Dr Dalal Akoury
Dr Akoury practices Integrative Addictive treatment, Integrative Cancer treatment, Age
Management and lifestyle medicine, focusing on customized nutrition and fitness
programs. she is fellowship trained and certified in Integrative Cancer Therapy, Anti-
Aging functional and regenerative medicine, as well as having more than twenty years of
accumulated experience in emergency medicine, pediatrics, and a master’s degree in
public health. Dr Akoury has also served fellowships in pediatric
hematology/oncology and has preformed research in leukemia and the effects of smoking
at Emory in collaboration with the CDC. This lifetime of experience, along with a unique
sensitivity, genuine compassion, and a driving passion to inspire health in everyone has
prepared her to be the doctor she is today helping both women and men resolve symptoms,
including weight gain, sexual dysfunction, declining energy levels, and stress brought on
by menopause and andropause.
2016 Workshop: Can Mindfulness Rewire the Brain
2016 Lecture: From Mindfulness to Metabolomics and Back (The OMICS Dance between Love and Hate)
1) Can Mindfulness Rewire the Brain
Mindfulness involves nonjudgmental attention to present-moment experience. In its therapeutic forms, mindfulness interventions promote increased tolerance of negative affect and improved well-being. Mindfulness training appears to enhance attention monitoring systems in the brain, supported by the anterior cingulate and lateral prefrontal cortices. In emotion regulation, this prefrontal training seems to promote the stable recruitment of a non-conceptual sensory pathway, an alternative to conventional cognitive reappraisal strategies. The transition to non-conceptual awareness involves reducing habitual evaluative processing supported by midline structures of the prefrontal cortex. Instead, attention resources are directed towards a limbic pathway for present-moment sensory awareness, involving the thalamus, insula, and primary sensory regions.
Neuroscience models suggest that addictive behavior occurs when environmental stressors and drug-relevant cues activate a cycle of cognitive, affective, and psychophysiological mechanisms, including dysregulated interactions between bottom-up and top-down neural processes, that compel the user to seek out and use drugs. Mindfulness-based interventions (MBIs) target pathogenic mechanisms of the risk chain linking stress and addiction. MBIs ameliorate addiction by enhancing cognitive regulation of a number of key processes, including: clarifying cognitive appraisal and modulating negative emotions to reduce perseverative cognition and emotional arousal; enhancing metacognitive awareness to regulate drug-use action schema and decrease addiction attention bias; promoting extinction learning to uncouple drug-use triggers from conditioned appetitive responses; reducing cue-reactivity and increasing cognitive control over craving; attenuating physiological stress reactivity through parasympathetic activation; and increasing savoring to restore natural reward processing. Treatment and research implications of our neurocognitive framework are presented. We conclude by offering a temporally sequenced description of neurocognitive processes targeted by MBIs through a hypothetical case study. Our neurocognitive framework has implications for the optimization of addiction treatment with MBIs.
Restructuring reward processing with Mindfulness-Oriented Recovery Enhancement: novel therapeutic mechanisms to remediate hedonic dysregulation in addiction, stress, and pain. Matching angry or frightened expressions was associated with increased regional cerebral blood flow (rCBF) in the left and right amygdala, the brain's primary fear centers. Labeling these same expressions was associated with a diminished rCBF response in the amygdalae. This decrease correlated with a simultaneous increase in rCBF in the right prefrontal cortex, a neocortical region implicated in regulating emotional responses. These results provide evidence for a network in which higher regions attenuate emotional responses at the most fundamental levels in the brain and suggest a neural basis for modulating emotional experience through interpretation and labeling.
Hedonic dysregulation is at the root of an array of maladies, including addiction, stress, and chronic pain, as evidenced by the allostatic shift in the relative salience of natural reward to drug reward observed among persons with severe substance use disorders. To address this crucial problem, novel interventions are needed to restore hedonic regulatory processes gone awry in persons exhibiting addictive behaviors. Mindfulness-Oriented Recovery Enhancement (MORE), is implicated in cognitive control and hedonic regulation. Dysregulated processing of natural rewards may be a central pathogenic process in the etiology and maintenance of prescription opioid misuse and addiction among chronic pain patients. This study examined whether a Mindfulness-Oriented Recovery Enhancement (MORE) intervention could augment natural reward processing through training in savoring as indicated by event-related brain potentials (ERPs. Treatment with MORE was associated with significant increases in LPP response to natural reward stimuli relative to neutral stimuli, which were correlated with enhanced positive affective cue-responses, and reductions in opioid craving from pre- to post-treatment. Findings suggest that cognitive training regimens centered on strengthening attention to natural rewards may remediate reward-processing deficits underpinning addictive behavior.
2) From Mindfulness to Metabolomics and Back (The OMICS Dance between Love and Hate)
The metabolic and genetic changes instigated by the Stress pathways are involved in the pathogenesis of Addiction and subsequently Cancer through a cascade involving Genomics, Transcriptomics, Proteonomic and finally Metabolomics.
Metabolic homeostasis is crucial for human survival. Hence ultimate health depends on proper functioning of the pathways that are involved in sensing and management of homeostasis. These metabolic systems are cohesively coupled and influenced by evolutionarily conserved pathways involving the stress signal pathways, pathogen - sensing and immune responses. The close functional and molecular integration of the stress, immune and metabolic systems are crucial homeostatic mechanism, the dysfunction of which underlies many chronic metabolic diseases, including and not limited to addiction, cancer, type 2 diabetes and atherosclerosis. Sizeable scientific research suggests that stress acts as a fertilizer that fuels addiction and cancer in humans. An emerging growing body of knowledge identifies and details the relationship between the stress signaling pathways and the changes they induce in the biology of metabolic homeostasis and of the immune system. Stress signaling pathways change the makeup of cells in particular immune cells - causing them to become harmful. Genotoxic stress and other adverse environmental conditions elicit a variety of stress-related signals that lead to the altered expression of multiple genes involved in cell-cycle control, programmed cell death, and DNA repair. Chronic stress causes cancer cells to escape from the primary tumor and colonize in distant organs. Many of the genes that promote cancer metastasis get turned on during the immune response by macrophages. Stress signaling from the sympathetic nervous system enhances the recruitment of macrophages into the primary tumor, and increases their expression of immune response genes that inadvertently facilitate the escape of cancer cells into other parts of the body. On the other hand mindfulness meditation practices have been linked to a myriad of positive patient health outcomes: pain relief, improved immune function, and improvements in stress-related responses such as blood pressure and cortisol levels. Patients often report improvements in psychological illnesses like insomnia, anxiety, depression, addiction, and eating disorders, as well. Mindfulness meditation training reduces stress and pro-inflammatory gene expression in older adults. The regulation of HDACs and inflammatory pathways may represent some of the mechanisms underlying the therapeutic potential of mindfulness-based interventions. Our findings set the foundation for future studies to further assess meditation strategies for the treatment of chronic inflammatory conditions. Mindfulness practices are also effective at reducing emotional reactivity and improving communication when used as a therapy to improve interpersonal relationships.