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04/25/2013 08:26 am ET Updated Jun 25, 2013

How to Change a Habit for Good: Pay Attention

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(Part 2 of 2)

In my last post, we discussed using good, old-fashioned self-control to quit smoking cold turkey -- resisting those urges to smoke until you've beaten your addiction into submission. For some folks, this works, but for many it doesn't. Besides taking a lot of blood, sweat and tears, relying on self-control may not work so well because, well, we run out of blood, sweat and tears. When our tank is empty (i.e., ego-depletion, as Roy Baumeister calls it), that habit comes rushing back with a vengeance. It's called the "abstinence violation effect" -- remember the mayor in the movie Chocolat?

Someone in a mindfulness group I was leading recently asked about this paradox: How can we work to change unhealthy habits if we can't rely on self-control? After all, isn't reinforcing self-control a mainstay of cognitive behavioral therapy (CBT), and other approaches that treat everything from depression and anxiety to addiction? CBT has a lot of evidence backing it and has earned the seal of approval by the National Institutes on Drug Abuse (NIDA). However, these types of treatments may rely on our prefrontal cortex, responsible for a lot of our conscious thinking, to help us literally change our cognitions (that's why they're called cognitive therapies). For example, a common strategy is to think of the negative health effects of smoking when you have a craving, to help you restrain yourself.

This is all well and good until we look at the biology behind these types of strategies. There has been a bit of work showing that the prefrontal cortex is the cognitive control muscle behind self-restraint. This is good and bad. Good because we can learn how the brain is working to change habits. Bad because as the youngest member of the brain from an evolutionary standpoint, the prefrontal cortex is just like any new member of a group or organization -- it has the weakest voice. So, when we get stressed or our ego runs out of gas, guess which part of the brain is the first to bail? You've got it. The prefrontal cortex. As Amy Arnsten, a neuroscientist at Yale, puts it: "Even quite mild acute uncontrollable stress can cause a rapid and dramatic loss of prefrontal cognitive abilities."

What to do? As I talked about in the last blog post, making sure your prefrontal cortex doesn't run out of juice can be one way to make it more likely to succeed (remember the HALT acronym?). Alternatively, we can look to other wisdom traditions to see what they've got up their sleeves. I mentioned mindfulness training last week as another possibility. Where do its roots come from?

Mindfulness comes from Buddhist psychology, which has pretty deep roots by evolutionary standards. For example, compare its approximately 2,500 year history to Freudian psychoanalysis, the latter of which began about 100 years ago. Then think about which one is more commonly used today. There's an interesting line in one of the early teachings that caught my eye so much that I used it as the backbone of our mindfulness training for smoking cessation program (which, by the way, in a clinical study was found to be twice as good as gold standard treatment, but more on that later).

The line is this (the Buddha speaking here):

"I set out seeking the gratification in the world.
Whatever gratification there is in the world, that I have found.
I have clearly seen with wisdom just how far the gratification in the world extends."

In other words, when the Buddha looked closely at what he was actually getting from his actions (I'm guessing he didn't smoke, but who knows?), he saw that their delivery never lived up to their promise. By following his urges, he was just perpetuating suffering because gratification of his desires was not only short-lived, but it set up the habit to crave these actions more. He dubbed this process samsara or endless wandering, because it was self-perpetuating.

But wasn't the Buddha reported to be enlightened (whatever that means)? What did he learn from exploring gratification to its end? What wisdom did he gain?

This is where we bring it back to self-control. Remember that saying, "If you can't beat 'em, join 'em"? Here's the kicker. If you can't beat down the craving with good, old-fashioned self-control, join in, but with one slight modification -- really pay attention to see what you actually get from your actions. Don't sugarcoat anything. Be honest. See what you actually get. In other words, be mindful.

For example, this is what we did on the first day of our smoking cessation classes. We simply taught folks to pay careful attention to every aspect of smoking, to see what they got from it. From that urge to smoke, to lighting up, to buying cigarettes, to the morning cough, to getting an upper respiratory infection (again).

And don't approach this from an intellectual or cognitive standpoint; everyone knows that smoking is expensive and bad for your health. Just pay attention.

This was amazing! Just like the Buddha described, our smokers started to see what they were getting from their actions. And we could see wisdom develop in these folks. Wisdom is really knowing something "in your bones" not just in your head, where knowledge resides. They began to realize that their cigarettes didn't actually taste very good. They began to see that they were smoking because they were stressed out at work. They were learning that smoking didn't actually fix the sources of their stress. It was only a temporary Band-Aid. And so on. And lo and behold, they started to become disenchanted with smoking simply because they were seeing more clearly.

This is important. Take a moment to think about something that truly, on a gut level, disgusts you. Here's some help: Think of someone dropping ice cream on the sidewalk in New York City. You don't need your prefrontal cortex or self-control to restrain yourself from picking up their ice cream and eating it, right? It is disgusting, on a visceral level (i.e., this is grasped at the level of our older "lizard brain"). We just have to be willing to look. And the deeper we get this, on a gut level, the less we need that good, old-fashioned, effortful self-control to let go of unhealthy habits.

The beauty of disenchantment as a form of self-control is that it likely doesn't need our prefrontal cortex, or even a lot of effort once it has been firmly established. Over time, our disenchantment becomes so strong that those urges lose all of their steam.

And this fundamental biological process is not just limited to bad habits -- it is common to all habitual behavior. For example, what happens when we really pay attention to what we get from our third helping of dessert, or after we've yelled at our spouse or child? Imagine how just paying attention to our actions can help us change our own habits, and perhaps even make the world a better place.

For more by Dr. Judson Brewer, click here.

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References:

Arnsten, A. F. (2009). "Stress signalling pathways that impair prefrontal cortex structure and function." Nat Rev Neurosci 10(6): 410-422.

Bodhi, B. (2005). In the Buddha's Words: An Anthology of Discourses from the Pali Canon, Wisdom Pubns.

Brewer, J. A., S. Mallik, T. A. Babuscio, C. Nich, H. E. Johnson, C. M. Deleone, et al. (2011). "Mindfulness training for smoking cessation: Results from a randomized controlled trial." Drug and Alcohol Dependence 119(1-2): 72-80.

Hare, T. A., C. F. Camerer and A. Rangel (2009). "Self-Control in Decision-Making Involves Modulation of the vmPFC Valuation System." Science 324(5927): 646-648.

Ochsner, K. N. and J. J. Gross (2005). "The cognitive control of emotion." Trends Cogn Sci 9(5): 242-249.

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