Train Your Mind, Kick Your Craving

Can you think your way out of addiction? Maybe not yet, but the latest results from the burgeoning field of research that examines how mental training can alter the brain—and therefore behavior—say the rest of the answer may be "but probably soon."

In a new study, just published online in Nature Neuroscience and scheduled for the print version later this year, Elizabeth Phelps of New York University and colleagues measured how volunteers responded physiologically (including through brain activity) to a cue that, they were told, meant they were about to win $4. Specifically, the volunteers were shown either a blue square or a yellow square for four seconds; the blue meant they'd win the $4.

As expected, seeing the blue square lit up a region in their brains called the striatum; activity there is linked to the expectation of reward. It's the part of your brain that sits up and pays attention when you think of the barista handing you your iced coffee on a sweltering day, your significant other walking through the door … or the thought of a hit of pot, cocaine or other illegal drug.

So far, as expected. But then the scientists showed people the blue square again, but this time they first told the volunteers either to ''think of the meaning of the blue square, such as a potential reward'' or to ''think of something blue in nature that calms you down, such as the ocean.'' The second strategy reduced activity in the striatum, the scientists find. That suggests that some similar cognitive strategy—the scientists call it "cognitive" because it is a thought, while the craving it has overridden is an emotion—might be used to control urges triggered by "reward-predicting stimuli." They call it "a first step to understanding how top-down modulation may effectively control positive emotions and eventual urges that may arise (for example, drug craving)."

What is so neat about cognitive approaches to overriding something more basic, more primitive, is that neuroscientists are not only applying the technique to more and more conditions, but they're also finding out how it works. And even if you believe, as I do, that neuroimaging data have been oversold, there is no denying the fact that when a PET or fMRI scan shows how a therapy (cognitive or pharmaceutical) alters patterns of brain activity, it is more convincing.

Historical aside: Back in the 1980s, a pioneer in this field, Jeffrey Schwartz of UCLA, taught patients with obsessive-compulsive disorder to think about their urge to check the stove or count cracks in the sidewalk, or whatever form their OCD took, in a new way. Specifically, instead of accepting the obsessive thought ("Oh, no, I left the stove on when I left the house this morning!") as accurate, they learned to regard it as just a brain glitch due to over-activity in the anterior cingulate (the "worry circuit").

One of the keys to Schwartz's success was showing patients PET scans of their brain, with the overactive region that underlies OCD as obvious as obvious could be. (Full disclosure: I co-authored Schwartz's 2004 book about this work and the power of thought to alter brain structure and function, "The Mind and the Brain"); in an earlier book, "Brain Lock," Schwartz describes how OCD patients can help themselves through these kinds of techniques.)

Since then, neuroscientists have been finding more and more conditions in which people can think themselves out of something. In depression, for instance, thinking about things differently—which is what cognitive behavior therapy (CBT) teaches patients to do—can lift depression and reduce the rate of relapse. What seems to happen is that CBT reduces activity in the frontal cortex, the region of the brain responsible for the kind of endless ruminating ("that bad date means no one will ever love me") that can tip someone with depression into a full-blown depressive episode and increases activity in the brain's emotion regions.

Just to be clear, if cognitive-behavior therapy works to reduce drug cravings—and years of research on addiction treatment has suggested that it can, at least in some people—then that should be enough. But there is no denying the power of the neuro-paparazzi: When scientists can produce a dramatic picture demonstrating how some intervention alters patterns of brain activity that underlie a disease or problematic behavior, it is more persuasive than if they merely reported that people's behavior had changed. Add this to the lengthening list of conditions in which training the mind to think differently can alter the brain's pattern of activity.

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