People come to see me for all sorts of reasons. But they all have something in common. Age, gender, sexual orientation, doesn’t matter; diagnosis, history or economic status don't change this factor. They come to me because things are not working well in their lives. Folks feel stuck in a rut and they can’t seem to get out. Usually by the time they end up in my office they have been mired in their situation for long enough and they are desperate for change. I’m rarely the first stop on this train of woe.
There are lots of ways to think about what ails each person. I start with a detailed history; asking about family of origin and developmental history. We discuss current themes and habits, we talk about hopes and dreams. I want to know all the details about relationships and self-care. I try to get into as much detail as possible. This is where the individual resides.
Once I have all this information, I work with the client to come up with a treatment plan. There are many different psychological theories that therapists use to help guide our thinking; Psychodynamic, Cognitive-Behavioral, Developmental, Interpersonal, and Family Systems to name a few. Each of them has their utility and their pitfalls. The one I want to look at here is called the Default Mode Network, because I think its a very useful tool to understand what's happening in our heads. I’m going to get a tad bit science heavy and nerdy, but just hold on the juice is totally worth the squeeze.
The Default Mode Network (DMN) is an organization of brain regions which interact with each other and are distinct from other brain systems. This is the system we use to operate on a day-to-day basis (how to move through the world) and contains the structure of the self (how we are in the world). This network of neurons is responsible for your memories, feelings, and reactions as well as your understanding of other people’s behaviors and their feelings, and organizes our memories and our thoughts about the past. Although the Default Mode Network was first described by Hans Berger in 1929 and has been supported by others since then, it was only in 2007 when researchers were really able to start to see the brain activity clearly in PET scans that the research on this system really took off. en.wikipedia.org/wiki/Default_mode_network
Physically the DMN is located in multiple sections of the brain, such as the older “reptilian” parts as well as the more “advanced” parts of our brains. This includes, but is not limited to the medial prefrontal cortex; the posterior cingulate cortex; the hippocampus; and the amygdala, as well as parts of the inferior parietal lobe. Want a quick refresher on brain anatomy, check it out here. brain diagrams
Why is the DMN important? Well it’s what makes you, you. This thing is the amalgam of all of your experience, thoughts, feelings, hopes, dreams and fears. The DMN is what makes us able to look at a face and recognize it as a face; and allows us to complete a task without having to learn it anew each time. The DMN is what reminds you not to eat the sushi that got you sick that one time, or evokes feelings when hearing a certain song. Accordingly, the DMN is modulated by everything that affects us; sleep, food, sex, exercise, acupuncture, meditation, drugs, etc. You name it, and it’s probably got something to do with how you experience the world. link for meditation effect on DMN
Here’s the kicker. When your brain is NOT involved in a task that requires concentration, such as giving a lecture, or focused on a task, such as cooking dinner, the sections of the DMN are more active. This is kinda cray-cray. But what it means is when you are not involved in a task fully, you might get stuck in rumination. You go sliding down the rabbit hole of: why did that person give me a funny look? Was it a funny look or not? Did I do something to deserve that look? In fact the DMN may pull us out of a task and down that same rabbit-hole. Sound familiar?
When that happens, we get pulled into all the times that we may have had a similar experience, and/or pulled into the future of fear when those feelings may come up again. This is precisely the problem with the DMN; while this network of neurons is what allows us to operate on a day to day basis, we also get caught, ensnared and reduced to the misery of rumination or habitual thinking. When you get “stuck” and start churning through our go-to mode of chasing whatever monkey-brain we each have, that is the DMN doing it’s thing.
So, knowing this the question becomes, how do we manage the monster? First (and anyone who has worked with me will tell you this is my default comment), you have to be aware of yourself. You have to be aware that you are in that space, and oops it happened again. The magic is in the struggle. Only then can we work to change the process. You have to be able to name it before you can change it. This is the work of getting to know yourself, and then laying down new neural networks. There are smaller more ways to change and more impactful ways of change, but they all start with the same step, knowing yourself.
Once you’ve committed to learning about yourself you can ask questions such as these:
What are your daily habits of thought? Are you kind to yourself or constantly critical and demeaning?
What are your daily habits of behavior? Do you get enough sleep? Feed yourself nourishing food? Do you exercise? Do you allow yourself pleasure?
What are your relationships like? Do you come away feeling understood or lonely after meeting people in your life?
The questions are a starting point, and the solutions are individualized. That’s where the hard work comes in, stripping away the layers of historical not-knowing to find a place where you can say, this is what works for me and stepping into that. That work can be done with a therapist, with a friend, or on your own with a journal. Solutions can involve food, sleep, exercise, meditation, drugs and connection. But only you can do it. So that’s your charge. Go forth and make change.
I spend a lot of time talking with people about sleep. A significant part of every new client meeting is delving into the nitty-gritty components of their sleep habits; the good, the bad, the ugly. We talk about caffeine intake (caffeine can influence your sleep many hours after you’ve had that precious cup of coffee), exercise and food (if and when we work-out and when and what we eat can influence our ability to fall asleep or sleep soundly), the atmosphere in the bedroom (it should be cold, dark, and quiet), sleep-timing (when do you fall asleep and when do you wake up) and lots of other minute details. Link
People who come to see me are often surprised that I’m so interested in their sleep, but there is a clear connection between sleep and mood. Link Sleep is at least as important as any other aspect of self-care; yet somehow culturally it’s okay to skimp on, or simply ignore our biologic need for sleep. Some people don’t allow themselves adequate hours, or have trouble with waking during the night. For many people, falling asleep is the hardest part, and it’s frustratingly one of those struggles that the more that you concentrate on the task, the more elusive the goal seems.
I also spend a significant amount of time talking about my client’s children’s sleep. All the same questions, plus what works for the parents? Can they set limits? Do they want their child to sleep in their own bed or does some other arrangement work better for the family?
For the past few months, one of my kids has been struggling to fall asleep. We’ve gone through every plan in the proverbial book, tried multiple solutions, with mixed success. But he’s been having a hard time falling asleep which is a very frustrating situation for me. I am by temperament and habit a morning person. When bedtime comes, I am ready to tuck my kids into their beds and start my own evening routine. My patience is thin. Whatever ability I have cultivated to stay calm through the course of the day has evaporated.
This particular night was no different. I read books, sang songs, snuggled, then stayed a little bit longer. I gave one-more-kiss. I said good-night and I left. I went to sit on the couch, thinking that I was home free, when I heard the bedroom door open and small feet pad down the hall.
“Mommy, I can’t sleep.” Rather than letting out the choice words that I wanted to, I took a deep breath, exhaled, and asked “what’s going on?” He had tears in his eyes and said, “I’m scared.” Instead of sending him back to bed, which is what I wanted to do, I invited him to snuggle on the couch and we started talking. He explained that he wasn’t scared of anything in particular, rather “something in (his) head” when he started to fall asleep would “jerk him awake.”
Just as he was starting to relax, his brain would start to puzzle over the difficult situations, which is what our brains do as they are shifting towards sleep. Link But then because he was nervous just as he would fall asleep, he’d wake himself up and the whole process would have to start over again. No wonder it was hard to fall asleep. He didn't feel safe, he couldn't let himself relax. We spoke about his worries and ways to address them moving forward. As we did, I could see his face change, his body relaxed. The whole conversation took about 30 minutes. He felt armed with a new approach and was able to go off to bed, on his own and fell asleep without any more difficulty.
With my son that night, I asked lots of questions. Slowly his story came out. He was having a struggle at school, and a similar struggle at home with his brother; he didn’t know how to handle either situation. He was sad, angry, and overwhelmed, as he voiced those feelings he was able to move through them. As we spoke I tried to stay calm, which further helped him to calm him down. As he was able to calm himself he was able to relax enough to eventually fall asleep.
I don’t mean to suggest with his story that this is the solution to every insomniac struggle. I’m positive that we will have more sleep struggles in my house. That’s inevitable. However, I think what helped my son that night was my being able to sit with him so he could voice his concerns, recognize his emotions and move on. My hope is that if we can learn to sit with and listen to ourselves, maybe we can learn something useful.