Watching the Mind - Working with Cravings

There is a hopeful new technique making the rounds of therapy recently. It is simple and easy to remember. It was originally formulated at the UCLA School of Medicine by Dr. Jeffrey Schwartz and colleagues for the treatment of Obsessive Compulsive Disorder. Dr. Gabor Maté, in his new book “In the Realm of the Hungry Ghost”, reports positive results with addictions using this approach, called by UCLA the”Four-Step Self Treatment Method.” It has good, solid theory behind it. Read Dr. Maté’s book for more.


There are four steps: re-label, re-attribute, re-focus, and re-value. Dr. Maté has added a fifth: re-create.


Re-label: Conscious awareness. See yourself as a spectator and watch your brain telling you that you need this substance or this activity. This is the step that takes practice, to break the cycle of immediately and unthinkingly complying with the order.


Re-attribute: “This is my brain sending me false messages. I don’t really need this. I may want it but I don’t need it” The brain doesn’t give up easily. The urges will continue, albeit with less intensity and less often as you work with the method.


Re-Focus: Cravings, like waves, do pass. Develop a list of distractions to get you through the next fifteen or twenty minutes. Exercise is good; crossword puzzles or Sudoku are handy; floors can always use a sweep or a vacuum—you get the idea. Whatever does not involve you in an addictive activity.


Re-value: Your brain has been telling you that this urge is the most important thing in the world. What has satisfying this urge done to your life? Be specific. Write it down and keep adding to it. Perhaps a small notebook you can carry with you. Dr. Jeffrey Schwartz says that the more thoroughly you examine the price you have paid, the more quickly the behavior will reduce. This is not about judging yourself. Be compassionate.


Re-create: As Dr. Maté puts it “Life, until now, has created you.” Now, take the time and thought to consider what values, what talents, what capabilities await you in your new life. Again, write about this, and take your time. Surprising things may result. Creativity may be what is missing. Dr. Maté has another great line in his book. (Actually, he has many great lines in the book, but this one resonated with me.) In many cases, substances and compulsive behaviors act to fill a great aching hole. Dr. Maté noted “A void I’ll do anything to avoid.”


This simple technique will need to be done many times, until it becomes as ingrained as the patterns of addiction were. Laughter helps.


The study of neurology has come a long way in the last few years. It is now clear that we can change some of the brain’s wiring by sheer persistence. That old cliché “You can’t teach an old dog new tricks” is wrong. I hope to discuss some of the more recent, and exciting discoveries in more detail in future blogs.