Two Minds Blog

You are probably familiar with the idea that depression, anxiety, and other mental health conditions are caused by a " chemical imbalance " or a deficiency of certain neurotransmitters in the brain. This causal explanation became popular in the late 1980s and early 1990s, coinciding with the development of a new set of drugs that treat depression, selective serotonin reuptake inhibitors or SSRIs. The first of these was fluoxetine (aka Prozac or Sarafem: sold by Eli Lilly & Co.). Other drugs in the same class are sertraline (Zoloft: Pfizer), paroxetine (Paxil: GlaxoSmithKline), citalopram (Celexa: Lundbeck), escitalopram (Lexapro: Lundbeck & Forest Labs), and fluvoxamine* (Luvox: Solvay). It became convenient for providers to explain the benefits of antidepressant medication by talking about how they modified brain chemistry: These drugs increase the availability of naturally occurring serotonin neurotransmitter molecules in the brain, by slowing down a process in whic...

Professional burnout has been a major problem over the 3 years of the COVID-19 pandemic, leading to decreased job satisfaction , increased turnover among nurses, decreased quality of care for patients, and a net decrease in the total healthcare workforce due to resignations and retirements. Nursing work in particular is intense, high-stress, and emotionally demanding;  nursing students start to experience these stressors  early in their clinical training. The usual stresses of clinical practice worsened during COVID-19, due to more fear of infection , more risk of secondary trauma from seeing patients suffer or die, more work as clinics are short-staffed, less support as colleagues are distracted by their own challenges, and greater isolation as providers felt their own experiences to be more anomalous. Paradoxically, the public perception of nurses as "heroes" during the pandemic might have made traumatic experiences even harder to talk about when nurses' sense of th...

  This week I'm looking at another concrete tool in the behavior-change armamentarium, social support . I have written previously about the Narrative mind's strong focus on social cues , and indeed perhaps the Narrative system evolved specifically to help us coordinate our behavior with groups of other humans. As a behavior-change strategy, social support can be used in several different ways. Instrumental Social Support . The most basic form of social support is instrumental, the type of help that a neighbor gives in loaning you a tool or that a friend provides in bringing you a meal. This type of concrete support can be helpful for diet change -- e.g., here are some fresh vegetables from my garden -- or exercise -- e.g., you can borrow my tent for your camping trip. Although instrumental support is particularly powerful because someone is actually doing something for you or giving you resources that you don't have, it is also usually short-term (I probably don't want...

I wrote previously about Colorado’s regulatory experiment with legalized psilocybin (also known as magic mushrooms), which began on January 1, 2023 although some implementation details are still being worked out. The state-level legalization of this drug (which is still illegal at the Federal level) has led to some high-profile new research at the University of Colorado. The focus of investigation is "treatment-resistant depression," which simply means depressive symptoms that haven't been effectively resolved with other existing forms of treatment. That's a significant problem because even with the best available algorithms to try multiple antidepressant medications, one after the other, 10% of people never achieve symptom remission. And, importantly, another two-thirds drop out of treatment somewhere along the way. Untreated depression is therefore still a major problem, and many mental health professionals are excited about the possibility of a new treatment th...

I wrote last summer  about artificial intelligence tools that are increasingly able to approximate human speech in free-form conversations. These tools then burst onto the public stage with the release of OpenAI's ChatGPT  at the end of November last year. As you probably know by now, the acronym "GPT" stands for "generative pre-trained transformer," which highlights the three most important aspects of this technology: (1) it generates novel responses that aren't based on an a specific algorithm or decision rule, but instead rely on pattern recognition; (2) it has been pre-trained  by consuming massive amounts of writing from the Internet -- much more than a human could read in several lifetimes; and (3) it transforms  those prior writing samples using a trial-and-error process that predicts the next phrase in a sequence until it has come up with a response that seems intelligible to humans. ChatGPT works much like the auto-complete feature in your email or ...

If motivation is what gets us to change our behavior, it seems that ambivalence might be what keeps us stuck -- the opposite of being motivated. But motivational interviewing practitioners are taught to look for ambivalence and use it as a source of motivation for change. Last time I wrote about how ambivalence can occur within both the Intuitive and the Narrative minds, rather than representing a conflict between them. But more than that, motivational interviewing suggests that the experience of ambivalence is what drives us forward. How can ambivalence be a good thing? The experience of ambivalence is an uncomfortable one for most people. An intention-behavior gap  is the natural consequence of having two separate mental systems, one of which controls our verbal intentions and explanations (the Narrative mind), and the other one of which controls our behavior (the Intuitive mind). If someone were a pathological liar, they might not be concerned about intention-behavior gaps at ...

  Ambivalence -- the experience of feeling two ways about changing your behavior -- is a core aspect of the human experience. This post is the first in a two-part series about what ambivalence is and what it has to do with motivation. In Two Minds Theory we talk about "intention-behavior gaps" that arise between the Narrative mind's statements about the future and the Intuitive mind's selection of behaviors in the present: The gap arises because of a fundamental difference in immediacy between the mental system that controls language and the one that controls actual behavior. And in motivational interviewing , a counselor's fundamental goal is to "explore and resolve ambivalence." Ambivalence is sometimes seen as a problem  to be solved, but it's helpful instead to think about ambivalence as just a part of being human. The less we blame ourselves for feeling ambivalence, the easier it becomes for us to work through it in order to select one course of...