Carrie Jacobs, Psy.D, CCS

10/04/2024

https://apple.news/ABZ3YXe-XTKaFvu7pfWaHiQ

We finally have enough data to get a grip on the potential health consequences of this increasingly popular addiction, says Graham Lawton

09/10/2024

Hitting Snooze: A Wake-Up Call to Recognize Sleep’s Vital Role in Therapy
By Jeff Kashou, LMFT

One-third of a person’s life is meant for sleep. Are we, as mental health providers, treating this with the respect it deserves in our practice with clients? It is well-established that sleep is essential for maintaining good physical and mental health. It plays a vital role in ensuring that our body and mind function optimally and is required for the repair and restoration of the body’s systems. Since sleep also has a significant impact on our mental health and well-being, it can affect our relationships with others.

Insomnia impacts nearly 25 percent of the population (Koffel et al., 2018), yet sleep is rarely assessed or targeted as part of therapy, which can lead to inadequate treatment of mental health conditions. Treating disordered sleep makes it easier to address other psychological issues, including depression and anxiety (Harvey et al., 2011). This article explores how sleep affects mental health, well-being, and relationships; how quality sleep can increase the ability to engage socially or in fulfilling activities; and how digital treatments can complement therapy and improve sleep for clients.

The Impact of Sleep on Mental Health and Well-being�Sleep’s far-reaching impact on mental health and well-being resonates across multiple dimensions of cognitive and emotional functioning. The consequences of poor sleep extend well beyond daytime fatigue and drowsiness. Research has shown that poor sleep quality and quantity are associated with a range of mental health problems, including depression, anxiety, and bipolar disorder (Harvey et al., 2015; Lam et al., 2015). Sleep quality has emerged as a critical determinant of cognitive function, influencing concentration, memory consolidation, and problem-solving abilities. The debilitating effects of sleep deprivation on cognitive processes underscore the pivotal role sleep plays in mental acuity. Furthermore, sleep disruption can interfere with the nuanced balance of neurotransmitters and hormones that regulate mood, amplifying the risk of depression and anxiety (Walker, 2017). By impairing mood regulation mechanisms, inadequate sleep lays the foundation for heightened vulnerability to emotional distress and difficulty in managing mental health conditions effectively.

The intricate interplay between sleep and mental health extends to our therapeutic endeavors. Successful therapy is predicated on the synergy between various psychological processes, including motivation, mental flexibility, and the ability to process new information and experiences. An unrested mind grappling with the consequences of sleep deprivation faces a compounding challenge in cultivating these essential aspects. The client's motivation for engagement may wane, and mental flexibility may be hindered, limiting their capacity to explore new perspectives or approaches within therapy. Additionally, the fundamental alliance the client shares with the therapist, which is vital for effective therapy, may be compromised as the cognitive resources required for attentive listening and genuine engagement become depleted.

In essence, recognizing sleep’s integral role in cognitive and emotional functioning should serve as a call for more holistic therapeutic approaches. By integrating sleep assessment and interventions into therapeutic practice, mental health professionals can optimize the conditions for successful therapy. As we strive to improve the lives of those who seek support from us, it becomes increasingly important to acknowledge sleep as a biological necessity and a cornerstone of mental well-being.

The Impact of Sleep on Relationships�Marriage and family therapists are experts in treating issues associated with relationships. Amidst the various elements that influence relationships, sleep quality emerges as a subtle yet significant force. The ramifications of sleep deprivation are tangible. Lack of sleep or poor-quality sleep can lead to irritability, mood fluctuations, and reduced desire for social interaction. These consequences become challenging when an individual strives to engage with others or inadvertently becomes embroiled in conflict with loved ones. It is within this context that therapists must embrace a holistic approach to relationship dynamics.

Therapists understand that the absence of conflict is not what makes a relationship strong; rather, strong relationships support healthy, positive expression of disagreement and frustration when seeking conflict resolution. Supporting clients in assessing and addressing sleep issues may enhance their ability to develop and access inner resources that lead to better conflict management and more satisfying relationships.

Studies have highlighted the intricate link between relationship dynamics and s*xual satisfaction. Litzinger and Gordon (2005) emphasized the role of s*xual satisfaction in overall marital contentment, recognizing its impact on emotional connection and partnership health. However, the influence of sleep quality on s*xual satisfaction has often been overlooked. Extensive research, including the work of Meltzer and Hiruma (2016), has revealed that poor sleep can disrupt s*xual well-being. In men, it can lead to reduced libido and erectile dysfunction, while women may experience decreased s*xual satisfaction. The mechanism underlying this connection is complex. Sleep disturbances contribute to chronic fatigue and heightened stress hormone levels, which affect the hormonal balance governing s*xual desire and response. Moreover, the emotional toll of poor sleep, including mood swings, can contribute to diminished emotional intimacy and lowered libido.

By recognizing these intricate connections and integrating discussions about sleep quality into their practice, therapists have an opportunity to offer comprehensive support. They can assist couples in identifying and addressing factors that impact their s*xual satisfaction, thereby fostering a more holistic approach to relationship wellness.

Barriers to Treatment for Sleep Problems�Despite its importance for mental health and well-being, sleep is often not assessed or targeted as part of therapy. This may be due to a lack of knowledge about or training in sleep assessment and treatment. Additionally, clients may not seek help for sleep problems due to a limited understanding of them, lack of access to care, or financial or logistical barriers.

Several obstacles impede the successful management of sleep-related issues, limiting individuals’ access to proper care and hindering treatment outcomes. One significant barrier is that sleep disorders are often underdiagnosed or misdiagnosed. Many sleep issues, such as insomnia and sleep apnea, go undiagnosed or are brushed off as normal or transient. This may be attributed to healthcare providers’ lack of awareness about the diverse range of sleep disorders and their etiologies, symptoms, and potential impacts on overall health (Smith & Sullivan, 2005).

Another significant barrier is the limited availability and accessibility of healthcare professionals. Many regions, especially in rural areas, have limited access to these resources, leading to delayed or suboptimal care for individuals with sleep disorders. The shortage of healthcare professionals trained in sleep medicine further compounds this issue, resulting in long wait times for appointments and reduced availability of evidence-based treatments (Chervin et al., 2003). A 2016 study estimated that there were only 659 behavioral sleep medicine providers in the United States, with 19 percent of them living in California or New York (Thomas et al., 2016).

Furthermore, socioeconomic disparities play a role in access to effective sleep disorder treatment. Individuals from lower socioeconomic backgrounds face financial constraints that may prevent them from seeking appropriate medical care. The costs of diagnostic tests, treatments, and medication for sleep disorders can be substantial, and insurance coverage may not always address these expenses adequately. As a result, individuals with limited financial resources may forgo or delay treatment, exacerbating the sleep disorder’s impact on their overall health (Grandner et al., 2012).

A variety of factors can contribute to therapists not addressing sleep quality during initial assessments. A primary challenge arises from the limited duration of early therapy sessions, which often focus on immediate concerns and rapport-building. Therapists may prioritize discussions related to the presenting issues that prompted the client to seek therapy (Swift & Callahan, 2009). As a result, the topic of sleep quality, crucial for overall well-being, may take a back seat.

Additionally, limited training or discomfort with exploring how sleep affects clients’ presenting concerns can deter therapists from delving into this area. Furthermore, therapists may assume they hold some medical responsibility, leading them to believe that sleep-related concerns should be addressed by medical professionals rather than within the therapeutic context. While this perspective is understandable, it underestimates the integral role that sleep plays in mental health. By ignoring sleep-related matters, therapists can miss an opportunity to provide comprehensive care, especially considering the growing body of research highlighting the bidirectional relationship between sleep and psychological well-being (Baglioni et al., 2016). Therefore, enhancing therapist knowledge and comfort level around sleep assessment and discussion is vital to overcoming these barriers and offering more holistic therapeutic support.

Digital Therapy Solutions Address Barriers to Assessment & Care�In recent years, the field of therapy has experienced a noticeable shift with the emergence of evidence-based digital therapy solutions. These platforms have transformed how mental health concerns, including sleep-related issues, are approached and treated. The integration of technology into therapeutic practices has opened new possibilities for overcoming traditional obstacles and providing accessible, adaptable, and effective care. This transformation is particularly evident in the realm of sleep assessment and treatment, where digital solutions are gaining recognition as a promising frontier.

Digital therapy solutions have the potential to address long-standing barriers to assessment and treatment of sleep-related problems. By building on the foundation of traditional therapeutic approaches, these platforms use technology to create a seamless and dynamic therapeutic experience. Therapists and clients can tap into a range of digital resources that enhance the comprehension, monitoring, and management of sleep-related concerns, including evidence-based interventions such as cognitive behavioral therapy for insomnia (CBT-I).

One of the most noteworthy aspects of digital therapy solutions is that they can be used to provide care remotely, eliminating geographical limitations and reducing the necessity for in-person appointments. This accessibility is particularly significant for sleep assessment and treatment, as clients may face difficulties accessing specialized care due to the limited availability of sleep clinics and therapists with expertise in sleep medicine. As we delve deeper into the potential of evidence-based digital therapy solutions to address sleep issues, it becomes evident that these platforms can reshape the landscape of mental healthcare by offering a dynamic and promising approach to improving sleep and overall well-being.

Within this evolving landscape, digital therapy solutions encompass diverse approaches. Some incorporate wearable devices that provide instant insights into sleep patterns by offering real-time data. This empowers individuals to monitor their sleep and make decisions about their daily routines. Other solutions take an asynchronous format that allows clients the flexibility to engage with therapeutic content at their own pace and on their own schedule. This adaptable approach reinforces the significance of addressing sleep-related concerns while acknowledging the diverse demands of individuals’ lives. These solutions range from interactive modules that teach sleep hygiene practices to relaxation exercises that help mitigate sleep-related anxiety. By making resources available beyond the confines of scheduled therapy sessions, digital platforms ensure that clients have ongoing support for tending to their sleep health.

Regardless of the specific format, these solutions are designed to complement the work of therapists and serve as resources clients can use between sessions. Collectively, they aim to enhance the quality of sleep assessment and treatment by providing accessible, evidence-based tools that empower individuals to take charge of their sleep habits and contribute to improved overall well-being.

The Importance of Sleep for Therapists�As clinicians, we are well aware of the importance of self-care, but awareness often fails to lead to ex*****on or change. In the realm of mental health, where our work demands emotional attunement, empathetic listening, and cognitive sharpness, prioritizing our own well-being becomes paramount. Amid the pressures of our profession, sleep emerges as a cornerstone of self-care that should not be underestimated. Often regarded as a passive state, sleep is anything but; it is a vital period of restoration, consolidation, and rejuvenation for our body and mind.

As providers whose craft relies on our cognitive abilities, we must turn our caring approach toward ourselves and recognize the indispensable value of adequate sleep. Just as we emphasize the importance of sleep for our clients, we must wholeheartedly embrace this message for our own benefit. Our cognitive functioning, emotional resilience, and ability to connect with clients are all intricately linked to the quality of our sleep. By acknowledging sleep as a non-negotiable aspect of our self-care routine, we empower ourselves to thrive in our professional roles and maintain the capacity to be effective, empathetic, and compassionate clinicians.

Exploring digital solutions tailored for therapists can provide practical tools to bolster our well-being while deepening our understanding of what is available to clients. By incorporating these innovative resources, we can not only enhance our sleep habits, but also set an example for those we guide, underscoring the significance of prioritizing sleep as a fundamental pillar of holistic self-care.

Summary�Sleep’s pivotal role in mental health underscores its significance for both clients and therapists. Its impact goes far beyond rest—it affects cognitive function, emotional resilience, and relationship quality. As therapists advocate for the importance of sleep in clients’ lives, it becomes equally vital to internalize this message and prioritize sleep for our own cognitive acuity, emotional well-being, and effective practice. Evidence-based digital solutions tailored for sleep offer a variety of ways for therapists to support their clients in assessing and addressing sleep issues while also maintaining control over the amount of time the topic of sleep requires in session. Emphasizing sleep in therapeutic practice has become increasingly relevant. Therapists now have a wealth of tools available to them, along with insights into the profound impact sleep has on mental health and the quality of relationships, to help them shape more holistic and effective therapeutic outcomes.

09/09/2024

The Best Rest
Some silence during the day (no cellphones, please) will prepare your brain for a better sleep at night.
By Alex Dimitriu, M.D.

In psychiatry and medicine in general, sleep should be considered a vital sign. Almost every psychiatric condition, whether anxiety or bipolar disorder, ADHD or dementia, is substantially affected by lack of quality sleep. Poor sleep undermines impulse control, making us “bingey,” settling for quick fixes over more meaningful goals; harder stuff takes perseverance and discipline—that is, impulse control. More than a decade of work as a psychiatrist and sleep medicine specialist has taught me that helping people sleep better is most of the cure.

Sleep has a cyclical structure that repeats about every 90 minutes during the night. Stages 1 and 2 are light sleep, followed by Stage 3, or slow-wave, sleep, and, last, REM, or dream, sleep. Notably, slow-wave sleep occurs predominantly in the first half of the night, dream sleep more in the morning hours. Slow-wave and REM sleep each take up about 20 percent of the night.

Early in the night, as you enter deep sleep, brain and metabolism slow, and it’s hard to wake up. If you do wake, you’re slow and confused. During deep sleep, the brain does massive maintenance work, cleaning out the by-products of a day’s worth of thinking. Among these are two proteins, tau and beta-amyloid, accumulations of which are seen in brain cells of people with Alzheimer’s disease. Lack of deep sleep is associated with earlier-onset dementia. In my practice, improving people’s deep sleep has slowed, even reversed, cognitive decline. Not many interventions can make that claim.

Deep sleep is also essential for memory formation and processing. The more you think or learn by day, the more deep sleep you need that night. Your brain moves memories from temporary to permanent storage and clears space for new information. People asked to remember pairs of words remember more in the morning if they got more deep sleep at night. (Be sure to sleep well before tests of memory!)

Spatial memory—required for navigating about town or remembering where you put the car keys— is also linked to slow-wave sleep. Notably, a loss of spatial orientation is an early symptom of dementia. Since normal aging is associated with a decrease in slow-wave sleep at night, do everything you can to get it while you can. Deep sleep also renews metabolism, restoring insulin sensitivity to provide energy, and it boosts immune function.

After the first period of deep sleep, usually 90 minutes after falling asleep, the brain enters REM sleep. Cycles of REM are short at first and lengthen toward morning. Think of REM sleep as the ultimate virtual reality experience. You’re basically awake—brain waves mimic those of wakefulness—but the body is paralyzed so you don’t act out your dreams. It’s easiest to wake during REM sleep.

In REM sleep, the brain is totally active, albeit internally. Heart rates and breathing rates vary as we go through the internal experience of our dreams. Men can get an er****on. The body will hit a temperature low for the entire day. While most muscles are paralyzed, airway muscles can become softer, leading to sleep apnea.

During REM sleep, the brain rehearses procedural memories like swimming or swinging a tennis racket. That’s why getting good sleep boosts physical performance. What’s more, the brain gets a large dose of psychotherapy. We replay and process emotional memories, make sense of daily emotional experiences, and simulate future situations and interactions.

REM sleep is also a source of human creativity. Imaging studies show the brain testing out new connections during REM sleep, which is why dreams can feel random, emotional, even outlandish. Yes, people score higher on creativity tests following more REM sleep. Research comparing the brain of people on psychedelic agents and during REM sleep shows similarities—explaining, perhaps, why both are associated with creativity.

Sleep is essential for thinking and feeling well. People deprived of sleep tend to be more impulsive. Internally, impulse control helps you harness runaway thoughts of anger, anxiety, and sadness. Moods are more intense and tempers shorter after a night of poor sleep. The ability to control impulses resides in the prefrontal cortex, the most advanced part of the brain and the first to go offline when we’re sleep-deprived.

You won’t die tomorrow from lack of sleep. But as with poor diet or lack of exercise, the effects add up over time, creating risk of obesity, diabetes, hypertension, heart attack, and stroke. Most mildly sleep-deprived people fail to recognize that they’ve got a problem, so they continue to get insufficient sleep.

Electric lights and electronic devices have made sleep a last priority. As fatigue builds during the day, willpower, rooted in impulse control, dwindles: We snack on unhealthy things, drink alcohol, and use drugs more in the evening. It’s also why it’s hard to put down your phone or stop bingeing on your favorite show as the hours advance— making you more tired tomorrow.

Adults need seven to eight hours of sleep per night. Human nature being what it is, if you aim for eight, you’re likely to get seven. It’s best brought on by a winding-down routine—slowing down, dimming lights, and putting down phones. Sleep loves rhythm, so regular bed and wake times are essential, without much drift on the weekends. Earlier to bed tends to boost slow-wave sleep. Getting enough sleep overall tends to boost REM sleep.

There’s one more thing that good sleep needs: silence. Unfortunately, digital technology has ended boredom, which previously afforded time to think about a conversation we had, an upcoming meeting, or future plans. That thinking needs to happen sometime, and the only time our brains have left to freely roam now is before we fall asleep. That’s a recipe for insomnia.
If you want to sleep better at night, give yourself a chance to think earlier in the day. Stare more. Distract yourself less. A meditation practice can be a great cure for insomnia. More silence in your day will deliver better nights.

How to Improve Deep Sleep
Get more sleep; it’s best to align sleep hours with your natural sleep pattern.
Boost sleep quality, allowing sufficient slow-down time before bed.
Supplements may be helpful in attaining and sustaining deep sleep. Supplements to consider include melatonin, L-theanine, glycine, and magnesium.
Alex Dimitriu, M.D., is the founder of Menlo Park Psychiatry and Sleep Medicine.

Facebook image: Mladen Zivkovic/Shutterstock
Link to article: https://www.psychologytoday.com/us/articles/202407/how-to-get-the-best-rest

09/08/2024

Triggers
Everyday day
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Triggers

At any given moment, someone’s aggravating behavior or our own bad luck can set us off on an emotional spiral that threatens to derail our entire day. Here’s how the experts suggest we can face our triggers with less reactivity and greater calm so that we can get on with our lives.

By PT Contributors | Photograph by Moya Mc Allister

09/07/2024

When To Trust Your Intuition
It’s a tiny-but-intense feeling that can push you in many directions. You just met The One, shady character. Is your impression correct? Your decision-making style and the information you’ve gleaned are all part of this mysterious package, delivered to you by subtle sensory clues.

By PT Contributors | Illustration by Edward Levine

Dr. Carrie Jacobs
Psychologist, Clinical Sexologist, Life Coach
ABS #21156
This page is an addition to my website: drcarriejacobs.com, to offer information, articles, and resources about the current social climate in mental health today.

09/07/2024

Oasis · (What's The Story) Morning Glory? (Deluxe Remastered Edition) · Song · 1995

09/06/2024

The Infidelity Paradox
Why do people cheat even if they’re in happy relationships?
By Noam Shpancer, Ph.D.

Why do people chat in their relationships? Popular arguments include that people who have affairs feel neglected by their partner, are unhappy or angry with their spouse, or have otherwise fallen out of love.

New research presents evidence for a simpler answer: People may have s*x outside of their relationship just because they want to have more s*x.

Social psychologist Dylan Selterman of John Hopkins University and colleagues surveyed registered users of the website Ashley Madison, which facilitates extramarital affairs—unmarried partners included. Interesting findings include a lack of guilt over having affairs, a feeling that cheating did not have anything to do with how much individuals love their spouse, and the expectation that an affair would not affect the quality of their primary relationship.

In the study, two groups of participants completed surveys three months apart. A smaller third sample was matched across the two occasions, allowing for some longitudinal analyses.

The first group included 810 respondents, mostly men, with an average age of 51, in a committed relationship. The second group contained 868 participants, also mostly men of similar age and relationship status. The third sample included 234 similar participants.

Selterman and his colleagues asked the participants questions about infidelity, including their history of affairs, enthusiasm about finding affair partners, the quality of their relationships and their affair (both s*xually and emotionally), their satisfaction in life, their level of regret, their motivation for seeking an affair, and more.

Most participants had had affairs before. This was, after all, a study of people using a website that facilitates affairs, but infidelity is common among the general population as well. Estimates show that 20 to 25 percent of married people and 33 to 50 percent of young adults in relationships have affairs.

Why People Cheat
According to those in the study, the quality of their relationship was not a significant driver of their desire for an affair. Moreover, relationship quality did not decrease as a function of having an affair, they reported, nor did it make divorce more likely. (Most participants reported that their partners did not know about the affair).

In terms of life satisfaction and self-esteem, those who cheated did not score differently from those who remained faithful, researchers found in the three-month follow up.

Sexual needs, rather than relationship needs, appear to drive the desire for affairs in this study. Approximately half of the participants across the samples said that they were not currently s*xually active with their partners. Sexual dissatisfaction in their relationship was the number one reason people chose to look for affairs. Other commonly cited reasons included low commitment to one’s partner, wanting autonomy, and a desire for a variety of s*xual partners.

These findings contradict both previous research and conventional wisdom. Existing research in the field has hypothesized a “deficit model” of infidelity, which assumes that cheating is often a result of problems in a relationship. Moreover, it is commonly assumed that those who commit infidelity will often be dogged by a guilty conscience and emotional upheaval because of their transgression.

Indeed, among the least endorsed reasons for wanting an affair were feeling a lack of love towards one’s partner, anger with one’s spouse, and feeling neglected, according to the study. Participants also reported that they enjoyed their affairs, both physically and emotionally, and have had few regrets about their infidelity.

The Paradox of Cheating
How can people feel both happy in their relationship and willing to cheat on their spouse?

One reason may be that the relationships of the cheaters resembled those of the non-cheaters. Those who had affairs did not report having worse relationships and did not behave differently in their relationships compared with those who remained s*xually exclusive. Those more satisfied with their relationships felt no more regret over their infidelity than those less satisfied. Further, as mentioned, cheating without being caught didn’t affect the quality of the relationship, according to the study’s participants.

To be clear, the study has several limitations. For one, it is based on self-report, which is often prone to inaccuracies, particularly when s*xuality exclusive. Those more satisfied with their relationships felt no more regret over their infidelity than those less satisfied. Further, as mentioned, cheating without being caught didn’t affect the quality of the relationship, according to the study’s participants.

To be clear, the study has several limitations. For one, it is based on self-report, which is prone to inaccuracies, particularly when s*xuality is concerned. Moreover, the sample is skewed toward middle-aged, heteros*xual males, which may not be representative of the general population. Many participants reported ambiguity about the exclusivity status of their relationship, which may further muddy the results. Finally, the participants were found through the Ashley Madison website. That may make them a significantly distinct cohort compared with the general population.

Still, the results suggest that infidelity may be more psychologically nuanced than previously believed. Marriage and long-term relationships come with compromises and trade-offs, and many marriages are painful. The data suggest that we may want to question some common assumptions about links between infidelity and relationship quality, and about moral consistency in intimate relations.

In the end, relationships, and the people in them, can be complex. Humans often behave in ways that contradict both conventional wisdom and common sense. We can also be quite simple. Sometimes, the s*x is just about the s*x.

Noam Shpancer, Ph.D., is a professor of psychology at Otterbien University and a practicing clinical psychologist in Columbus, Ohio.

09/05/2024

How Working Memory Works
Your frontal cortex and hippocampus strike up a rhythm so that you can remember why you must read this.
By William A. Haseltine, Ph.D.

Have you ever put your keys down and then quickly forgotten where to find them? When you try to recall where you might have left them, you are drawing on working memory, which is the ability to maintain and manipulate small amounts of information in your mind over a short period of time. Only recently has research begun revealing how the brain pulls off this feat.

A study recently reported in Nature pinpoints interactions between the frontal part of the brain that controls cognition—the mental actions involved in thinking, planning, and sustained focus—and the hippocampus, a structure nestled deep inside the brain and critical for memory formation and storage. Brain waves passing between the two regions trigger a group of brain cells called phase-amplitude coupling (PAC) neurons that help coordinate working memory. The findings provide fresh insight into not only how the brain manages memory but also how we might improve attention, decision-making, and memory retrieval.

What Is Working Memory?
Think of working memory as a filing cabinet that holds a few documents (about seven items) for a brief period ranging from a few seconds to several minutes, depending on the task and the individual’s cognitive abilities. You hold a phone number in your mind, for example, just long enough to dial it. Unless it’s a number you will call often, you do not want it to take up valuable storage space, so it slips out of memory soon afterward. If any documents are deemed essential and frequently revisited, they are stored for long-term use.

But working memory is fragile; the brain is constantly multitasking, holding and manipulating many snippets of information at once, all competing with working memory and distracting us from the task at hand. That number you were trying to remember? P**f, gone. Mental focus —technically termed “cognitive control”—is what allows us to intentionally foreground specific information relevant to a task or a particular social context while suppressing possible distractions.

A breakdown in either the temporary storage of information as memory or the cognitive control to retrieve and foreground the information long enough to complete a set task risks interrupting working memory. If a filing cabinet does not contain the desired document, there is no way of proceeding. Similarly, if the cabinet is in a state of complete clutter, with many other documents floating around, it will be hard to find the one that’s needed.

How the Brain Makes Memories
Memories are initially encoded in the hippocampus. The process hinges on neural plasticity—the ability to strengthen the connections, or synapses, between neurons through repeated stimulation. (That is why flashcards and other rote learning techniques work; continual exposure helps solidify new information at the neuronal level.)

Throughout the process, the hippocampus and prefrontal cortex communicate via brain waves of different frequencies. Faster gamma waves reinforce correct associations, while slower theta waves weaken incorrect ones, guiding what the brain learns.

The two types of brain waves work together—theta-gamma phase-amplitude coupling—creating a certain rhythm. They become synched so that when one gets stronger, so does the other. Such coordination is thought to facilitate working memory by enabling us, on the one hand, to maintain temporary storage of information and, on the other, to keep this information at the front of our minds until we have used it for its intended purpose.

The idea was put to the test in 36 patients undergoing surgery to treat their drug-resistant epilepsy. As their brains were monitored, they observed 140 rounds of one or three differing pictures they had to hold in memory in order to later identify whether a new picture matched any previously seen.

The study revealed a direct link between theta-gamma phase-amplitude coupling and the firing patterns of single neurons. When patients responded quickly and accurately, researchers saw two types of neurons activate: One set, category neurons, latched on to the category of the image —say, a human face; the other, phase-amplitude coupling neurons, helped direct focus.

Neurons that show phase-amplitude coupling synchronize with frontal theta waves, particularly when demands on working memory are high, improving cognitive control and facilitating recognition of a previously seen image. The phase-amplitude coupling neurons also fire in time with gamma waves, which are closely linked to information processing.

Categories and Control
The phase-amplitude neurons firing in tandem with the category neurons help home in on the correct information in the brain. The category neurons keep an eye on the content of the memory (like someone yelling, “Human face”), while the phase-amplitude neurons make sure that the information is kept in focus (like someone yelling, “Remember!”). Lead researcher Ueli Rutishauser compares the effect to an orchestral performance: “The two groups of neurons create a harmony superimposing their messages,” leaving us with the final signal: Remember/human face.

Like the label on a file, the category neurons provide a quick outline of the information to be remembered. The phase-amplitude coupling neurons, like a clear set of instructions, detail where and how to locate the file.

Theta and gamma brain waves help stimulate category neurons and phase-amplitude coupling neurons, which together scaffold working memory. Category neurons hold onto the information to be kept in mind, while phase-amplitude coupling neurons make sure this information is foregrounded and prioritized over possible distractions. Combined, the neurons coordinate the frontal and hippocampal regions of the brain so that you can effortlessly find your car keys.

Hippocampus Helpers
Nutrition is one known way to influence neuronal plasticity in the hippocampus of adults. Animal studies show that what you eat can help or hamper memory.

Positive effects:
Curcumin supplements
Polyunsaturated fatty acids, including omega-3 fatty acids
Polyphenols
Intermittent fasting
Caloric restriction

Negative effects:
High-fat diet
High-sugar diet

William A. Haseltine, Ph.D., is chair and president of the nonprofit Access Health International.

Link to article: https://www.psychologytoday.com/us/articles/202409/how-working-memory-works