(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)

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?

Yes, 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 a acti­va­tion 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.

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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.