How Chronic Stress Affects Neural Circuitry Unending stress can promote anxiety and depression.


Posted Apr 02, 2018 in Psychology Today

By Brain & Behavior Research Foundation Staff


Chronic stress alters neural circuits in the brain, increasing the risk of depression and anxiety. According to animal studies reported in the January issue of the journal Biological Psychiatry, some of these changes are mediated by the immune cells that reside in the brain.

The brain’s resident immune cells are called microglia. They are responsible for fending off infections, but this is not their only role. They also help build and remodel neural circuits. Such activity is constantly going on in the brain. In the current study, researchers led by Ronald S. Duman, Ph.D., a 2005 Distinguished Investigator at Yale University, investigated what happens to the brain’s microglia under conditions of chronic stress. Dr. Duman was also a 1997 Independent Investigator, 1989 Young Investigator, and the 2002 Nola Maddox Falcone Prizewinner. Eric S. Wohleb, Ph.D., a 2016 Young Investigator, is first author of the paper and initiated these studies as a postdoctoral scholar in the laboratory of Dr. Duman. Dr. Wohleb is currently at the University of Cincinnati College of Medicine.

They conducted their studies in mice, intermittently exposing the animals to stressful conditions over a few weeks, then examining the impact on their brains. As expected, the treatment provoked anxiety and depression-like behaviors in the mice.

The team’s experiments showed that under conditions of stress, neurons in the brain’s prefrontal cortex—a region involved in complex functions such as decision making and social behavior—produce a signal that triggers microglia to begin remodeling neural circuits. As a result of these functional changes in microglia, neurons in the prefrontal cortex lose a portion of their synaptic connections. This is important because limited connectivity in the prefrontal cortex has been linked to major depression in clinical studies.

The research team found that when they prevented neurons from producing their microglia-stimulating signal, mice exposed to chronic stress did not develop signs of anxiety or depression. The finding suggests that interrupting stress-induced signaling between neurons and microglia might be a way to treat anxiety and depression in patients.

By Brain & Behavior Research Foundation Staff


(link is external)

Mindful Breathing

Many people realize that stress is greatly impacting their lives.  It may be related to school, their work life, finances or family situations.  Chronic stress has a debilitating effect on all aspects of our lives, including our academic performance, our interpersonal relationships and our physical and mental health.  One way to combat chronic stress is to incorporate mindfulness practices into your daily life.  Finding a few moments each morning or evening to practice mindful breathing is a first step in managing and reducing chronic stress.  It begins with a simple intention to make a change for the better.

Mindful Breathing is a metacognitive strategy for cultivating wellness and reducing stress.  It combines a deep breathing technique with mindfulness that increases our ability to monitor our cognition and regulate our attention and emotions.   It also promotes a healthful mindset so we can cope with daily stressors more effectively.  Mindful breathing increases our resilience to respond to stressful situations and to regulate our responses to them.  Using a technique called “diaphragmatic breathing” we can reteach our bodies to slow down and work more efficiently in stressful situations.  We can focus our attention on our breathing, which we frequently take for granted because it is regulated for us by our autonomic nervous system.  With sustained practice, mindful breathing helps us to gently take back control to calm our bodies and our minds.

Diaphragmatic Breathing Technique

  1. Begin in a seated position, either on the floor with your legs crossed in front of you, or seated in a chair.  Sit upright with your back straight.  If you feel too much sway in your back you can place a firm pillow or rolled towel or blanket under your bottom.  This should tilt your pelvis forward slightly and help to straighten your back.
  2. Place the palm of your right hand on your stomach over your navel.  Place the palm of your left hand on your chest.  You will be observing your hands while learning this breathing technique.
  3. As you inhale through your nose, fill your lower lungs with air.  Your diaphragm muscle will relax and your lower belly should rise with this inhalation.  As you continue to inhale your chest should also rise at the end of the inhalation.  Observe your right hand rise as your lower lobes of your lungs fill  with air.  Your left hand will rise as you fill your upper lobes with air.
  4. As you slowly exhale, either through your nose or mouth, watch your chest and your lower abdomen fall and return to a normal resting position. You will still have residual air in your lungs and as you master this technique you will finish each exhalation by lifting your diaphragm to push out some additional air from your lower lungs.  This forced exhalation allows you to take in more air on the next inhalation.
  5. Repeat the cycle, again watching your hands as they rise with the inhalation and fall with the exhalation.

As you engage in Diaphragmatic Breathing you can integrate this Mindfulness Technique:

  1. On your inhalation breath, focus on the word “in” or say “breathing in” in your mind.  Do not engage in any other dialogue or self talk during your inhalation.
  2. On your exhalation breath, focus on the word “out” or say “breathing out” in your mind.  Do not engage in any other dialogue or self talk during your exhalation.
  3. As you repeat this process you will notice thoughts appear or ideas emerge.  Return your attention to the breath and focus on “in” or “out”.
  4. As you continue the cycle of in and out breaths, give yourself permission to not respond to ideas or thinking about what you are doing, other than focusing on the “in” or “out” breath.
  5. Continue to sustain your breathing cycles for 10 minutes.  After ten minutes check in with yourself to see if you were able to maintain your focus for the 10 minutes.  If so you can increase the session to 15 minutes in your next sitting.

Take control over the stress that is making you feel unhealthy and unhappy.   It all begins with just a breath.

To learn more about Mindful Breathing, go to

Donald D. Matthews, PsyD




Proofreading and Editing: The Final Step


What do you like to put on toast? Butter? Jam? Marmite? Does it change depending on your mood? I’m a butter and jam gal, myself. This question came up while I was searching for ice breaker activities for a class that I’m currently co-teaching. It got me thinking about a lot of things toast-related (For instance, did you know that sprinkles are a popular and completely acceptable bread topping in Holland? It’s called hagelslag, and I was introduced to this tasty trend while staying at a youth hostel in Amsterdam). What we choose to put on toast got me thinking about individuality and possibility and, yes, even writing, which I’ll discuss below.

For most people, the toast topping is the finishing touch: the final step. When you write, proofreading and editing is the final step. For some students, leaving proofreading and editing to the very end feels counterintuitive; it’s difficult to resist the urge to correct as you go along. But just as you wouldn’t spread butter on your bread before toasting it (well, okay, maybe you would, but then you’d likely be left frantically Googling such topics as those featured in the image at the top of this post), you shouldn’t proofread or edit your paper until you’ve finished writing it. If you can, try to save these steps for last and follow these tips:

1.) Take time away before you do it! Walk away from your paper for a day or two before you proofread and edit. Doing so will allow you to read your work with fresh eyes.

2.) Proofread and edit a hard copy. Print out a copy and make your corrections directly on the paper. You’re more likely to catch mistakes on a printed copy.

3.) Take your time. Make sure you leave ample time for proofreading and editing so you don’t feel rushed.

4.) Read out loud. Hearing the words you’ve written can help you catch errors.

5.) Start at the end. Read the last sentence of your paper and look for errors. Then jump up to the next-to-the-last sentence and do the same thing (and so on and so forth). Reading your paper “backwards” sentence-by-sentences enables you to focus more closely on each individual thought and idea.

6.) When in doubt, get help. Have a trusted friend look over your paper. Visit your instructor or a tutor. Or come see me in Academic Support at 690 Walnut, #215.

Until then, go enjoy some toast.

Katie Brundage, Learning Specialist (and Toast Enthusiast)




Autonomy and Motivation: The Keys to Successful Learning and Goal Attainment

A recent article from Useful Knowledge published by the Harvard Graduate School of Education examines the relationships between self-control, autonomy and learning in teen and tween populations. The researchers (Robinson, Duckworth and Rodgers, 2017) examined whether “commitment devices” which are voluntary agreements that can “limit choices through restrictions or penalties for failing to accomplish a goal” to measure goal attainment. The teen and tween participants in the study had to be willing to impose a personal restriction or punishment, in this case the loss of 20% of a paycheck, for not meeting the intended goal. The study found statistically insignificant differences in goal changing behavior between control and intervention groups, and no evidence that commitment devices effected student behavior.

So why is this so?   Commitment devices (in this case) act as negative reinforcers. They are viewed a punishments for not meeting a goal. Considering the age and maturity level of the population…the study recognizes that tween and teen students who are asked to engage in high levels of self regulation must be able to identify and apply self regulation strategies that are developmentally accessible. Goal attainment for any age requires high levels of self regulation. More importantly, reaching a goal is contingent upon other factors related to self regulation including attention and focus, intrinsic and extrinsic motivators and autonomy. Autonomous learning opportunities serve to enhance intrinsic motivation (Ryan and Deci, 2000). When we are engaged in self regulated learning, perceptions of academic competence and self-efficacy beliefs increase (Zimmerman, 1989). Students who are intrinsically motivated become goal oriented and are able to sustain goal-oriented behavior that meets their needs for competence, relatedness and autonomy (Ryan & Deci, 2000).

From a goal setting perspective, we need to consider whether we have the drive needed to attain a goal. Why is this goal important to me? Without a driving passion or positive outcome associated with the goal, its attainment may be unlikely. Goals are more easily attained if we believe there is a high probability that we can achieve them.

Consider these three factors that are linked to reaching our goals:

  • Proximity – Is the goal within reach? Is there a moderate expectation that it can be achieved? If the goal is not time bound, it may be too far off to be attainable. Setting a goal for a year is hard to meet. Try setting short-term goals that can be achieved today or by the end of the week.
  • Difficulty – Is the goal realistic? Sometimes we expect too much of ourselves. For instance, if I want to run a 5-minute mile I would need to practice daily. If that practice is not sustainable, then I will not likely reach the goal.
  • Specificity – Is the goal specific and measurable? I want to be able to do 10 pull-ups.   Now I have to increase my capacity to reach this goal through sustained effort and practice. Reaching this goal will make me feel stronger, which may be a motivating behavior.

An ideal goal is specific, measurable, attainable and achievable, relevant, and time-bound. The acronym SMART goals illustrates each of these words and helps to construct a situation where the time between the initiation of behavior and the end state is close and thus provides the necessary structure to meet the goal.

Here is a short YouTube video that describes SMART goals:

When setting goals, ask yourself, “Is the goal motivating enough to challenge me to grow and improve?” “Am I passionate about reaching this goal? Is it within my ability to reach it? If you bring passion and meaning to your goals, you will have a much greater ability to reach them.

If you need assistance with goal setting or motivation strategies, please reach out to the staff at the Academic Support Office.


Donald D. Matthews, PsyD



Robinson, Carly. (2018). Some Middle School Students Want Behavior Commitment Devices (But Take-up Does Not Affect Their Behavior).

Ryan, R. M., & Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American psychologist, 55(1), 68.

Shafer, Leah (2017). Learning to Self Manage: For tweens and teens, self-control is connected to autonomy and other intrinsic motivators. Useful Knowledge, Harvard Graduate School of Education. Retrieved from

Zimmerman, B. J. (1989). A social cognitive view of self-regulated academic learning. Journal of Educational Psychology 81(3), 329-339.




What do you like to do in your spare time? (Yes, I do realize asking medical students what they like to do in their “spare time” is kind of ridiculous, but hear me out anyway). I like to bake (especially if it involves chocolate and/or butter). And I tend to not follow recipes when doing so; I might glance at one for the basics, but I’m more prone to tweaking the ingredients as I go along—dropping X and adding in Y, for example—until I come up with a finished treat. Through process, trial (and sometimes error), good things come to those who bake. And the same concept can be applied to writing, I think. Writing, like baking, requires trial and error, process and patience.

In previous posts on this topic, we discussed the writing process and its first stage (prewriting). In this post, we’ll discuss the second stage—drafting—in greater detail. When you draft a paper, you take the jumble of ideas that you developed in the prewriting stage and start to add some sense and order to them.  You begin to organize the information more logically into separate paragraphs, and you create connections between these paragraphs and your thesis statement (the overall point of your paper).

Some things to keep in mind as you draft:

1.) Writing begets more writing: As you write, you’ll likely discover (and write down) additional ideas or thoughts connected to your topic. Some writers find it best to focus on the body of the paper prior to drafting an introduction/finalized thesis statement.

2.) You still don’t have to worry about the little details: As with the previous two stages, when drafting, don’t worry too much about spelling, grammar, or sentence structure. Focus on building your ideas into supportive body paragraphs.

3.) You can (and probably will) change your mind: Drafting is just that: a preliminary version. You will likely go through several drafts before you consider a piece of writing “final.”

In the next post, we’ll go over the final stages of the writing process: proofreading and editing. In the meantime, happy writing, or baking…or whatever it is that you do in your spare time.

Need help? Stop by Academic Support: 690 Walnut Ave, #215.


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College Stress and Mindfulness

No doubt about it….graduate school is stressful. The American College Health Association (ACHA) administers a yearly survey to students to collect data about student habits and behaviors and their perceptions about health related topics (ACHA National College Health Assessment, Spring 2015.) The ACHA survey reports on many aspects of student perceptions of stress.

Here are a few not-so-surprising findings…

85.6% of all students who took the survey self reported feeling overwhelmed by all they had to do within the last twelve months. 

56.9% of all students felt overwhelming anxiety within the last twelve months.

45.1% of students surveyed identified “academics” as being traumatic or hard to handle within the last twelve months. Academics were higher scoring than other items on a list of traumatic or difficult situations students face including finances (33.5%), intimate relationships (30.2%), family problems (27.0%), career related issues (26.4%), other social relationships (25.4%), personal appearance (25.5%) and personal health issues (20.5%).

Overall stress levels were also self-reported ranging from “no stress” to “tremendous stress”. 53.5% of students self reported more than average stress to tremendous stress.

Source: ACHA National College Health Assessment, Spring 2015 Reference Group

In an effort to combat the daily stressors encountered by students, colleges and universities are beginning to explore mindfulness and meditation as a coping strategy for stress reduction and to enhance mood, regulate emotions and improve attention. Mindfulness meditations, yoga, therapy dogs, and exercise are just a few strategies that build resilience and help students to combat the stress of academic life. The goal being to increase the number of self-regulating tools that students can use during college and to develop practices that can be sustained into life after grad school.

0300501350697119904835071458388To learn more about Mindfulness, check out my blog at or mindful

Donald D. Matthews, PsyD



American College Health Association – National College Heath Assessment II: Reference Group Executive Summary Spring 2015. Hanover, MD> American College Health Association; 2015. Retrieved from

James, S.D. (2017). Mindfulness Meditation Mindfulness Meditation May Help Students Combat High Levels of Stress, Depression. NBC News. Retrieved from


In this post, we’re going to take a closer look at prewriting (you might want to read the first post in this series by clicking here).

Prewriting describes the work you do before you begin to write; these strategies can help you generate ideas. What are good prewriting strategies? Consider the following:

Brainstorming (Listing): Quickly jot down your thoughts and ideas as they come to you. Some writers like to use bullet points or list their ideas in short phrases. When you brainstorm, don’t worry about connecting or clearly expressing your thoughts. You’ll clarify what you’re trying to say later on. In the prewriting stage, it’s important to just RELAX and let your ideas flow without judgment or worry. (By the way, if you have a couple of minutes, try this technique for calming your mind prior to beginning your work).

Freewriting (Journaling): This strategy is similar to brainstorming in the sense that you’re focusing on getting your ideas and thoughts down on paper. While brainstorming resembles a list of short phrases, however, freewriting usually consists of full sentences. Think of freewriting like a journaling exercise. Don’t worry about grammar, spelling, or punctuation. Again, relax and let your ideas flow without judgment, worry, or censorship. If you can’t think of what to write, put that phrase down on your paper: “I can’t think of what to write.”

Clustering (Concept Mapping): Clustering helps you form associations between thoughts and ideas. Usually, you begin clustering with a single thought or idea in a circle in the middle of your paper. You then create a “map” of associated words/thoughts/ideas in other circles around the middle circle and draw lines to show the associations between the different words/thoughts/ideas. Take a look at the following example:



So there you have it: three different prewriting strategies to try out on your next writing assignment. In our next installment, we’ll take a closer look at the next stage of the writing process.

Need help? Have some other ideas you’d like to try out? Stop by Academic Support at 690 Walnut Ave, #215.


Katie Brundage

The Write Stuff

One of my favorite grammar jokes goes, “The past, the present, and the future walk into a bar. It was tense.” As you join me in my overly-unbridled enthusiasm deep appreciation for the subtle witticisms that are grammar jokes like this one, you might wish to consider a related topic: verbs (and the time and action that they convey) are not the only sources of tension in your lives as graduate students. It has come to my attention that writing, in general, is a big headache for a lot of you. Thus part of my job as a Learning Specialist is to help you overcome these headaches by providing you with the necessary resources and strategies. And hey, I might even get you to like the writing process.

The key word here is process. Writing is—and should be—regarded as a process. It is rare that any person can sit down in front of his or her computer, tablet, or phone and construct a perfectly-crafted piece of writing on the first take. Many students fail to consider that the writing process is just that: one of drafting and revising…and drafting and revising again…and again…and (lastly) editing and proofreading.

You might think of the writing process like this:


Or this:wp2

Or this:



Which writing process is best? Whichever one works for you.  Each student’s writing process is unique. You will need to experiment to find what works best for you. Regardless of the process you use, there are similarities between each: drafting, revising, and editing. Some students find it extremely helpful to prewrite before they actually begin writing. Your last step in the process should be proofreading.

In the next post, we’ll go over these steps in greater detail. In the meantime, think about your own writing process: what works? What would you like to improve?

If you are needing assistance with strategies for efficient learning or writing, please feel free to contact the Academic Support Office at Touro University, California for a consultation or support.

Active Learning


Are you familiar with the concept of Active Learning? When we study, we often approach the learning task passively by simply reading the textbook information with no intentional goal beyond comprehension. While retention or comprehension may be the desired effect of studying, it is not always an effective learning strategy. Previous research suggests that we retain only about 15-20% of what we read passively.

Recent research by Augustin (2014) suggests that we don’t fully retain information unless it is followed by an intentional process that supports retention. One method of retaining information is through self testing.

The Testing Effect.
The testing effect is enhanced when we receive feedback about what we have read in the form of active recall.  Active recall is a term applied to the repetition of information. As a retention strategy it is significantly more effective than passive reading or studying. Testing is a form of active recall that can be applied in different ways.  Giving yourself a short quiz after reading a chapter or section of text has the ability to enhance your retention by 10%. Testing as a form of delayed feedback given at the end of a study session has the greatest impact on enhancing learning.  Self testing can be used as a metacognitive strategy for enhancing retention through working memory.

Some active recall strategies you might consider after a study session…….

1.  Create a test to give yourself at the end of the chapter.

2.  Write down the five main adverse effects of beta blockers.

3.  Draw a picture that illustrates the Kreb’s cycle.

Each example demonstrates how factual knowledge can be actively retained after the study session through active recall. Active Learning methods enhance retention through intentional feedback.
Cognitive neuroscience continues to inform our understanding of how to be more efficient learners. We can use testing and feedback as active recall methods during our study sessions to make the retention of complex information more efficient.

If you are needing assistance with strategies for efficient learning, please feel free to contact the Academic Support Office at Touro University, California for a consultation or support.

Donald D. Matthews PsyD

Augustin, M. (2014). How to learn effectively in medical school: test yourself, learn actively, and repeat in intervals. Yale Journal of Biology and Medicine 8-7 (2014) pp. 207-212.

Diary of an intern’s night shift

Diary of an Intern On Her First All Nighter Lauren photo

by Hope Olzewski

First Night Shift on Family Medicine Inpatient Rotation at Arrowhead RMC

(Note, not all nights have been this challenging, and this is an abbreviated form of the entire night.)
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