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Intuitive Decision-Making by People with Diabetes

People with diabetes often find it challenging to maintain their blood sugar levels, in part because diabetes is a complicated disease. When the kidneys don't produce enough insulin fast enough to adjust for changes in digestion or activity, blood sugar can fluctuate rapidly, even over the course of a single day. To manage this, people with diabetes often need to make changes in multiple areas: adopting a low-carbohydrate diet, managing the timing and amount of exercise they get, keeping track of the times when their blood sugar rises and falls, potentially giving themselves a dose of insulin around mealtimes, managing stress, and other preventive measures as well.  But despite all of this complexity, the people who manage their diabetes most successfully are often the least  obsessive about the fine details. When my Dad was first diagnosed with diabetes, he checked his blood sugar often (using finger sticks; continuous glucose monitoring [CGM] devices weren’t yet a thing). Bu...
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Leventhal's Common-Sense Model and Two Minds Theory

Leventhal, Diefenbach, and Leventhal's (1992) "common sense model" of self-regulation. My 2018 paper describing Two Minds Theory (TMT) cites work by my colleague and coauthor Dr. Paula Meek, who conducted studies of patients experiencing the symptom of breathlessness due to chronic obstructive pulmonary disorder (COPD). Paula's research used a model by Howard and Elaine Leventhal (with Michael Diefenbach) that was an early iteration of the dual-process approach also used in TMT. She found that people who focused their attention on different aspects of the feeling of breathlessness then in turn had different interpretations of what that symptom meant for them, and that those interpretations changed their perception of the symptom's intensity. This example illustrates a back-and-forth between perceptions and thoughts, which is characteristic of Leventhal's model. Leventhal's dual-process model, sometimes called the "common sense model" of self-reg...

What Happens in the Brain During Psychotherapy?

This week I'm pleased to announce the first publication from a study that I've been working on for several years, with my colleague Dr. Deb Sandella from the RIM Institute in Denver. The paper itself is worth a look, even though I'm going to summarize it below. It has some of the coolest figures I have ever published, from brainwave data that we collected during the study! In this study we recruited nursing students who wanted to talk about difficult experiences -- it could be any kind of stressor past or present, although a high percentage of our participants did have past trauma of some kind. Many also talked about family or relationship issues, and the challenges of the nursing role that they were learning. We met in my office, where Dr. Deb used her Regenerating Images in Memory approach to help the students generate images and access difficult memories, and then to re-integrate these into their sense of self (the method is described in more detail in our paper, and ...

Surviving the Apocalypse

This blog has been a little scary recently: Since January I have written about political  disinformation , combatting vaccine misinformation , managing overwhelming stress, the harmful effects of social media , and the risk of a worldwide AI takeover . That's a lot! For a bit of relief, I recently finished Dr. Athena Aktipis's book A Field Guide to the Apocalypse: A Mostly Serious Guide to Surviving Our Wild Times . Aktipis argues that  although there are many potentially civilization-ending threats in our world today, there is also good reason to believe that humans will survive them. Her fundamental argument is that people have faced civilization-ending threats many times before, and the ones who survived those events were those who had the evolutionarily favored traits that enabled them to get through them! Apocalypticism (a sense that the world as people know it is coming to an end) was prevalent 2000 years ago in the near east, but also earlier in Mesopotamian civilizati...

Reducing the Impact of Stressful Times

  American's stress levels have increased significantly since 2017, as shown in the Gallup poll graph above. The American Psychological Association's " Stress in America " survey showed a jump in stress levels during the COVID-19 pandemic in 2020 that never completely resolved, followed by another jump in 2024 that people mainly attributed to the U.S. political environment. The latest APA survey, conducted in October 2024, showed that 77% of U.S. adults  were feeling significant levels of stress in their lives, similar to the number at the height of the pandemic in 2020 -- and that was before the election results were known. The fall 2025 APA report is likely to be very interesting. In my sector of the economy, higher education, people are finding their lives substantially  more stressful in 2025 than they were in 2024, for all kinds of reasons . Given the well-known negative effects of stress on concentration, anxiety, depression, and physical health, how can we kee...

The Four Types of Artificial Intelligence: Opportunities and Risks

  Artificial intelligence is now so ubiquitous that it can be hard to remember its public debut (with ChatGPT) occurred on November 30, 2022. In a little over 2 years, we have all gotten used to AI systems that can understand natural language requests, read our intentions, and produce lengthy and reasonably accurate creative responses in the form of text, images, and video. Most articles about AI in 2025 are about how to use these tools more effectively, or about the next upgrades that are coming, rather than about the amazing fact that we have these tools at all. Here's a look at how quickly AI tools have reached human-level capabilities, and in some cases exceeded them: If you are at least a little bit worried about this, you aren't alone. The American public is much less enthusiastic about AI's benefits, and has much greater concern about its risks, than the technology experts who are developing AI. Right now, a great deal of that worry is about job loss. Looking farth...

Vaccine Beliefs and the Dunning-Kruger Effect

  By now you have probably heard of the Dunning-Kruger Effect : A reliable finding across multiple domains of expertise, showing that experts on a topic know the limits of their own knowledge, but people who know only a little about it are unaware of their own limitations. This can also be stated in terms of a gap between one's competence  in a topic area and one's confidence  about it, with over-confidence being a typical characteristic of less-competent individuals. There is a slight tendency on the high end, as well, for experts to be overly  pessimistic about their own performance, with their results on average tending to be slightly better than they give themselves credit for. The logical conclusion from this extensive body of knowledge is that one should probably evaluate people's expertise, rather than how confident they seem, in deciding whether to take them seriously or not. The Dunning-Kruger effect is not enormous, by the way, even though it is statistical...