02 Apr Behavioral Therapy Shown to Curb Nicotine Cravings
Cognitive behavioral therapy (CBT) is a form of psychotherapy that seeks to provide a healthy alternative to negative or unproductive thought processes that arise during stressful situations. This type of therapy frequently plays a prominent role in treatment programs for people recovering from drug and alcohol addictions. CBT technique have been shown to reduce cravings in smokers, even when those smokers have no stated desire to curb their tobacco use. This technique involves the use of simple mental reminders about the harmful effects of smoking.
Cognitive Behavioral Therapy Basics
Stress affects people in different ways. While some individuals adapt to stressful situations relatively well and maintain their sense of mental equilibrium, others lose their sense of equilibrium in stressful situations. People addicted to drugs, alcohol or nicotine commonly react to stress by engaging in thoughts or mental images that support and promote their continued substance use/abuse. Even when they decide to combat their addictions, their thought processes and images that supported the addictions typically remain intact. During sessions of cognitive behavioral therapy, recovering addicts learn to replace the thoughts and images that support substance use with thoughts and images oriented away from substance use. When the therapy is successful, recovering addicts gradually start to respond to stressful situations in ways that emphasize a balanced mental perspective rather than fulfillment of a short-term urge to smoke, drink or take drugs.
Brain Effects of CBT
As a result of information gathered in the first decade of the 2000s with the help of an imaging technology called function magnetic resonance imaging (fMRI), scientists have a fairly clear picture of the basic brain mechanisms that underlie the effectiveness of cognitive behavioral therapy. When an addict experiences cravings for nicotine, alcohol, or drugs, activity increases in a part of the brain known as the reward circuit or limbic system. This makes sense, since the same part of the brain is chemically activated by most substances of abuse, which achieve their basic effects by boosting the limbic system’s supply of a neurotransmitter called dopamine; this boost in dopamine produces a sense of pleasure by increasing the rate of communication between the nerve cells (neurons) contained within the system.
When addicts learn new coping techniques and consider the long-term consequences of their actions during moments of stress, activity increases in another circuit in the brain, located in a region called the prefrontal cortex. This region serves as the brain’s center for higher-level control functions that rein in impulsive urges arising in other brain areas. For this reason, when activity in the prefrontal cortex circuit increases, activity in the limbic system decreases. Through the techniques learned in cognitive behavioral therapy, the individual essentially learns how to boost prefrontal cortex activity and simultaneously diminish limbic system activity.
Effects on Smoking
In 2010, researchers from Columbia University’s Social Cognitive Neuroscience Laboratory used a verbal/visual experiment and fMRI imaging to examine the effects of cognitive behavioral therapy on the cravings of a group of smokers with a history of nicotine use extending back an average of 10 years. As indicated previously, these people did not have any intentions of quitting smoking. During testing of these smokers, the Columbia University researchers asked them to consider the rewarding sensations associated with smoking when randomly given a verbal cue of “now,” and alternately, to consider the negative effects of smoking when randomly given a verbal cue of “later.” Each verbal cue was given 50 times and accompanied by an image of a cigarette. After receiving each combination of cue and image, the participants were asked to rate their cravings for a cigarette on a scale of one to five.
After administering this experiment, the researchers measured the subjective craving levels reported in response to each type of cue. Compared to the level of craving associated with the smoking-positive “now” cue, the level of craving associated with the smoking-negative “later” cue dropped by an average of 34 percent. When they examined the fMRI images of the study participants’ brains during the experiment, the Columbia University researchers found a correlating increase in prefrontal cortex activity and decrease in limbic system activity during the “later” cue. Conversely, they found a correlating decrease in prefrontal cortex activity and increase in limbic system activity during the “now” cue.
These findings point to a potential real-world role for simple cognitive behavioral therapy techniques as a means to curb smoking levels in active smokers, or to reinforce abstinence in people who quit smoking.
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