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Dr. George Koob is an internationally recognized expert on alcohol, stress, and the neurobiology of alcohol and drug addiction. He is the Director of the National Institute on Alcohol Abuse and Alcoholism, where he provides leadership in the national effort to reduce the public health burden associated with alcohol misuse. As NIAAA Director, Dr. Koob oversees a broad portfolio of alcohol research ranging from basic science to epidemiology, diagnostics, prevention, and treatment. Dr. Koob earned his doctorate in Behavioral Physiology from Johns Hopkins University in 1972. Prior to taking the helm at NIAAA, he served as Professor and Chair of the Scripps' Committee on the Neurobiology of Addictive Disorders and Director of the Alcohol Research Center at the Scripps Research Institute. Dr. Koob is the recipient of many prestigious honors and awards for his research, mentorship, and international scientific collaboration. Dr. Koob has authored more than 650 peer-reviewed scientific papers and is a co-author of The Neurobiology of Addiction, a comprehensive textbook reviewing the most critical neurobiology of addiction research conducted over the past 50 years.

Neurobiology of Addiction refers to the of changes in the brain circuits of an individual after repeated use. In the most severe cases, there are changes in the reward system, decision making, and self-control become impaired. The specific changes in the brain will depend upon what addictive substance is used: alcohol, opioids, cocaine. These agents induce an increase in dopamine in the part of the brain called the basil ganglia which in turn produces an intense feeling of pleasure. The other part of the brain referred to as the prefrontal cortex becomes impaired after repeated substance use, which makes stopping more difficult. After repeated use, tolerance develops, and the brain needs more of the substance to create that experience of pleasure. This can make life without the substance feel less enjoyable. When a person experiences the pain of withdrawal symptoms, they will seek to use substances in order to reduce those distressing feelings associated with withdrawal.

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Dr. John Krystal is the Robert L. McNeil, Jr. Professor of Translational Research, Psychiatry and Neuroscience at Yale School of Medicine, the Chair in the Department of Psychiatry at Yale-New Haven Hospital and the Director of the Clinical Neuroscience Division at the Department of Veterans Affairs' National Center for PTSD. He is a leading expert in the areas of alcoholism, schizophrenia, depression and the Neurobiology of Post-Traumatic Stress Disorder which is the topic we will discuss today. Dr. Krystal's work is interdisciplinary and links psychopharmacology, neuroimaging, molecular genetics, and computational neuroscience to study the neurobiology and treatment of these disorders. He is best known for leading the discovery of the rapid antidepressant effects of ketamine in depressed patients.

Neurobiology of PTSD refers to changes in their brain and body that develop, as a protective response, after a frightening or dangerous event. Other symptoms include intrusive or negative thoughts, avoidance behaviors, becoming easily startled or irritable, feeling like one's surroundings or oneself is unreal, and problems with sleep. Most people who experience a trauma naturally recover. Those who experience prolonged psychological and physiological symptoms may require treatment.

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Dr. Judith McCoyd is an Associate Professor at Rutgers School of Social Work and co-author of Grief and Loss Across the Lifespan, a book that seeks to educate mental health clinicians about how to address the needs of someone experiencing grief and loss. She is also a co-author of Social Work in Health Settings, a comprehensive and insightful casebook of social work practice in health care.

In this podcast, Dr. McCoyd returns to specifically discuss grief and loss within the context of the COVID-19 pandemic. Many individuals are grieving the loss of loved ones and lifestyle due to COVID-19 and the personal and economic changes it has instigated. Dr. McCoyd discusses the theory of Disenfranchised Grief as a framework for understanding many of the losses experienced during this time. She provides suggestions for how we can process grief and loss during these uncertain times, as well as during more typical times of grieving.

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Kelly Smyth-Dent, LCSW, along with Dr. Ignacio Nacho Jarero, created the Acute Stress Syndrome Stabilization Procedure and the ASSYST-Remote for Telebehavioral Health. Having access to remote therapy during the Covid-19 pandemic is important, especially during this time of social distancing when therapists are looking for creative ways to help their clients.

Kelly is the CEO of Scaling Up a company dedicated to inform the masses about the benefits of EMDR therapy and AIP-informed procedures and to make EMDR-based individual and group intervention trainings and services more accessible and affordable to therapists, clients and organizations. Through these networks, training opportunities and services, we aspire to global healing through rapidly scalable and effective mental health interventions. ASSYST-R is a mental health procedure that can be performed remotely.

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Deb Dana is a Licensed Clinical Social Worker and a leading expert in the field of using polyvagal theory in therapy. Ms. Dana is a consultant for the Traumatic Stress Research Consortium in the Kinsey Institute which is focused on using the lens of Polyvagal Theory to understand and resolve the impact of trauma. She is the author of the book The Polyvagal Theory in Therapy, co-edited with Stephen Porges Clinical Applications of The Polyvagal Theory, and I encourage everyone to read her new book Polyvagal Exercises for Safety and Connection which will be released in April 2020 and can be pre-ordered on Amazon.com.

Polyvagal Theory, developed by Dr. Stephen Porges and translated into a therapy framework by Deb Dana, LCSW, identifies a biological order of human response that is active in all human experience. We come into the world wired to connect and with our first breath we embark on a quest to feel safe in our bodies, in our environments, and in our relationships with others. The autonomic nervous system, working below awareness and far away from our conscious control, is our personal surveillance system, always on guard, asking the question "Is this safe?" Its goal is to protect us by sensing safety and risk, listening moment by moment to what is happening in and around our bodies and in the connections we have to others.

Dr. Porges, understanding that this is not awareness that comes with perception, coined the term neuroception to describe the way our autonomic nervous system scans for cues of safety, danger, and life-threat without involving the thinking parts of our brain. Because we humans are meaning-making beings, what begins as the wordless experiencing of neuroception drives the creation of a story that shapes our daily living.

The autonomic nervous system is made up of two main branches, the sympathetic and the parasympathetic, and responds to signals and sensations via three pathways, each with a characteristic pattern of response. Through each of these pathways, we react "in service of survival." The sympathetic branch is found in the middle part of the spinal cord and represents the pathway that prepares us for action. It responds to cues of danger and triggers the release of adrenaline, which fuels the fight-or-flight response. In the parasympathetic branch, the remaining two pathways are found in a nerve called the vagus. Vagus, meaning "wanderer," is aptly named. From the brain stem at the base of the skull, the vagus travels in two directions: downward through the lungs, heart, diaphragm, and stomach and upward to connect with nerves in the neck, throat, eyes, and ears.

Dr. Porges identified a hierarchy of response built into our autonomic nervous system and anchored in the evolutionary development of our species. The origin of the dorsal vagal pathway of the parasympathetic branch and its immobilization response lies with our ancient vertebrate ancestors and is the oldest pathway. The sympathetic branch and its pattern of mobilization was next to develop. The most recent addition, the ventral vagal pathway of the parasympathetic branch brings patterns of social engagement that are unique to mammals.

When we are firmly grounded in our ventral vagal pathway, we feel safe and connected, calm and social. A sense (neuroception) of danger can trigger us out of this state and backwards on the evolutionary timeline into the sympathetic branch. Here we are mobilized to respond and take action. Taking action can help us return to the safe and social state. It is when we feel as though we are trapped and can't escape the danger that the dorsal vagal pathway pulls us all the way back to our evolutionary beginnings. In this state we are immobilized. We shut down to survive. From here, it is a long way back to feeling safe and social and a painful path to follow.

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Dr. Michael LaSala is the Director of the DSW program and an Associate Professor at the School of Social Work at Rutgers University. His research and clinical interests are the couple and family relationships of gay men and lesbians. Dr. LaSala has published extensively in peer-reviewed professional journals, and his current work examines the role of gay and lesbian family relationships in coping with stigma, ethical practice with LGBTQ populations, as well as the parental influence on gay youth's safe sex behaviors. He is the author of Coming out, coming home: Helping families adjust to a gay or lesbian child which describes the findings and practice implications of a National Institute of Mental Health-funded qualitative study of 65 gay and lesbian youth and their families. Dr. LaSala has been practicing social work for over 30 years at the direct practice, supervisory, and administrative levels and continues to practice part-time as a licensed clinical social worker at the Institute for Personal Growth in Highland Park, New Jersey

Therapy for Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ) focuses on mental health issues related to an individual's sexual or gender identity and treats mental distress caused by the oppression, marginalization, and discrimination that may occur when coming out to family members, adjusting to a person's authentic identity, and dealing with family pressures and expectations. According to the research, youth who identify as LGBTQ have an increased risk of self-harm and suicidal ideation, especially when they are faced with discrimination. In school, students who identify as LGBTQ are bullied, victimized, and rejected by their peers, which can lead to mental distress. LGBTQ adults may also experience similar persecution at their workplace, schools, and housing. These stressors may be the catalyst for LGBTQ individuals to seek mental health treatment, and an LGBTQ informed therapist can help reduce symptoms of depression, anxiety, and substance use in their clients (Almeida, et al., 2009; Yarbrough, 2018). Family Therapy for those who are Gay, Lesbian and Transgender targets the relationships between the individual and their family members. We have repeated findings that strongly suggest that supportive relationships between LGBTQ+ and their family members can be protective, reducing their risk for suicide, anxiety, depression, substance abuse, and risky sexual behaviors. Family therapy can thus help the family harness this protective power. When a child comes out to a parent, the child is looking for support and acceptance while the parents is possibly experiencing shock, guilt, sadness and worry. Family therapy techniques targeting this population involve education, enactments, or getting family members to talk to each other in productive, non-reactive ways, and reframing difficult conversations (LaSala, 2010; Nealy, 2017; Stone Fish, 2007).

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Dr. Arnold Pallay received his medical degree from Boston University School of Medicine and has been in private and academic practice for more than 30 years. He practices family medicine and genetics in Montville, New Jersey and is affiliated with multiple hospitals in the Northeast. Dr. Pallay is the Founder and currently is Associate Medical Director of the Genomics Program at Atlantic Health System, has advanced training in genetics and genomics and is a frequent lecturer locally and nationally to both physicians and the lay public. Dr. Pallay is an appointed member of the Commission on Education of the American Academy of Family Physicians and is a teaching clinical faculty member at a number of New Jersey, New York and Pennsylvania medical schools including Rutgers, Seton Hall, Thomas Jefferson and Tauro Medical Schools. His practice participates in genetic research, including serving in a 13-site national genetics consortium studying children with genetic disorders that was sponsored by the American Academy of Pediatrics. He has been involved in research protocols to determine if precise genetics testing can alter the care received by medical and mental health patients by choosing to use or avoid certain medications in larger population cohorts.

The vast majority of Pharmacogenetic Testing is performed and implemented with antidepressants. Many individuals who are prescribed antidepressants do not respond to their first choice of medication, and this may lead to impediments to recover. It is often the case that a trial-and-error process takes place before a person responds to psychiatric medications. This can be problematic because of the time that elapses before recovery, as well as exposing a person to potential adverse side effects from psychiatric medications that have no benefit to them. Some patients do not respond to treatment, and genetic researchers believe that there may be a genetic reason for their non-response. Often if an antidepressant is tolerated and improves symptoms for a family member, it will have a higher chance of success on a patient. Since each person has a unique way that they metabolize psychotropic drugs, exploring a pharmacogenetic approach to narrowing down which antidepressant is the better choice to begin treatment.

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Dr. Helen Blair Simpson is a Professor of Psychiatry at Columbia University Medical Center and Director of the Center for Obsessive-Compulsive and Related Disorders. Dr. Simpson is also the Director of the Anxiety Disorders Clinic at the New York State Psychiatric Institute. Her research program focuses on how to improve treatments for people with obsessive-compulsive disorder so that they can live productive lives. Dr. Simpson's research is interdisciplinary and includes treatment development studies, clinical trials examining the effects of medication and cognitive-behavioral therapy, brain imaging studies exploring the brain mechanisms of Obsessive-Compulsive Disorder, and animal studies in collaboration with basic scientists. Her work has been funded by the National Institute of Mental Health, and private foundations like the Obsessive-Compulsive Foundation and the Brain and Behavior Research Foundation. Dr. Simpson was a member of the workgroup that developed the first Practice Guidelines for the Treatment of Patients with Obsessive-Compulsive Disorder for the American Psychiatric Association. She is an advisor to the World Health Organization for Obsessive-Compulsive Disorder and related disorders.

Obsessive-Compulsive Disorders (OCD) are persistent intrusive obsessive thoughts accompanied by repetitive behaviors and involves persistent and intrusive thoughts about any number of topics accompanied by repetitive behaviors often performed to alleviate anxiety. A person suffering with OCD can have recurrent unwanted thoughts that are very difficult to ignore or at times feel compelled to perform a compulsion (repeated behaviors like checking, washing, and ordering) which are experienced as distressing and affect functioning. These behaviors are time consuming and interfere with daily functioning. Some people suffering with obsessive-compulsive disorders have a suspicion that their obsessions are untrue, and others believe their obsessions have a chance of being true. However, even if they believe their obsessions may be untrue, someone with obsessive compulsive disorder still finds it difficult to stop their obsessions and compulsions.

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Dr. Jesse Wright is the Kolb Endowed Chair of Outpatient Psychiatry and Director of the Depression Center at the University of Louisville, the Founding President of the Academy of Cognitive Therapy and the President of the Kentucky Psychiatric Association. He is a Fellow of the American College of Psychiatrists and his research interests include the development and testing of computer-aided psychotherapy programs and the interaction between pharmacotherapy and psychotherapy. Dr. Wright created a popular software application that is used to help people learn cognitive-behavior therapy skills to reduce symptoms of depression and anxiety and his book, Learning Cognitive-Behavior Therapy: An Illustrated Guide, which includes a DVD with video demonstrations of key treatment methods, is being used in training programs throughout the world. Dr. Wright's book, Cognitive-Behavior Therapy for Severe Mental Illness, presents advanced strategies for treating challenging conditions. This volume was chosen as the "Mental Health Book of the Year" for 2009 by the British Medical Association. I highly recommend Dr. Wright's first book written for the general public, Getting Your Life Back: The Complete Guide to Recovery from Depression, which was chosen by Self Magazine as one of the eight best self-help books. His most recent book, also written for the public, is titled Breaking Free from Depression: Pathways to Wellness and has also received rave reviews.

Twitter @Jesswrightmd

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Dr. Tayyab Rashid is a licensed clinical psychologist at the Health & Wellness Centre, University of Toronto Scarborough. For more than 15 years, Dr. Rashid has worked with individuals experiencing complex mental health issues including severe depression, debilitating anxiety, borderline personality disorder, and suicidal behavior. Dr. Rashid has also worked with individuals experiencing with severe trauma, including 9/11 families, survivors of Asian Tsunami of 2004 and Syrian refugee families. Dr. Rashid has recently won Outstanding Practitioner Award from the International Positive Psychology Association and Chancellor Award from the University of Toronto. Dr. Rashid's work has been published in academic journals, included in textbooks of psychiatry and psychotherapy and has also been featured in the Wall Street Journal, Maclean's magazine, Canadian Broadcasting Cooperation and at TEDx. His book Positive Psychotherapy along with Martin Seligman, is considered the most comprehensive in the field and has been translated in five languages since its publication in late 2018.

Positive Psychotherapy (PPT) encourages individuals to fully recognize what is good inside of them and use those strengths to become resilient in order to meet the challenges that come with mental distress. A PPT therapist does not view clients as broken. Rather uses a type of positive inception within the therapeutic interaction using optimism with the hope of building a foundation for a supportive and co-creative relationship. The human brain is hard-wired to react more strongly to negatives than to positives, and this can make some suffering with a mental illness less functional. A better therapeutic approach is to emphasize strengths and work toward reducing symptoms. It is important to note that PPT does not deny negative emotions nor encourage clients to see the world through rose-colored glasses. A PPT therapist does not offer empty platitudes, such as pointing out the positive opportunities that trauma, loss, or adversity may present for a person's development and growth. PPT can help clients learn how to encounter negative experiences with a more positive mindset and reframe and label those experiences in ways that are helpful. As the quality of the client-practitioner relationship has always been a strong predictor of therapeutic outcomes, it stands to reason that the relationship should be a goal in and of itself. PPT strives to allow clients to experience a sense of wellbeing during sessions and throughout the client practitioner engagement, while the attitude of non-attachment and realistic expectation are practiced and instilled. PPT builds on strengths and positive emotions and equips clients to find meaning in their lives in the effort to undo psychopathology and promote wellbeing.

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Disclaimer: The information shared in this podcast is not a substitute for getting help from a mental health professional.