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Judith Beck: Train Your Brain to Think Like a Thin Person

(Brain Fit­ness doesn’t require the use of expen­sive equip­ment. Your brain is enough. Today, as part of our research for The Sharp­Brains Guide to Brain Fit­ness, we are hon­ored to inter­view Dr. Judith Beck on how cog­ni­tive tech­niques can be applied to improve our health and our lives. The lat­est appli­ca­tion? Los­ing weight.)Judith Beck, Cognitive Therapy

Dr. Judith Beck is the Direc­tor of the Beck Insti­tute for Cog­ni­tive Ther­a­py and Research, Clin­i­cal Asso­ciate Pro­fes­sor of Psy­chol­o­gy in Psy­chi­a­try at the Uni­ver­si­ty of Penn­syl­va­nia, and author of Cog­ni­tive Ther­a­py: Basics and Beyond. Her most recent book is The Beck Diet Solu­tion: Train Your Brain to Think Like a Thin Per­son.

Dr. Beck, thanks for your time. What does the Beck Insti­tute do?

We have 3 main activ­i­ties. One, we train prac­ti­tion­ers and researchers through a vari­ety of train­ing pro­grams. Two, we pro­vide clin­i­cal care. Three, we are involved in research on cog­ni­tive ther­a­py.

Please explain cog­ni­tive ther­a­py in a few sen­tences

Cog­ni­tive ther­a­py, as devel­oped by my father Aaron Beck, is a com­pre­hen­sive sys­tem of psy­chother­a­py, based on the idea that the way peo­ple per­ceive their expe­ri­ence influ­ences their emo­tion­al, behav­ioral, and phys­i­o­log­i­cal respons­es. Part of what we do is to help peo­ple solve the prob­lems they are fac­ing today. We also teach them cog­ni­tive and behav­ioral skills to mod­i­fy their dys­func­tion­al think­ing and actions.

I under­stand that cog­ni­tive ther­a­py has been test­ed for many years in a vari­ety of clin­i­cal appli­ca­tions. What moti­vat­ed you to bring those tech­niques to the weight-loss field by writ­ing The Beck Diet Solu­tion?

Since the begin­ning, I have pri­mar­i­ly treat­ed psy­chi­atric out­pa­tients with a vari­ety of diag­noses, espe­cial­ly depres­sion and anx­i­ety. Some patients expressed weight loss as a sec­ondary goal in treat­ment. I found that many of the same cog­ni­tive and behav­ioral tech­niques that helped them over­come their oth­er prob­lems could also help them to lose weight‚ and to keep it off.

I became par­tic­u­lar­ly inter­est­ed in the prob­lem of over­weight and was able to iden­ti­fy spe­cif­ic mind­sets or cog­ni­tions about food, eat­ing, hunger, crav­ing, per­fec­tion­ism, help­less­ness, self-image, unfair­ness, depri­va­tion, and oth­ers, that need­ed to be tar­get­ed to help them reach their goal.

What research results back your find­ing that those tech­niques help?

Prob­a­bly the best pub­lished study so far is the ran­dom­ized con­trolled study by Karolin­s­ka Insti­tute‚¬ Stahre and Hal­strom (2005, ref­er­ence below). The results were strik­ing: near­ly all 65 patients com­plet­ed the pro­gram and this short-term inter­ven­tion (10-week, 30-hours) showed sig­nif­i­cant long-term weight reduc­tion, even larg­er (when com­pared to the 40 indi­vid­u­als in the con­trol group) after 18 months than right after the 10-weeks pro­gram.

That sounds impres­sive. Can you explain what makes this approach so effec­tive?

A unique fea­ture is that the book doesn’t‚- offer a diet but does pro­vide tools to devel­op the mind­set that is required for sus­tain­able suc­cess, for mod­i­fy­ing sab­o­tag­ing thoughts and behav­iors that typ­i­cal­ly fol­low people‚¬its  ini­tial good inten­tions. I help dieters acquire new skills. We have sold over 70,000 books so far, and are plan­ning to release a com­pan­ion work­book this month to fur­ther help read­ers imple­ment the 6-week pro­gram and track progress.

So, in a sense, we could say that your book is com­ple­men­tary to all oth­er diet books.

Exactly‚¬it will help read­ers at set­ting and reach­ing their long-term goals, assum­ing that the diet is healthy, nutri­tious, and well-bal­anced.

The main mes­sage of cog­ni­tive ther­a­py over­all, and its appli­ca­tion in the diet world, is straight-for­ward: prob­lems los­ing weight are not one‚¬ fault. Prob­lems sim­ply reflect lack of skills–skills that can be acquired and mas­tered through prac­tice. Dieters who read the book or work­book learn a new cog­ni­tive or behav­ioral skill every day for six weeks. They prac­tice some skills just once; they auto­mat­i­cal­ly incor­po­rate oth­ers for their life­time.

What are the cog­ni­tive and emo­tion­al skills and habits that dieters need to train, and where your book helps?

Great ques­tion. That is exact­ly my goal: to show how every­one can learn some crit­i­cal skills. The key ones are:

1) How to moti­vate one­self. The first task that dieters do is to write a list of the 15 of 20 rea­sons why they want to lose weight and read that list every sin­gle day.

2) Plan in advance and self-mon­i­tor behav­ior. A typ­i­cal rea­son for diet fail­ure is a strong pref­er­ence for spon­tane­ity. I ask peo­ple to pre­pare a plan and then I teach them the skills to stick to it.

3) Over­come sab­o­tag­ing thoughts. Dieters have hun­dreds and hun­dreds of thoughts that lead them to engage in unhelp­ful eat­ing behav­ior. I have dieters read cards that remind them of key points, e.g., that it isn’t¬ worth the few moments of plea­sure they all get from eat­ing some­thing they hadn’t planned and that they’ll feel bad­ly after­wards; that they can’t eat what­ev­er they want, when­ev­er they want, in what­ev­er quan­ti­ty they want, and still be thin­ner; that the scale is not sup­posed to go down every sin­gle day; that they deserve cred­it for each help­ful eat­ing behav­ior they engage in, to name just a few.

4) Tol­er­ate hunger and crav­ing. Over­weight peo­ple often con­fuse the two. You expe­ri­ence hunger when your stom­ach feels emp­ty. Crav­ing is an urge to eat, usu­al­ly expe­ri­enced in the mouth or throat, even if your stom­ach is full.

When do peo­ple expe­ri­ence crav­ings?

Trig­gers can be envi­ron­men­tal (see­ing or smelling food), bio­log­i­cal (hor­mon­al changes), social (being with oth­ers who are eat­ing), men­tal (think­ing about or imag­in­ing tempt­ing food), or emo­tion­al (want­i­ng to soothe your­self when you are upset). The trig­ger itself is less impor­tant than what you do about it. Dieters need to learn exact­ly what to say to them­selves and what to do when they have crav­ings so they can wait until their next planned meal or snack.

How can peo­ple learn that they don’t have to eat in response to hunger or crav­ing?

I ask dieters, once they get med­ical clear­ance, to skip lunch one day, not eat­ing between break­fast and din­ner. Just doing this exer­cise once proves to dieters that hunger is nev­er an emer­gency, that it is tol­er­a­ble, that it doesn’t keep get­ting worse, but instead, comes and goes, and that they don’t need to “fix” their usu­al­ly mild dis­com­fort by eat­ing. It helps them lose their fear of hunger. They also learn alter­na­tive actions to help them change their focus of atten­tion. Feel hun­gry? Well, try call­ing a friend, tak­ing a walk, play­ing a com­put­er game, doing some email, read­ing a diet book, surf­ing the net, brush­ing your teeth, doing a puz­zle. My ulti­mate goal is to train the dieter to resist temp­ta­tions by firm­ly say­ing “No choice”, to them­selves, then nat­u­ral­ly turn­ing their atten­tion back to what they had been doing or engag­ing in what­ev­er activ­i­ty comes next.

You said ear­li­er that some crav­ings fol­low an emo­tion­al reac­tion to stress­ful sit­u­a­tions. Can you elab­o­rate on that, and explain how cog­ni­tive tech­niques help?

In the short term, the most effec­tive way is to iden­ti­fy the prob­lem and try to solve it. If there is noth­ing you can do at the moment, call a friend, do deep breath­ing or relax­ation exer­cis­es, take a walk to clear your mind, or dis­tract your­self in anoth­er way. Read a card that reminds you that you all cer­tain­ly not be able to lose weight or keep it off if you con­stant­ly turn to food to com­fort your­self when you are upset. Peo­ple with­out weight prob­lems gen­er­al­ly don’t turn to food when they are upset. Dieters can learn to do oth­er things, too.

And in the long term, I encour­age peo­ple to exam­ine and change their under­ly­ing beliefs and inter­nal rules. Many peo­ple, for exam­ple, want to do every­thing (and expect oth­ers to do every­thing) in a per­fect way 100% of the time, and that is sim­ply impos­si­ble. This kind of think­ing leads to stress.

The title of the book includes a  train your brain  promise. Can you tell us a bit about the grow­ing lit­er­a­ture that ana­lyzes the neu­ro­bi­o­log­i­cal impact of cog­ni­tive ther­a­py?

AmygdalaYes, that is a very excit­ing area. For years, we could only mea­sure the impact of cog­ni­tive ther­a­py based on psy­cho­log­i­cal assess­ments. Today, thanks to fMRI and oth­er neu­roimag­ing tech­niques, we are start­ing to under­stand the impact our actions can have on spe­cif­ic parts of the brain.

For exam­ple, take spi­der pho­bia. In a 2003 paper (Note: ref­er­ence below)  sci­en­tists observed how, pri­or to the ther­a­py, the fear induced by view­ing film clips depict­ing spi­ders was cor­re­lat­ed with sig­nif­i­cant aAmygdala fMRIacti­va­tion of spe­cif­ic brain areas, like the amyg­dala (Edi­tor note: pics added for illus­tra­tion. On the left, the yel­low cir­cle shows the loca­tion of the amyg­dala. On the right, the red col­or indi­cates the lev­el of acti­va­tion of the amyg­dala, the “fear cen­ter of the brain”). After the inter­ven­tion was com­plete (one three-hour group ses­sion per week, for four weeks), view­ing the same spi­der films did not pro­voke acti­va­tion of those areas. Those indi­vid­u­als were able to “train their brains and man­aged to reduce the brain response that typ­i­cal­ly trig­gers auto­mat­ic stress respons­es. And we are talk­ing about adults.

Dr. Beck, that is exact­ly what we find most excit­ing about this emerg­ing field of neu­ro­plas­tic­i­ty: the aware­ness that we can improve our lives by refin­ing, “train­ing” our brains, and the grow­ing research behind a num­ber of tools such as cog­ni­tive ther­a­py. Thanks a lot for shar­ing your thoughts with us.

My plea­sure.

————————–

Research Papers men­tioned

Stahre L, Hll­strm T. (2005). “A short-term cog­ni­tive group treat­ment pro­gram gives sub­stan­tial weight reduc­tion up to 18 months from the end of treat­ment. A ran­dom­ized con­trolled tri­al” Eat­ing and Weight Dis­or­ders. 2005 Mar;10(1):51–8.

Paque­tte, V., Levesque, J., Men­sour, B., Ler­oux, J. M., Beau­doin, G., Bour­gouin, P., et al. (2003). Effects of cog­ni­tive-behav­ioral ther­a­py on the neur­al cor­re­lates of spi­der pho­bia. Neu­roim­age, 18, 401–409.

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46 Responses

  1. Sarah Connar says:

    Train your brain to think like a thin per­son”
    That is a hor­ri­bly dis­crim­i­nate head­line, you make it seem like there is a bio­log­i­cal dif­fer­ence in the men­tal­i­ty or cog­ni­tive abil­i­ties between a thin and obese indi­vid­ual. While there are some bio­log­i­cal traits that lead to obe­si­ty , I don’t think that obe­si­ty can be so read­i­ly trained into some sort of mind­set to becom­ing thin.

  2. Alvaro says:

    Dear Sarah: there seems to be some com­mu­ni­ca­tion prob­lem. That is the title of the real book, and it reflects the key point of the book and the ben­e­fits of cog­ni­tive ther­a­py: we can train our mind­sets (which have a neu­ro­log­i­cal base, so in prac­tice we can train our brains) to adopt good atti­tudes, beliefs and skills that will help us not only lose weight but be able to main­tain a healthy, fit body over the long term, beyond “quick fix­es”. This is not innate (what I guess you call bio­log­i­cal). I hope this helps.

  3. john says:

    Sarah Con­nar:

    It’s a MENTALITY dif­fer­ence cre­at­ed by day to day habits that man­i­fest into phys­i­cal traits. This is a per­fect exam­ple of teach­ing your brain the dif­fer­ence between ‘want’ and ‘need’ which is very often the rea­son why obese peo­ple often stay obese, why com­pul­sive shop­pers can’t break the habit, etc.

  4. CBT fan says:

    hey, thx for doing the good inter­view with Judith Beck. I do a reg­u­lar Google blog search on that sub­ject, as I am using the book myself, and have dropped close to 40 lbs in about 3 months, and am almost done with the weight-loss process, and now have to use the cog­ni­tive-behav­ioral tools to make sure I don’t back­slide.

    I hap­pened to have a lot of expe­ri­ence with CBT, so I was able to apply the book quite quick­ly. For me, the most impor­tant thing was learn­ing to Tol­er­ate Dis­com­fort. That is, learn­ing to say NO to myself for cer­tain Crav­ings, and not act on them, and to just observe the “painful emo­tions” increase and then extin­quish them­selves. Most of us will give into Crav­ings as we think NOT giv­ing into them will be “too painful”. If we real­ly fol­low through on it, we find its not that bad, and the Crav­ing will extin­guish itself, some­thing like Clas­si­cal con­di­tion­ing, but due to cog­ni­tive eval­u­a­tions like…“hey, I didn’t eat it, and its wasn’t that bad”.
    There is some great stuff in that book, and CBT is an amaz­ing set of cog­ni­tive-emo­tive-behav­ioral tools…

    and the best thing about it, is that its not sta­t­ic, and its always being test­ed and fal­si­fied, so it can improve, this is because Dr. Aaron Beck has used the sci­en­tif­ic method to devel­op CBT.

  5. CBT fan says:

    whoops, I for­got to men­tion there is an online group of folks doing the Beck Diet Solu­tion at Peer­train­er, you can join here for free if you are work­ing through the book. There are about 90 mem­bers…
    —————
    MIND OVER MATTER
    http://www.peertrainer.com/TeamDetails.aspx?GroupID=25340

  6. Alvaro says:

    John: thank you for that great com­ment.

    CBT fan: thanks for shar­ing your first-hand per­spec­tive. And thanks for the offer, but I con­fess I am not on any diet pro­gram myself, my main inter­est is to under­stand how cog­ni­tive tech­niques can be used to devel­op men­tal skills that help us accom­plish our goals, and Dr. Beck’s great work has been open­ing new ground. Good luck with your pro­gram!

  7. CBT fan says:

    hi there, yeah, my post­ing of the link would be for any­one who hap­pens to read the blog who has the book and is look­ing for a place to sound-out a bit.

    CBT is an amaz­ing set of tools. You should try to get an inter­view with the God­fa­ther him­self, Dr. Aaron Beck, and ask him some ques­tions about that, as he is a very smart guy. His book “The Inte­gra­tive Pow­er of Cog­ni­tive Ther­a­py” is tru­ly excel­lent.
    He designed many tools, like the TIC-TOC method and many oth­er ways to achieve Goals and prob­lem solv­ing.

    Also, Dr. David Burns has writ­ten a num­ber of gen­er­al books from the CBT per­spec­tive as well. He has a new book out called WHEN PANIC ATTACKS which is pure CBT, he might do an inter­view as well.

    In my view, CBT is the best “self-help” set of tech­niques out there, for dozens of rea­sons. The #1 rea­son is that they are sci­ence based, are Real­is­tic, and so far haven’t been abused and over­sold by hucksters…yet.

    Some peo­ple have said CBT sounds like “The Secret”, but the real­i­ty is that it is the oppo­site of “The Secret” as CBT is the oppo­site of MAg­i­cal Think­ing, that is a Cog­ni­tive Dis­tor­tion.

    Basi­cal­ly, CBT is lit­er­al­ly the Sci­en­tif­ic Method applied on a per­son­al lev­el. Ask Dr. Aaron Beck about that.
    That sounds sim­ple, but it is not.
    CBT is apply­ing the sci­en­tif­ic method to our own cog­ni­tions and beliefs. That is heavy stuff…

  8. Alvaro says:

    CBT fan: very good com­ments. Thank you. I will in fact be talk­ing more about some fas­ci­nat­ing CBT stud­ies.

    And, why not, I will see if Dr. Aaron Beck if avail­able for an inter­view. It would be a very stim­u­lat­ing hon­or to inter­view him.

    Will check Dr. Burns book.

  9. carlos says:

    great idea.

  10. Alvaro says:

    Thanks, Car­los. I find Dr. Beck’s work fas­ci­nat­ing.

  11. Phil says:

    CBT is great, because it is a step by step method to retrain one­self to react like some­one who is able to feel emo­tions but not be over­come by them. Overeaters must be able to reframe their emo­tions which may be behind the crav­ings to be less “dan­ger­ous”, for exam­ple, “I feel as though I am worth­less, but that is just a feel­ing or a thought, not absolute truth”, in order to tol­er­ate the dis­com­fort of expe­ri­enc­ing them. This can work for more than just eat­ing, as was men­tioned ear­li­er. I am so glad this method is get­ting more wide­spread cred­i­bil­i­ty.

  12. CBT fan says:

    You could ask Dr. Aaron Beck about the many mis­con­cep­tions about CBT, he has writ­ten about that.
    For exam­ple, many ther­a­pists even crit­i­cize CBT for how it han­dles Emo­tions.

    For exam­ple, above was men­tioned that CBT seems brain­washy, and how it relates to Emo­tion.
    But that is a tricky area.

    For exam­ple, if a per­son digs into CBT beyond the charts, one sees that CBT is about human free­dom. Look into the 10 Axioms of Cog­ni­tive Ther­a­py by Dr. Aaron Beck.
    http://www.amazon.com/Integrative-Power-Cognitive-Therapy/dp/1572303964

    I see CBT as the oppo­site to any type of Preach­ing, as ulti­mate­ly you are going to become your own ther­a­pist, and make up your own mind, and solved your own prob­lems, etc.

    As far as human emo­tion, that is extreme­ly tricky. The com­mon error about CBT is that it tried to negate human emo­tion, which again is the exact oppo­site of what CBT real­ly is!
    Its the old Straw Man argu­ment again.

    CBT is about feel­ing deeply, and feel­ing the entire range of human emo­tions. But it also gives a way to deal with extreme human emo­tions that screw peo­ple up.

    But as far as I know, CBT has not yet been prop­er­ly applied to enhanc­ing human per­for­mance. This will have to be done in a sci­en­tif­ic and care­ful way, as opposed to the typ­i­cal method of the self-helper pub­lish­ers of pulling things out of their pos­te­ri­or that they think will sell.

    Judith Beck’s recent book, “Cog­ni­tive Ther­a­py for Chal­leng­ing Prob­lems” is quite good, and deals a lot with Core Beliefs, which seem to be the foun­da­tion of our per­son­al­i­ties and behav­iors, emo­tions, assump­tions, rule, and even thoughts.

  13. Alvaro says:

    Phil: thanks for your great com­ment.

    CBT fan: I agree with many of your com­ments. What do you mean with “CBT has not yet been prop­er­ly applied to enhanc­ing human per­for­mance.”?

  14. Wally says:

    This is won­der­ful. Thanks for shar­ing this.

  15. Alvaro says:

    You are wel­come, Wal­ly. Let’s thank Judith for her work and time!

  16. Pat says:

    Inter­est­ing. This cog­ni­tive ther­a­py is indeed great for our brain with all its ben­e­fits.

  17. kelly says:

    Very good arti­cle and i think the 1st step to los­ing weight is your mind­set. You can’t lose weight just by think­ing like a thin per­son, but it does help to have that mind­set, as you are work­ing on your goal to get thin­ner.

  18. Alvaro says:

    Yes, Kel­ly, what I think is Judith’s main mes­sage is that it is SKILLS that mat­ter, and that we can all devel­op them.

  19. Anna4 says:

    Yes, great job. 🙂 Inter­est­ing indeed.

  20. Thanks Alvaro for bring­ing Beck’s work to the fore for dis­cus­sion.

    Two thoughts:

    The gen­er­a­tional issue here is writ large. The effi­cien­cy and suc­cess of skill based log­ic varies from work with chil­dren, teenagers and adults. Agreed?

    Sec­ond, As an adult who can look back on teenage years when ther­a­pies for obe­si­ty and eat­ing dis­or­ders focused sim­ply on the “O.C.D” or addi­tion motif, it’s great to see neu­ro­science weigh­ing in on the sub­ject.

    May I sug­gest that with respect to diet­ing, mind­set and the brain, we think about the role brain-map­ping plays in body-map­ping and body image. Behav­ior, after all, is embed­ded into a com­plex sys­tem of skills that work at the sys­temic lev­el of the body “tis­sues” — skills that enable an embod­ied sense of being at peace (or in strug­gle) with onself or the world.

  21. Mary says:

    This is so excit­ing!! I spent 10 years trapped in my home by ago­ra­pho­bia. A friend of mine, a physi­cian who was in ther­a­py, was giv­en “The Feel Good Hand­book,” which she passed on to me. What a hor­ri­ble title 🙂 But I skimmed it any­way, just so I’d have some­thing intel­li­gent I could say to my friend that would show I appre­ci­at­ed her thought­ful­ness. Ooooohma­good­ness. None of the book made sense until I looked at my beloved dog and real­ized he would be lunch in anoth­er coun­try, and only because of the way they think. I dove into that book, searched out oth­ers like it, then went look­ing for a CBT ther­a­pist that was close. He ter­mi­nat­ed ther­a­py after 6 weeks and I’d achieved my top goals, the most impor­tant being able to renew my dri­vers license (long since lost because I couldn’t renew). He said I’d made excep­tion­al progress and had gone as far as could be expect­ed. Ha!! I kept dig­ging and research­ing and work­ing, work­ing, work­ing, work­ing towards the day when I’d no longer have any bound­aries. It took a very long time, but even­tu­al­ly the “tip­ping” point was achieved. I was “nor­mal,” and then some, fly­ing 150,000 miles around the globe in just one year.

    I can’t believe I’ve been so cocky in my suc­cess that I nev­er even con­sid­ered apply­ing CBT in con­trol­ling these ever-expand­ing thighs I’ve got­ten in mid­dle age. I’ve seen this book but thought it was a touchy-feely “The Secret” of thun­der thighs.

    Excuse me while I leave skid marks on the dri­ve­way while head­ing for Barnes & Noble 🙂

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