Connections

My favorite aspect of being a grad student, so far, is the daily-growing sense that everything is connected - our courses to each other, our courses to our research interests (and vice versa), our courses to our clinical training (and vice versa), our Friday clinical lunch talks to our courses and clinical training and all the rest of it, and, last but not least, our courses and research interests and clinical training and all the rest of it to our lives. This week's readings made this growing network of connections especially palpable for me - and not just because we had a clinical lunch speaker just this past Friday whose presentation focused on the implementation of a web-based Stimulus Control treatment for insomnia, which complements and applies the principles presented in the Bootzin & Epstein paper perfectly. I also noticed "vertical" connections in addition to the "horizontal" ones - for instance, the connection between the broad relationship we've been studying between environmental context and conditioned behavior (as well as thought and mood), on the one hand, and the particular manifestation of this relationship in domains of life that I'm so intimately well-acquainted with (as are most of us, I imagine) - such as sleep and food, for example.

It was striking and actually somewhat inspiring to me to learn from our speaker last week, Frances Thorndike, that simply improving people's sleep patterns by strengthening the association between their bed (the stimulus) and sleep (the conditioned response), and meanwhile cutting the associations between the bed and other, non-sleep-related responses (such as eating, working, worrying, etc.) actually helps to reduce depressive symptoms in individuals with comorbid depression and insomnia. This not only made certain things "click" into place even more in my brain in connection with our class discussion of behavioral conditioning and environmental contexts last week (and how did this "clicking" in my brain actually occur? Perhaps via interactions between that region in the prefrontal cortex whose name I already forgot - the one we designated with green sharpie - and those automatic circuits coursing through the amygdala and hippocampus and all those other structures which we designated with red sharpie?), but it also reinforced for me certain observations I've made - or half-made, or started to make but lacked the motivation (and self-efficacy, for that matter!) to follow through on - about the automated stimulus-response associations that cause frequent problems and disruptions in my own sleeping and eating patterns (particularly, surprise surprise, when things get stressful!).

But the most important connection, at least the most important for me at this current stage of my connection-making, was the account of the reciprocal "feedback loop" that exists between all these various connected parts: e.g., submitting to cravings in response to high-risk contexts and triggers deals a blow to a recovering addict's self-efficacy (don't I know it, at least as far as my chronic food addiction is concerned!), whereas lack of self-efficacy in turn makes it harder to effectively handle such "lapses" and avoid a relapse into addiction; similarly, stress lights up the brain circuits that propel us to self-medicate with alcohol and other addictive substances (like food!), which then further lead the charge of "remodeling the brain" (what a scary and apt description!) by increasing its dependence on what are essentially "dopamine shots" and ultimately strengthening the circuitry that underlies stress, depression, and, for that matter, insomnia. Everything is connected, I tell you!

Speaking for myself, this realization is itself, in turn, a kind of positive reinforcement, in that it promises that everything I learn, everything I observe and attempt to change in myself, every article or book I read and every report write-up I toil over in Assessment class - all will make a non-trivial impact on my brain and thought and mood and, ultimately, on the quality of my life. So not only am I more motivated (at least for now!) to do all that stuff in light of this realization, but I'm also more motivated to make sure I'm doing it right. And what's more, I've got a clearer guidepost now for determining what's "right" for me: namely, what kinds of behaviors and thoughts and emotions does it condition in me, and are they ones I want conditioned?