Comment on “What Vietnam Taught Us About Breaking Bad Habits” on Morning Edition for 1 Feb 2012, where I discuss how to use mind-body medicine techniques to break bad habits. I discuss how addiction involves memories and how successfully changing a behavior involves breaking down those memories into tiny parts, which allows an unconscious act to become conscious in as many ways as possible. By making all of a memory conscious, we then can analyze it in such a way that causes the brain to break those circuits apart and release us from an addiction.
NPR Reporter Alix Spiegel takes us back to 1971 when then President Nixon created The Special Action Office of Drug Abuse Prevention in response to the report that 15% of American soldiers returning from the Vietnam war were addicted to heroin. The Office set up a program to test every returning American soldier for addiction and 20% of the soldiers identified themselves as addicted. They were not allowed home until they had been treated and dried out. Nixon did another thing that was especially helpful. He required research on the soldiers before, during and after treatment, tracking them after they returned home to see if they relapsed later. Psychiatric researcher Lee Robins did the research and found extremely low relapse rates in these soldiers, about 5%. When these rates were compared with the 90% of heroin addicts treated in the US who relapsed, many would not accept Dr. Robins’ numbers. Now 40 years later, these results are accepted.
Spiegel interviewed Wendy Wood, a University of Southern California psychologist, Dr. David Neal, a Duke University post-doc researcher, who both study behavior change, and Jerome Jaffe who was appointed by Nixon to head that Office. Dr Wood studied the behavior change research done during the 1960s, ‘70s, and ‘80s and found out that most such attempts were done by using a “campaign” style of motivating people to change. This style emphasizes changing people’s goals and intentions by using social pressure. Dr. David Neal says these strategies work but only for those behaviors we do not do often, and thus, are very conscious of when and how we do them.
However, the “campaign” style doesn’t work on behaviors that we have repeated so often that they become unconscious to us (putting the phone back “on the hook” or using fork, spoon and knife when we eat, brushing our teeth a certain way, etc.) Dr. Neal says that when the behavior you want to change is done often and in the same setting, the “campaign” style will change the intention but not the behavior, because the environment helps to shape our behavior. He uses the analogy of getting into the car to drive it. He then breaks down the behavior into all of its parts to show how complex the behavior is, as well as how much it becomes almost a reflex to us when repeated often enough.
The environment is the cue. We become so integrated with the environment that the behavior seems to follow when we get into that environment. Most smokers want to smoke because something in their environment triggers that craving. Change the environment, and you can change the behavior. Both Drs. Wood and Neal agree that to change these easily repeated, unconscious behaviors the best way is to disrupt the environment, causing the behavior to become conscious. They say that this “environment-disrupting” style of behavior change involves breaking down the behavior involved with the addiction into its parts and disrupting the environment by changing just one or more of the actions we do to force the behavior into our conscious control.
Jerome Jaffe says that the return to the US after treatment for heroin was a large environmental disruption because the US had changed so much during the war. These returning soldiers, if they tried to relapse to heroin, they had to become very conscious of every action they took because it was so different from what they did in Vietnam.
Posted at NPR
The take-home message here is that trying to get a person to change their behaviors (using “external” reasons–what we normally call “motivation” in the campaign style) is not as effective as tapping into “internal reasons” that affect behavior. I discuss this on my blog post “Nutrition Reviews“, especially the section where I comment on the NPR report “Why Doctors And Patients Talk Around Our Growing Waistlines”, “Using MRT: Recovering From Trauma“, and “Mindfulness Techniques.”
Although these interviews discuss how unconscious behaviors are the part that needs to change, none of the people seem to realize that there are ways to get at changing the unconscious behaviors by going directly to the unconscious brain. The best way to do this is to use mindfulness, visualization and muscle reflex testing as basic methods of mind-body medicine techniques (see my blog posting on “Mindfulness Techniques“.
Thus, I think the real cause of the loss of the addiction in these soldiers was due to both parts of the program: 1) the act of breaking down all of their behaviors into individual steps, becoming aware of all the sensations their brains were receiving each time they wanted to use drugs and 2) then disrupting the environment. By forcing these unconscious parts of memory into the conscious brain, all of us then automatically analyze and categorize them as we would the original memory (the role of the hippocampus). In the case of the soldier, this happened when he first tried the drug that brought the initial dulling of many of those senses. By forcing the unconscious parts of a memory into the conscious brain, we then can “repair” the pathways that we had used by disrupting them (e.g. thus, disrupting the “environment” of our addictive behavior).
Needless to say these mind-body methods can be applied to just about anything we do, and even help to increase memory recall abilities. What I particularly like about these techniques is how they help a person to really understand how their physiology works, creating a more sensitive and tolerant person over time. I discuss more of this at my blog post “Successful Recovery from Drug Addictions” at https://marthalhyde.wordpress.com/2012/01/08/successful-recovery-from-drug-addictions.
My Extended Comments
Two Methods for Breaking Addictions
This report mentions two styles of breaking addictions. The first one that has been tried the most in this country (and appears to dominate all efforts to change American behaviors from smoking to behaviors that “lead” to obesity) is called the “campaign” style. The second method is called “disrupting the environment”, and seems to have worked in these soldiers because their addiction is unconscious. All the latter method is doing is putting unconscious behaviors into the conscious mind by forcing the patient to actively think about, and be aware of all the behaviors that go into the performance of an addiction. Since most Americans have probably never heard about this latter method, it is being reported in this broadcast.
The campaign style of changing behaviors only works on conscious aspects of memory, not unconscious. It works only because it directly affects centers responsible for “motivating” us to do something–where the final “ok” to go ahead with the planned action occurs. There are several motivating centers in the brain. Neuroscientists seem to only recognize the one involved with the conscious part of the brain, e.g. the putamen. I suspect that there are several others scattered throughout the unconscious part, the brainstem. Since they are “lower” down on the hierarchy of nervous circuits that attach our body’s physiology to what we call “the mind” in the conscious brain, we are unaware of their existence and importance. Most critically, they are attached to strong emotions, which by their nature demand a greater physiological change in the body in order to feel these emotions.
In order to disrupt the environment, we need to become aware of every step involved in carrying out the addictive behavior. Breaking down an unconscious act into its parts involves noticing what activity generates a sensation (triggering the sensory receptors of sight, sound, taste, smell, touch, pain, temperature, pressure, and proprioception). Each of these senses contributes to a complete memory but most of them remain in memory storage areas found only in the brainstem and thus, are not conscious to us. By teaching our unconscious brain to “recall” these sensations, you can teach it to re-associate these memory storage cells with newer ones, disconnecting them from the bad habit you want to lose. This is what the techniques described in this report as “disrupting the environment” are doing. By associating these sensations with a different situation, you are removing the very strong unconscious path you created with the development of the addiction.
Another case of changing behavior by “disrupting the environment” was reported on the same Morning Edition program as this report. It involved efforts by one couple to change the environment which caused the smoking culture of Japan to develop (see “Japanese Smoking Culture Proves Hard To Snuff Out“). Since the Japanese seem to be particularly shy people when it comes to interaction with those who are not family or know very well, smoking has taken a very strong hold in that culture. It was suggested in that report that smoking was a shared activity that brought people together for the purpose of smoking anyway, and so made it easier to start talking about other things at the same time. This couple decided to blow soap bubbles through a pipe at these gatherings to encourage others to do the same, making it possible to drop the smoking and still accomplish overcoming of shyness that smoking used to do.
The Role of Emotion
More important for changing behavior is recognizing that emotion plays a role in doing anything at all. It has very deep connections to the unconscious mind and must be recognized when we tap into the physiology of emotion and behavior change.
Just think about what you feel when you start to feel anger or rage, or depression (that last one has far more subtle effects and involves the dulling of sensations from ligaments and tendons). The body communicates to us that we are feeling these emotions mainly by the sensations we get from the tissues, e.g. in the case of anger, tightened muscles, tendons and ligaments, increase heart rate, blood pressure, and respiratory rate, all of which readies the body for action if called upon. We do not feel these emotions first, but only “feel” them when we recognize these sensations in a particular context.
In this way, we learn as a child how to interpret our behaviors as reflecting these emotions, simply because we always associate these physiological changes with these behaviors. This lesson is more complex than the simple one of learning how to ride a bicycle because it entails having to recognize several different behaviors, and different contexts being associated with a particular set of physiological changes. The motor control over a bicycle involves the same set of muscles each time, memorizing a sequence of timed contractions, and increasing our awareness of the positions of our joints at each moment. It is a far more easily focused activity than the one involved with recognizing an emotional shift and its cause.
Depression does the opposite of anger or rage, and we are conscious only of the feeling that we are unable to do anything. Unlike anger or rage, that “feeling” comes from the absence of feeling in the body’s tissues when no signals to muscle, tendon and ligament are occurring when there are supposed to be. Internal motivation has dropped, so that when we even think about getting up and making a nutritious meal because we are hungry, we are stopped. That “ok” from motivation centers has been squelched when we feel depressed.
Motivation and Mind-Body Medicine
Motivation affects many other actions that we cannot do when feeling depressed. Only the “comfort-giving” activities are given the “ok” in these motivation centers. For some, that means snacking on the “forbidden foods”, for others, listening to certain music, or sleeping a lot. Even if the behavior is “bad” for you (as doctors say), the brain only wants to return the body to the proper equilibrium. Its decision to do these things is the right one because it is returning you to a better condition than when you felt depressed, but only for the moment. The unconscious brain acts only for short-term solutions at first. The conscious brain then must step in to redesign circuits to stop the short-term solutions in favor of long-term solutions.
Using mind-body medicine techniques of mindfulness, visualization, and muscle reflex testing, a person can find out what the unconscious brain is doing, and force it into the conscious brain long enough to set up a different program from what was operating before. In this way, a person can make a “campaign” style behavior change into a permanent change, integrating it with a disruption in the environment by changing the internal environment.
This is what this report is telling us, that the addict must make a conscious effort to change unconscious pathways. Until we recognize all the physiology involved with a behavior, as well as the emotional circumstances that lead us to do this behavior, we cannot make permanent changes. What is critical here is that the techniques described in this report belong in the class of mind-body medicine techniques because they involve doing the same thing–making the unconscious conscious.
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