Saturday, June 9, 2018

The Craving Mind -- Judson Brewer

Operant conditioning:
  • We see food, and our stomach sends a hunger signal to our brain (trigger) >> We eat the food (behavior) >> It tastes good (reward). 
  • Next time we feel bad, we remember that eating that food made us feel better (trigger) >> So we eat that food (behavior) >> It tastes good (reward). 
  • Addiction: Something makes me feel bad (trigger) >> I get drunk (behavior) >> I feel better (reward). Example: Something reminds me of a traumatic event (trigger) >> I get drunk (behavior) >> I'm no longer thinking about the traumatic event (reward) (negative reinforcement). 

John Kabat-Zinn's definition of mindfulness: "The awareness that arises from paying attention, on purpose, in the present moment, and non-judgmentally."

* * * * * 

Smoking Cessation Study. Two groups of smokers: first group participated in the American Lung Association's four-week Freedom From Smoking program, second group participated in four-week mindfulness group. 

Session #1. Participants taught the habit look -- that is, how certain triggers led to them smoking, which made them feel better. Participants told to collect data: "to simply pay attention to their triggers and to what it felt like when they did smoke." 

Session #2:
[P]eople would come back with reports of noticing how many times they smoked out of boredom. One gentleman cut down from thirty cigarettes to ten in those two days because he realized that the majority of his smoking was either habitual or a “solution” to fix other problems. For example, he smoked to cover up the bitter taste of coffee. With this simple realization, he started brushing his teeth instead. Perhaps more interesting were the reports I got from participants about what it was like to pay attention when they smoked. Many of them couldn’t believe how their eyes had been opened; they had never realized how bad smoking tasted. One of my favorite responses: “Smells like stinky cheese and tastes like chemicals. Yuck.”

Mindfulness is about "being interested in, and getting close and personal, with what is happening in our bodies and minds. It is really this willingness to turn toward our experience rather than to try to make our unpleasant cravings go away as quickly as possible." 

Participants then learned RAIN:
We can learn to ride the waves of wanting by surfing them. First, by RECOGNIZING that the wanting or craving is coming, and then RELAXING into it. Since you have no control over it coming, ACKNOWLEDGE or ACCEPT this wave as it is; don’t ignore it, distract yourself, or try to do something about it. This is your experience. Find a way that works for you, such as a word or phrase, or a simple nod of the head (I consent, here we go, this is it, etc.). To catch the wave of wanting, you have to study it carefully, INVESTIGATING it as it builds. Do this by asking, “What does my body feel like right now?” Don’t go looking. See what arises most prominently. Let it come to you. Finally, NOTE the experience as you follow it. Keep it simple by using short phrases or single words. For example: thinking, restlessness in stomach, rising sensation, burning, etc. Follow it until it completely subsides. If you get distracted, return to the investigation by repeating the question, what does my body feel like right now? See if you can ride it until it is completely gone. Ride it to shore.

Subsequent Sessions. Participants learned formal meditation practices that were to be done daily. Participants recorded how often they meditated and how many cigarettes they smoked. 

Results. Participants in the mindfulness group quit at twice the rate as those in the Freedom From Smoking group. Moreover, "nearly all the mindfulness participants had stayed quit, while many of those in the other group had lost ground." 

Mechanism of Change. "[P]eople who quit reported craving cigarettes at the same level as those that didn’t quit. They just didn’t smoke when they craved. Over time, their cravings decreased as they quit smoking." "While formal meditation practices were positively correlated with outcomes, the informal practice of RAIN was the only one that passed statistical muster—showing a direct relationship to breaking the craving-smoking link."

The Problem with Avoiding Triggers. Sometimes we can't avoid triggers -- e.g., if we avoid the boss who stresses us, we might get fired. 

The Problem with Substitution Strategies. Often you're just trading one vice for another -- e.g., replacing cigarettes with candy. 

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