavioral Health Education Center of Nebraska
www.naadac.org/neurocounseling-bridging-recovery-gap
Cost to Watch:
Free
CE Hours
Available:
1 CEs
CE Certificate for
NAADAC
Members:
Free
CE Certificate for
Non-members:
$15
To obtain a CE Certificate for the time you spent watching this
webinar:
1. Watch and listen to this entire webinar.
2. Pass the online CE quiz, which is posted at
www.naadac.org/neurocounseling-bridging-recovery-gap
3. If applicable, submit payment for CE certificate or join
NAADAC.
4. A CE certificate will be emailed to you within 21 days of
submitting the quiz.
CE Certificate
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