This year's blog posts included a few one-off topics like the idea that orchestra conductors communicate with musicians by way of the Intuitive mind; a post on medieval understandings of psychology that was published on my 50th birthday in a nod to my own "middle ages"; and a look at the role of social connections in forming our identities that was done as a podcast interview by my daughter the high school senior. But there were also some consistent themes across this year's postings on the Two Minds Blog:
Theory Development: the Neuroscience of Stress and Trauma. The blog had more applications of Two Minds Theory than new theoretical developments this year, but many of the neuroscience-oriented posts were centered around stress and trauma. Many public reports this year drew attention to long-term mental health consequences of the COVID-19 pandemic, ranging from increased anxiety among adolescents, to PTSD reactions from stressors experienced in 2020-2022, to a huge increase in burnout among health care workers. My blog this year included an article about how traumatic experiences affect pain among people with opioid use, based on a paper written by one of my BSN honors students. You can also see my 2021 blog post on trauma for a more general look at how stress reactions can affect our future behavior. More generally, I wrote a post about how organizations and leaders might be exacerbating their workers' stress as we struggle to find a "new normal" after the COVID-19 pandemic. I rounded out the year with a post about neuroplasticity, mainly in the context of physical trauma to the brain, but those thoughts apply to re-wiring the brain after mental trauma as well. Look for another related post in the traumatic stress thread soon, reviewing a new paper by one of my PhD students that describes the role of inflammation as a possible link in the trauma-behavior chain. I have some papers in the pipeline with mental health colleagues about various other aspects of trauma and trauma treatment as well.
Application of Two Minds Theory: Exercise. In another thread I wrote about how exercise affects every system in the body, as a true biobehavioral intervention. In the context of the stress reactions described above, we shouldn't neglect the very real and sizeable benefits of exercise for mental health: It's a cheap, low-risk intervention that has "side effects" of improved cardiovascular fitness and muscle strength, in addition to working as well as common medications in alleviating anxiety and depression. I also wrote about a recently published paper in which my colleagues and I looked at predictors of exercise among people with HIV. We found that people who were more stressed-out based on low heart rate variability unfortunately tended to exercise less, even though doing so probably would have helped them to feel better. On the other hand, a measure of "avoidance coping" (which is usually viewed as unhealthy) had a positive correlation with exercise, possibly because exercise itself is a way to avoid stressors. We also learned that a subjective feeling of tiredness was a stronger inhibitor of exercise than how well someone actually slept. Together, these findings unfortunately suggest that exercise may seem hardest when you are feeling down, tired, and stressed -- but that's also when it could help you the most. There’s more to come on this topic in 2023, with a planned blog post about exercise maintenance; our ongoing study of exercise among people with HIV is also sure to produce some new results.
States of Consciousness. An unplanned topic area that first showed up in 2020, I previously labeled this “subjective experiences and phenomena,” but I think the new label is clearer. This topic picked up steam in 2022 partly because of the continued flow of new research on psychedelic drugs. I wrote an article early in the year about these medications as a treatment for trauma and depression. Colorado then approved a ballot measure in November that legalized use (but not sale) of psilocybin in our state, and I wrote a post about the psychological experience of synesthesia. Here's a roundup of recent commentary on psychedelic practice and research from the University of Colorado, if you’re interested in the legal and therapeutic developments. Given the recent change in Colorado's laws, I expect that psychedelics will continue to be a hot area of research in 2023, which carries potentially high risk as well as high reward. I’m not directly involved in any of those studies, but have been learning quite a bit about brain states from their findings and measurement techniques. A much less risky way to use body states to change your mood might be to push a pencil to the back of your lips in order to force a smile; this method similarly shows how purely physical changes can affect our mental experiences of the world. I also wrote a post about the altered state called "flow" that's often seen in creative work; a post about a new study of how clinicians think differently when they are fatigued; a post about some surprising changes that happen in the brain at the moment of death; and as promised I provided an overview of the latest research on mindfulness, which has a reputation for changing consciousness but actually might be as simple as a learned behavioral response. Mindfulness has a reputation for altering consciousness -- generating a sense of centering and control over one's actions -- but it might be as simple as a learned behavioral response that gives the Narrative mind time to engage. Whether mindfulness actually changes brain states is an open question. I'm currently working on a study looking at people's EEG brainwave readings during an imagery-based regenerating images in memory (RIM) intervention, and there are hints that this also changes people's state of consciousness. In 2023 I plan to write more about how various experiences can change conscious awareness, and whether those changes are similar or different from the changes produced by psychoactive drugs.
Technology and Citizenship. This year's biggest contribution to my ongoing thread about technology for behavior change was an admiring look at China’s social credit system. China’s “zero COVID” policy has broken down spectacularly in the past few weeks, which makes my blog seem a bit naïve in retrospect. What happened there is actually true of many behaviorist strategies over the long run: They produce a big initial benefit, but either fade out or collapse entirely over longer time horizons. Perhaps, as the American ideal would suggest, this is simply a feature of the human spirit: that a desire for liberty will always win out over authoritarianism in the long run. There's a solid argument for this in Steven Pinker's book Enlightenment Now, which I reviewed in July. But it also seems to me that maintaining a society requires some form of social contract, that individual liberty cannot always be prioritized over the common good. For a lasting social system that includes both freedom and responsibility, we need individuals to internalize some of the values that are good for society, like respect for others and support for social institutions. Going back as far as Aristotle’s Nichomachean Ethics we’ve known that one of the best ways to develop virtue is to practice it daily. For that reason I still like many of China’s social reinforcement methods to build positive behaviors among its ordinary citizens. A different strategy was the “nudge” approach popularized by the Obama administration, and I wrote an update about recent books in that area as well. Comparing the two approaches side by side suggests a difference of degree rather than in kind, a sometimes thin line between prosocial prompting and social control. China overstepped that line in its COVID policies, and now the government is seeing social upheaval as a result. How psychology can address social problems is an ongoing interest, connected to former APA President George Miller’s famous call to “give psychology away” for the good of society.
Other Behavior-Change Strategies. I promised more content about health behavior change interventions this year, and I think that I delivered. The post about mindfulness crosses over into this category. There were two posts related to an ongoing study looking at how adolescents with type 1 diabetes self-manage their condition: one based on a paper we published about daily survey variables that predict successful blood sugar control, and another about these adolescents’ capacity for “situational awareness,” which is the focus of a soon-to-be-published second study using sensor data (more to come on that paper as soon as it appears in print). And I had a two-part series about the transtheoretical model’s processes of change and levels of change, rounding out a three-blog series about this influential behavior-change model that I began with a stages of change post last year.
Health Decisions. In the area of applying Two Minds Theory, I wrote a piece early this year about health decision making, focused on what happens when patient preferences come into conflict with providers' expert recommendations and the best available evidence. COVID-19 brought this type of situation into sharp relief, for instance in the case of unproven treatments or the example of patients refusing vaccines. With one of my PhD students, I wrote a blog specifically about children's COVID vaccine uptake, which has been much lower than the rate among adults and also involves some special considerations -- e.g., parents feeling more responsible for exposing their children to medical risks than to corresponding disease risks, even though the disease risk might be both more likely and more severe. I'm planning at least one more post next year about heath decision-making and how clinicians can support it more effectively. I also wrote a post about whether artificial intelligence might help us to make better health-care decisions using algorithms, a solution that can overcome some biases but might create unknown new ones. I still think this is an open question, although my title for that blog post ("can A.I. save the universe?") generated more controversy and critique than I anticipated. That leads me directly into the final topic on this list ...
Artificial Intelligence. AI is showing up in more parts of health care, with CU establishing a new center this year to study those applications. I also think this technology raises interesting questions about human decision-making and consciousness. My post about AI was already quite long, so I omitted a fun side story about the philosopher Daniel Dennett. Dennett, as you might remember from some of my previous posts about consciousness and free will, is a philosopher who believes that human consciousness is an illusion. He argues, instead, that we learn language by observing its effects on others, and that our statements about our own internal experiences don't really reflect anything but physical states. This follows directly from B. F. Skinner's view of language as the product of rewards and consequences. LaMDA is in some ways a validation of Skinner's viewpoint, which was developed to prove to the philosopher Alfred North Whitehead that no series of stimuli and reinforcers could ever account for Whitehead's decision to say suddenly that "no black scorpion is falling on this table." Skinner argued in his book Verbal Behavior that this statement could be completely explained by learning and reinforcement histories, but he was hard pressed to defend that view (the linguist Noam Chomsky made his career by demolishing Skinner's argument a few years later). Today, it appears that LaMDA really could learn to say "no black scorpion is falling on this table," as long as it was something that people in general might tend to say when engaged in a philosophical argument with B. F. Skinner. In Dennett's view, there is nothing "that it's like" to be me, and all of these words I write are the automatic product of brain chemistry, stimuli, and consequences. Dennett thinks that he, and everyone else, is a "philosopher's zombie" with no genuine internal experience. Dennett therefore might be expected to agree that LaMDA is in fact conscious, because he defines "consciousness" in such a peculiar, Narrative-mind-only type of way. Dennett is a proponent of the idea that human language is no different from other behaviors that are maintained by their consequences, and that we can go about our lives without any internal representation of the world -- much like a Roomba vacuum that successfully navigates a room without a map. In my view, human experiences like creativity emerge from an interaction between the Narrative and Intuitive minds, and I don't accept Dennett's argument that people are only deceiving themselves about free will, so a computer system with no Intuitive mind cannot truly be conscious. Nevertheless, Dennett an influential voice in consciousness research, and I'm eager to see whether he will go all-in by endorsing the idea that LaMDA is just as conscious as you or me. In yet one more twist of artificial intelligence research, consciousness researcher Eric Schwitzgebel once created a neural-network chatbot using GPT-3, the same basic platform that was the starting point for LaMDA. But instead of training it on human conversations in general, he had it specifically read the collected works of Daniel Dennett. What he got was an AI that did a pretty good imitation of Dennett's philosophy. Dennett himself loved the result, and said that he would happily sign on to some of the Dennett-bot's arguments! In one last version of the Turing Test, you can take a quiz here to see whether you are able to successfully differentiate Dennett's authentic writing from passages on the same topic that were generated by an AI.
Other Directions. What I didn’t have too much of in 2022 was history or profiles of particular thinkers from a Two Minds perspective. There was less specifically about sensor devices, although technology still played an important role in the pieces about AI and the Chinese social credit system. Later this month I’m planning an update on “Smart Health” technologies, which involve a mix of several themes frequently covered by this blog: sensors, AI, and tailored messages.
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