For the Obsessed, the Mind Can Fix the Brain

TO JOSEPH DEE, THIS WAS REALITY: someone was lying limp at the bottom of the Los Angeles hotel pool. As the security guard responsible for locking the pool each night, Joseph, now 28, so obsessed over this image "that every night I would go back as much as five or six times" to check the water. To Barbara K., 33, this was reality: worried that she had not turned off appliances at home, she habitually returned several times -- and even took the coffee maker and iron to work once just to be sure. In both cases, psychiatrist Jeffrey Schwartz saw a deeper reality. Joseph and Barbara, he suspected, had a malfunction in a part of their brains called the caudate nucleus, which acts like a gearshift for processing thought. When it fails to shift, the brain structure called the orbital cortex -- which alerts us when something is dirty or off-kilter or otherwise needs attention -- becomes perpetually engaged. "The feeling that something needs to be washed or checked does not go away," says Schwartz. As a result, Joseph and Barbara and about 5 million other Americans suffer from obsessive-compulsive disorder.

The most popular treatment for OCD is Prozac or a similar drug. Some 30 percent of OCD patients do not respond well to medication, though, and if a patient stops the pills the symptoms return. But last week, Schwartz and four UCLA colleagues reported in Archives of General Psychiatry that the mind can be at least as powerful as medicine when it comes to remodeling the brain. Behavioral modification (changing the way patients act) and cognitive therapy (changing how they think) can alter the biology of their brains. PET scans of brain activity after therapy show markedly decreased activity in the "are-you-sure-the-stove-is-off?" caudate. The team had seen hints of this in a 1992 preliminary study, but last week's is the first to report persuasive evidence that, as Schwartz says, "the mind can change the brain."

In the UCLA treatment, patients first "relabel" their compulsion. Feeling the need to wash their hands for the umpteenth time that day, they tell themselves, "I am having a compulsive urge," as Schwartz describes in his upcoming book, "Brain Lock" (219 pages. HarperCollins. $23). Then they attribute their obsession to "a biochemical imbalance in my brain," as shown on PET scans. Third, they focus on some constructive activity -- gardening, playing an instrument, knitting -- for 15 minutes or so. By engaging another part of the brain, the caudate gets unstuck and shifts out of the pattern that insists the hands need washing. "If you develop new patterns of response to OCD," says Schwartz, "you will change the brain circuits that cause it." It isn't easy, and it worked on only 12 of 18 patients who tried it. But when the process is successful, PET scans show a much quieter caudate after one-hour weekly therapy sessions, for eight to 12 weeks, combined with practice in "relabeling" and "refocusing" that are done at home. Now the UCLA team is targeting other mental illnesses: the mind can also, they suspect, rewire neural synapses that cause phobias and depression.