The newsletter of the
International Trauma Training Institute (ITTI)
Mike Dubi, Ed.D., LMHC, Editor
Jeanne Thomas, MBA, Associate Editor
April 2020, Vol. 3, No. 1
I hope you are all well, especially in this tense time of COVID-19. In recognition of the difficulties that some of you may face over the coming months, we are reducing our course fees by $22 through the end of 2020.

In this issue we are fortunate to be able to share a book chapter, with permission, by Barry Mascari and Jane Webber from a book they edited in 2010, Terrorism, Trauma, and Tragedies: A Counselor's Guide to Preparing and Responding. This powerful and important chapter deals with pandemics. The link below is a CNN article dated April 1, 2020, on COVID-19 which features Jane Webber. Click on 

ITTI continues to provide pertinent courses. Coming soon, The Anxious Brain, 13 NBCC CE Hours, created and taught by Dr. Andy Brown, LPC. Andy is a clinician and teacher with many years of experience. This course is in a 6-module format. It will cover foundations of anxiety; what is anxiety and where does it come from; neuroscience of anxiety; bottom-up anxiety; top-down anxiety; how we make bad things really worse; understanding how we speak the language of the amygdala; treatment interventions; bringing it all together; process into practice; and integration into current work. It is a course that will help your practice and beef up your toolbox.

Also, please check out our journal, The Practitioner Scholar and consider writing an article. If interested, contact

Best regards,
Mike Dubi, Ed.D., LMHC
Now may be the time to investigate tel-conferencing systems. There are a number of them out there, some even free. Providing mental health counseling remotely should be on all our minds right now. There are also many volunteer opportunities available.

Mental health professionals have always heeded the call when needed. Now is the time.
Digital Online Training Mentoring Learning Education Browsing Concept
beginning on
May 18, 2020

To see course descriptions and to register, click this link:


Responding to Pandemics:
Preparing Counselors
J. Barry Mascari, Ed.D. and Jane Webber, Ph.D.

The following is an April 2, 2020 update of the book chapter Responding to Pandemics: Preparing Counselors , the original of which appears below:

The devastating impact of the corona virus worldwide has shattered our belief that people will be safe and remain immune from the corona virus in the United States. On September 11th, 2001 people no longer felt safe from terrorism on U.S. soil. The country is sheltering in place in 2020 not from the fear of terrorist attacks; rather, from a deadly invisible enemy, COVID 19, that has rapidly crossed oceans and continents. The corona virus has filled people with fear and dread. Persons unknowingly transmit the virus to other persons, not knowing where its droplets might land but knowing there is no cure or vaccine yet.

When natural disasters strike, counselors are often second responders in their own communities where they experience the same trauma that their clients experience. We–counselors, clients, responders, doctors and nurses–are all at risk. The corona virus has forced counselors to live and work differently as we help others while doing no harm. This includes not spreading the virus.

As disaster mental health counselors and counselor educators, we (Barry and Jane) prepare counselors to respond to persons affected by natural disasters, such as floods, hurricanes, and tornadoes. COVID 19 has drastically different effects. In the fourth edition of our book Disaster Mental Health Counseling: A Guide to Preparing and Responding, we inadvertently omitted the chapter on “Responding to Pandemics: Preparing Counselors.” This omission likely rose from our misbelief that after SARS, we would be spared another public health pandemic, at least for a long time.

In the beginning of the chapter in the third edition, Barry described his conversation as a young boy at the cemetery with his grandmother. He didn’t understand how her two brothers had died, Barry said, “Ma, no one dies of the flu.”

The Spanish Flu that killed her brothers has been the deadliest pandemic, killing about 30% of the world’s population or between 20 and 50 million people. However, as COVID 19 rapidly and invisibly spread around the world, humans are transmitting the virus, often not knowing they have it. It is a disease out of control: thus, the enormous need for public health prevention to contain and reduce infection, as well as counseling support to struggle through it.

When we moved online this month to teach, I (Jane) felt some discussion and sharing about the impact of the pandemic was needed, as well as talking about self care–emotionally, physically, and personally as this crisis spreads exponentially. Ironically and perhaps tragically, I discussed existentialist therapy and its key ideas of death, isolation, freedom, and meaninglessness with my Advanced Theories students as they read Night by Eli Wiesel and Man’s Search for Meaning by Viktor Frankl.

I encouraged them to read The Plague by Albert Camus about a fictional plague in Algeria. The story paralleled the Black Death in the mid-fourteen century that killed an estimated 30% to 60% of Europe’s population. The main character, Rieux, a physician, is asked what decency is. Doctor He responded: ‘In general, I can’t say, but in my case I know that it consists in doing my job .’

Existentially, in a world of chaos, people live with fear and dread. As counselors, we must find ways to maintain and foster our connections and relationships with others, albeit in different ways to help everyone survive. In my own experience, we must provide telehealth support and services especially to first responders–EMTs, doctors, nurses, medical staff, police officers, and the National Guard–who do their job to help victims of COVID- 19.

I trust in our ability and skills as counselors to help others in our communities at this crucial time. Reinvent yourself and advocate for others in new ways, putting your oxygen mask on first before helping others. Count on your ability to listen, to support, to hear what is not said, and to be patient. In his essay, “Return to Tipasa,” Camus concluded, “In the midst of winter, I discovered in me there was an invincible summer.”

Responding to Pandemics: Preparing Counselors
b y J. Barry Mascari and Jane Webber.
(See preceding April 2, 2020 update)

At 8 years old, I was at the cemetery with my maternal grandmother. She was caring for gravestones with the names of her parents and two brothers, both of whom died under the age of 20 in 1918. I asked, “Did they die in the war?” She replied, “No, they died of the flu.” I said, “Ma, no one dies of the flu.” She never spoke of the flu again, and, like many who remember 1918, the horror was once again buried inside. We can only imagine what pain and traumatic memory remained and how, without the benefit of intervention, those memories took a toll on a generation (Mascari, 2009).
Much to our surprise, as of the writing of this chapter, the Swine Flu (H1N1) pandemic is on its second wave, appearing first as rare spring flu and then as a declared pandemic. On June 11, 2009, the World Health Organization (WHO, 2009) declared it the first pandemic in 41 years. It returned in the fall with widespread outbreaks in 48 states and serious outbreaks around the world, raising fears of the possibility that the strain might mutate and become more lethal. Many counseling colleagues—shocked by the WHO’s declaration—sought direction on how to prepare. For traumatologists, and other counselors who will be called upon to respond in times of crisis, knowledge about pandemics and influenza is vital.
Our approach to managing our own anxiety over the Avian Flu in 2006 was to read and learn as much as possible. During a trip to Barcelona, where street vendors on Las Ramblas were selling domestic birds as pets, we watched wild birds land on cages and were struck with the startling reality that a possible jump from bird to human was very real. This led to an even more frightening realization: the world is overdue for a pandemic, defined as when an epidemic spreads rapidly across many geographic locations, countries, or continents. Pandemic is not to be confused with an epidemic, when the observed number of cases exceeds the expected number of cases of a given disease in a defined time period. In brief, a pandemic is an epidemic gone wild, spreading beyond borders.
To respond to the threat of a pandemic, we monitored the worldwide H5N1 flu outbreaks (more commonly referred to as Avian Flu) and SARS. Attendees at the 2007 American Counseling Association Annual Conference and the Argosy University Symposium on Trauma, Tragedy, and Crisis (Webber, Mascari, & Dubi, 2007) reacted to our concerns with a combination of fear and concern but lacked a sense of urgency. The final chapters on H1N1 and H5N1 are yet to unfold.
There have been 10 known pandemics in 300 years, occurring approximately three to four times every 100 years. The Bubonic Plague (the Black Death) of 1348 killed 25% to 50% of the European population in 3 years; the next pandemic was the Spanish Flu of 1918. Infection estimates for the Spanish Flu ranged from 200 million to 1 billion people and number of deaths from 50 million to 100 million (Billings, 2005). The 20- to 40-year-old population suffered the most deaths, instead of elderly and children—who are usually the most at risk. In 2 years and three waves, nearly half the world was infected. Although these two pandemics were separated by centuries, one commonality is that the fields of public health and medicine had limited understanding, and crude forms of disease control were practiced.
Unlike world wars that have celebrated veterans and honored the dead with stories shared by parents and grandparents, pandemics have no such history. Instead, what most people know comes from history books or children’s rhymes (Ashes, ashes, we all fall down ) (see Chapter 31) or the children’s jump rope rhyme (I had a little bird, its name was Enza, I opened the window and in-flu-enza ) (Crawford, 1995). The Plague (Camus, 1947) was a novel about a fictional plague in Algeria, although few people make the connection between Camus’ existential worldview and pandemic.
Modern pandemics include the Asian Flu of 1957 (H2N2 strain) and the Hong Kong Flu of 1968 (H3N2 strain) that led to 1 to 4 million deaths. Recent outbreaks with pandemic potential include HIV/AIDS, SARS, the West Nile Virus, and Avian Flu (H5N1).
Pandemic is Not Seasonal Flu
Most people have experienced a seasonal flu, often minimizing it as a bad cold, despite its ability to kill. Pandemics are different—they infect 15% to 50% of the population, placing all ages at-risk and producing severe illness and a high death rate. The US Department of Health & Human Services (2009) noted:
It is the sheer scope of influenza pandemics, with their potential to rapidly spread and overwhelm societies and cause illnesses and deaths among all age groups, which distinguishes pandemic influenza from other emerging infectious disease threats, and makes pandemic influenza one of the most feared emerging infectious disease threats.
Each seasonal flu vaccine is an educated guess based on the strains that have been identified the previous year. In a pandemic, new strains may emerge or old ones may reappear, with no effective vaccine available for 4 to 6 months after onset. Antiviral drugs such as Tamiflu have been effective, but their impact on a new or reappearing strain is largely unknown. Drugs will likely be in short supply and government stockpiles are limited. Preliminary data from the H1N1 outbreak in fall 2009 indicated shortages in Tamiflu and vaccine–production has not met demand (MSNBC, 2009).
In most pandemic outbreaks, unlike seasonal flu, the healthiest individuals are at greatest risk, ironically, because they have the most robust immune system. Non-seasonal flu is devastating because of the cytokine storm, an extreme immune system overreaction that results in a ferocious assault on the lungs by immune cells. The inflamed lungs can become congested with dead cells and fluids, resulting in serious respiratory distress and suffocation (Ukrainetz, 2009). The H1N1 pandemic of 2009 has produced a more surprising at-risk group: the very young.
Based on historical patterns, experts suggest a pandemic resulting from a new virus subtype within the next decade. This new strain will have little immunity in the current population, most likely because there has been no prior exposure to the new virus. Because this virus can replicate in humans, transmitting efficiently from one human to another, it can cause community-wide outbreaks (WHO, 2009). The current H1N1 pandemic might not become this long-dreaded outbreak because current death rates are much lower than feared. Taubenberger and Morens (2006) cautioned that:
Even with modern antiviral and antibacterial drugs, vaccines, and prevention knowledge, the return of a pandemic virus equivalent in pathogenicity to the virus of 1918 would likely kill [greater than] 100 million people worldwide. A pandemic virus with the (alleged) pathogenic potential of some recent H5N1 outbreaks could cause substantially more deaths (p. 21).
Avian Flu (H5N1) Remains a threat
Avian flu produced sporadic epidemics in migratory birds and poultry in Asia in 1997 and has remained active. Bird-to-human infection has been confirmed in the following countries where people live in close proximity to poultry: Vietnam, Cambodia, Thailand, Indonesia, Russia, Azerbaijan, Egypt, India, Iraq, Laos, Nigeria, and Turkey. It is not known whether human-to-human transmission has occurred.
Although the number of individuals infected with H5N1 is small, nearly half of those infected die from it. (2009) projected that 200 million United States citizens, 15% to 35% of the population, could become infected with 87,000 to 207,000 deaths and 314,400 to 733,800 individuals hospitalized.
Unlike previous pandemics that spread slowly through sea travel, the frequent use of air travel increases the probability of reaching all continents within 3 months. Also, the world’s population has increased, and the majority of people live in densely populated cities. In New Jersey, the most densely populated state in the nation, where nearly half the population lives in one-third of the state (near New York City), there could be 8,000 deaths, with 5,700 occurring in hospitals, and 41,000 hospital admissions. (See Chapter 38).
When the perceived threat is greater than the actual threat in a health crisis, fear and anxiety are common reactions. Storming a vaccination or medication point-of-distribution site or a government building where supplies are believed to be stored can threaten to undermine governmental authority. In general, stress and fear lead to somatic complaints; more healthcare is sought, taxing resources and leading to the perception that the outbreak is worse than it is.
While helping the general public, counselors also will be needed to help people cope with illness, death, mistrust, and scarcity. Counselors may simultaneously serve as caregivers to family members and others outside of the family, leading to role conflict. Working with death may lead to vicarious traumatization when counselors begin to experience the same symptoms as their clients.
Altering the Delivery System for Counselors
In order to ensure the safety of those providing disaster response, new methods of delivering disaster first aid and general social support to victims and survivors will be needed. With possible closings of schools, senior centers, or programs for the disabled and the canceling of social, religious, or cultural gatherings, social support could crumble. People will need help in other ways as social distancing, isolation, quarantine, and travel restrictions occur. These methods must ensure the “perceived” safety of counselors, while at the same time provide access to mental health services because there may be no way of knowing if vaccinated providers are safe. These delivery methods may include telephone counseling, home visits with face-to-face sessions outdoors at a safe distance, Internet sessions, drive-in window counseling using banks or similar facilities, or door-to-door delivery of psychiatric medication.
Lessons Learned from SARS
As we look back to SARS, the first epidemic of the 21st century, we learned that first responders experienced role conflict because they were torn between protecting property and maintaining order and remaining at home with their family, while at the same time experiencing personal loss or illness (LeDuc & Barry, 2004). Unlike with fires and terrorist attacks, healthcare workers were the first responders to respond to the Hong Kong and Toronto SARS outbreaks. Studies of these workers found a higher degree of emotional distress than that of the public, although they were dying at same rate during the outbreak. Mackler, Wilkerson, and Cinti (2007) found that these workers stayed away from home to protect their family, refused work assignments, and avoided patients. Counselors may be faced with similar challenges in a pandemic.
A report by the Central Intelligence Agency (2003) following the SARS epidemic warned that “...understanding and managing the public’s psychological and behavioral reactions to an unexpected outbreak of infectious disease are integral to successful response and containment.” Counselors may be a key factor in how well the nation handles the next pandemic and the challenges unique to a disease.
Ambiguous Loss
A number of human factors will complicate the successful management of a pandemic: 
·        Ambiguous loss, the process of losing a loved one without cultural funeral rituals or the ability to see or care for the dying person
·        A psychological presence with a physical absence , when family members are hospitalized or quarantined, disconnected from relatives, and experiencing profound uncertainty
·        Overwhelmed funeral homes and the potential for mass graves or mass cremation
·        Inability to travel to funerals leading to bereavement without closure
Most of what we know about pandemics is from history. The good news is that unlike the 1600s or 1918, medicine, public health, and our understanding of disease have evolved. Equally significant is the fact that governments, the WHO, the Red Cross, and the Council for the Accreditation of Counseling and Related Educational Programs (2009) (with its infusion of the new disaster standards) suggest that counselors and the public health system in general are better prepared to respond to a pandemic. Still, diseases offer unique challenges that have yet to be tested in a large-scale 21st century pandemic. We now know that in addition to arming themselves with disaster and trauma skills, counselors who anticipate being on the front lines are advised to read more about pandemic and public health procedures to ensure they know what they may be facing.
Billings, M. (2005). The influenza pandemic of 1918 . Retrieved from

Camus, A. (1947). The plague . New York: Random House.

Centers for Disease Control and Prevention. (2009). CDC resources for pandemic flu . Retrieved from

Central Intelligence Agency. (2003). SARS: Lessons learned from the first epidemic of the 21st Century . Washington, DC: Author.

Council for the Accreditation of Counseling & Related Educational Programs. (2009). 2009 Standards . Alexandria, VA: Author.

Crawford, R. (1995). The Spanish Flu. Stranger than fiction: Vignettes of San Diego history . San Diego, CA: San Diego Historical Society. (2009). Flu pandemic morbidity/mortality. Retrieved from

LeDuc, J. W., & Barry, M. A., (2004, November). SARS, the first pandemic of the 21st century. Emerging Infectious Diseases . Retrieved from

Mackler, N., Wilkerson, W., & Cinti, S. (2007). Will first-responders show up for work during a pandemic? Lessons from a smallpox vaccination survey of paramedics. Disaster Management and Response 5 (2), 45–48. (2009). Kids Tamiflu in short supply . Retrieved from

Taubenberger, J., & Morens, D. (2006). 1918 Influenza: The mother of all pandemics. Emerging Infectious Diseases, 12 (1), 15–22.

Ukrainetz, G. (2009). Swine flu and the cytokine storm . Retrieved from
*page not found

U.S. Department of Health & Human Services (2009). HHS pandemic influenza plan. Retrieved from

Webber, J., Mascari, J. B., & Dubi, M. (2007, March). Responding to pandemic flu: What counselors need to know. Presentation at ACA Annual Conference. Detroit, MI.

World Health Organization. (2009). Pandemic 2009 . Retrieved from   
About the Authors
J. Barry Mascari EdD, LPC, LCADC, is chair of the Counselor Education Department at Kean University, Union, New Jersey and holds New Jersey Disaster Response Crisis Counselor certification (NJDRCC).
Jane Webber PhD, LPC, was associate professor and coordinator of the Counseling Program at New Jersey City University at the time of writing. She is currently assistant professor and doctoral program coordinator in the Counseling Education Department at Kean University, Union, New Jersey and holds New Jersey Disaster Response Crisis Counselor certification (NJDRCC).

Amygdala Focused Anxiety:
The Command Unit Within
Dana C. Schaefer, MA, M.Div., Andy Brown, Ed. D.,
& Mallory Hardesty, MA

Each spring the Parks and Recreation department of our town holds a family event called “Touch-A-Truck.” During the event, the town brings out all the specialized vehicles needed to maintain our city and puts them on display for curious kids and parents to touch and see up close. Amidst the ambulances, police cruisers, trash trucks, and fire engines one vehicle stands out: the Mobile Command Unit. It is impressive in stature and capability. The Mobile Command Unit is a custom-built, shiny, gunmetal-colored, 43-foot truck equipped with the latest communications equipment needed to oversee any disaster; it is also outfitted with practical amenities that provide a place for first responders to get a cup of coffee, work collaboratively, dispatch help, and even use the restroom. It is always one of the must-see trucks at the annual event! 

While the Mobile Command Unit is an impressive vehicle, the human brain has an even more impressive command unit within: the amygdala. The amygdala has an important role during an actual crisis or perceived crisis. These small, almond-shaped masses are located deep in the human brain and are part of the limbic system. They receive input from the senses and help keep the body safe by alerting the autonomic nervous system that danger may be present.

The Mobile Command Unit has one main job: to keep communication running during an incident. If communication is successful then the likelihood of successful resolution is much higher. Likewise, the amygdala has one main job: to keep the body in a ready state of defense against trouble (Pittman & Karle, 2015). Another part of the brain, the left cortex, is able to analyze risk associated with presumed danger. The amygdala does not waste any time in analysis, it reacts quickly and decisively, sometimes even pulling rank over higher functioning brain processes to send out an appropriate response to protect the body (Pittman & Karle, 2015).

If the Mobile Command Unit rolls out to a fire, firefighters and Emergency Medical Services (EMS) will be on call to fight and/or contain the fire and treat wounded victims. If a hazardous substance is the reason for the Mobile Command Unit to show up, then hazmat suits are going to be on the scene. Like the first responders who work inside the Mobile Command Unit, the amygdala quickly learns how to best and most appropriately respond to a perceived threat. The amygdala is especially gifted at perceiving a benign stimulus and linking associations which may be related to a perceived threat (Blair et al., 2016). A common springtime example would be the return of the honeybee. A curious child may want to reach out and grasp the bee from a blossom, but the bee responds with a sting to the hand to protect itself. The child quickly learns to associate “bee” with pain. Later, at a local farmer’s market the child sees a picture of a bee on a jar of honey and begins to cry. This shows that the amygdala has successfully encoded an association connecting the stimulus (bee) with pain (sting). Sense-based memories like a bee sting are stored in the lateral nucleus. As the memory is recalled, the child whimpers and steers clear of the honey because the amygdala has sent messages to prevent future endangerment. 

The Mobile Command Unit is equipped with communication technology that allows fire, police, and EMS to work from inside the truck. The equipment each department uses is duplicated inside the truck so that the responders do not have to learn new equipment when managing a situation. They can simply rely on their training and experience to continue their work in this new environment. The amygdala has a similar capability; it operates heavily from associations and experiences. Experiences are embedded deeply into the amygdala, and this control unit overrides rationalization. This makes talk therapy feel useless for amygdala-based trauma. Imagine trying to rationalize with the whimpering child mentioned earlier each time a bee buzzes in her flower garden. In order to get over the fear of the bee, the child needs to be exposed to bees in ways that will not result in pain. The amygdala will require new and positive experiences in order for new links to be made. Past anxiety research has been founded on the idea of Pavlovian fear conditioning. Instead, new research efforts should focus on neuroplasticity which showcases the brain’s amazing ability to retrain the amygdala (Blair et al., 2016).
Treatment Options
Recently, the Mobile Command Unit rolled up to a hotel fire on a main thoroughfare in town. It was impressive to watch as the support teams showed up to resolve the issue. The fire department was obviously there to stop the blazes, EMS formed triage tents in the parking lot to assess injury and the local university sent over two charter buses to transport guests to new accommodations. Once the unit was in place the chaos turned into a cooperative effort to rescue and restore. If the amygdala is the seat of painful memories or associations, it can be treated so that restoration of behavior and emotions is possible.
Exposure Based Cognitive Behavioral Therapy
One way to begin that process is to reduce activity in the amygdala which formerly caused anxiety. Research shows that this can be done quickly—in as little as four sessions using Exposure Based Cognitive Behavioral Therapy (Reinecke et al., 2018). Exposure based therapy uses a gradual exposure model to reintroduce objects or experiences that would induce panic or anxiety. For a client who wants to try this type of therapy it might look like creating a staircase of experiences which gradually becomes more triggering as you ascend. Imagine a client who presents with a fear of snakes. They may report sensing some anxiety if they see a snake on television; this would be a low level response. As they step up the model, they may report encountering a real snake in the garden as a significant experience for them. How can you help? As the therapist, guide them through a progression of low-level experiences while using relaxation, mindfulness, and focused breathing techniques to help the client stay in the moment and face the offending object or experience. As they become more comfortable, progress to more difficult situations. As the progression occurs, the amygdala is forming new associations and changing the scenario for the client.
Eye Movement Desensitization and Reprocessing
Exposure therapy is not the only means of treating the amygdala. Because the amygdala is so deeply embedded in the brain and acts as a command center, another viable treatment has been Eye Movement Desensitization and Reprocessing (EMDR). EMDR has been effective in calming the amygdala and creating new associations in the brain. So how does EMDR work? This treatment asks the client to recall a distressing memory while following a light bar making the eyes move back and forth. Involving the eyes in bilateral movement while simultaneously recalling fearful memories has been shown to reduce general fear for over 24 hours after the session (De Voogd et al., 2018). One explanation for the reason this might happen is that following the light bar during bilateral eye movement requires the amygdala to disengage so that new learning can occur (De Voogd et al., 2018).
While not a first line response to trauma healing, meditation, guided breathing, or progressive muscle relaxation may reduce amygdala activation (Pittman & Karle, 2015). Research indicates that a daily practice of meditation can reduce amygdala arousal in as little as eight weeks (Kral et al., 2018). Just as the Mobile Command Unit called on more than one agency to resolve the hotel fire, anxious clients and therapists may need to combine more than one strategy to treat the amygdala to prevent anxiety from ruling their lives. A combination of an active exposure-based therapy with a soothing meditative practice may help bring anxiety under control and the healing process can continue. 
The amygdala acts as a built-in command center to keep the body prepared to deal with danger. If the amygdala is overactive, anxiety can result. Clients who experience amygdala-based anxiety can be treated through exposure based cognitive therapy, EMDR and meditation (Pittman & Karle, 2015). The brain can effectively be reprogrammed with new ways of handling fear sensations without resorting to panic and anxiety. This is good news for people who want to move forward with healing!

While not all people will get to attend “Touch-a-Truck” and tour this rolling emergency jack-of-all-trades, nearly all people will experience anxiety at some point in their lives. Many of those anxious people will have amygdala-based anxiety. Isn’t it good to know that tucked deep in the gray matter is a little piece of yourself looking out for your safety and dispatching help when you need it most? And if that little mass gets overexcited, isn’t it also good to know that you can be the commanding officer and choose to learn new ways to help it stay focused on its main job—keeping you safe?
Blair, R.J.R., Veroude, K., & Buitelaar, J.K. (2016). Neuro-cognitive system dysfunction and symptom sets: A review of fMRI studies in youth with conduct problems. Neuroscience and Biobehavioral Reviews. 2016 Advance online publication.

De Voogd, L., Kanen, J., Neville, D., Roelofs, K., Fernández, G., & Hermans, E. (2018). Eye-movement intervention enhances extinction via amygdala deactivation. The Journal of Neuroscience: The Official Journal of the Society for Neuroscience, 38 (40), 8694-8706. #

Kral, T. R., Schuyler, B. S., Mumford, J. A., Rosenkranz, M. A., Lutz, A., & Davidson, R.J. (2018). Impact of short- and long-term mindfulness meditation training on amygdala reactivity to emotional stimuli. NeuroImage, 181 , 301-313.

Pittman, C., & Karle, E. (2015). Rewire your anxious brain: How to use the neuroscience of fear to end anxiety, panic & worry . Oakland, CA: New Harbinger Publications, Inc.

Reinecke, A., Thilo, K. V., Croft, A., & Harmer, C. J. (2018). Early effects of exposure-based cognitive behaviour therapy on the neural correlates of anxiety. Translational Psychiatry, 8 , 1-9.
About the Authors

Dana Schaefer, MA, MDiv, is on the faculty at Heritage Bible College where she has the privilege of teaching ministers and laity courses in psychology, counseling and Biblical studies.
Dr. Andy Brown is a professor at The Chicago School of Professional Psychology in the CMHC program. He also teaches and trains through the ITTI and blogs via
Mallorie Hardesty, MA, is a Seattle native and currently works with the Washington State Department of Corrections and is an advocate for trauma-informed care within state and federal prisons.

All courses are NBCC approved
(ACEP# 6674);
CTSW is approved by NASW

May 18 - June 28, 2020*


(For additional certification requirements go to:

*May 18 - July 12, 2020

For additional certification requirements and for recertification requirements
go to: