Additional insights for behavioral change at the neurological level are provided by the process applied by Doidge (2007) in which he describes techniques used for patients with Obsessive Compulsive Disorder (OCD) in which psychotherapist Jeffrey Schwartz attempts to shift the obsessive focus of OCD patients who get immobilizing “brain lock”. He achieves this by training these patients to actively focus on something else, specifically a pleasurable experience, besides the obsessive worry. Doidge notes that this makes sense from a neuroplasticity perspective because this kind of focus, when practiced and repeated, “grows” a new brain circuits that provide the pleasure sensation by triggering dopamine release which rewards the new thinking process and consolidates and grows new neuronal connections. This new circuit can eventually become a more dominant connection than the previous one, and the old neuronal connections weaken. Doidge continues to describe that in this way “we don’t so much “break” bad habits as replace bad behaviors with better ones”.
Swartz, as described by Doidge, describes a three-step process to rewire negative thinking and behaving patterns:
* The first step is to “re-label” what is happening. In the case of an OCD patient, this may be to begin to recognize that the negative thought is not actually happening, say being invaded by massive swarms of toxic germs, but rather recognizing it as a faulty connection in the brain that can be corrected. In other words, similar to the “mindfulness” technique of creating distance from the thinking process and contemplate the “thought from a distance” – in other words develop the skill to “think about our thinking”. In this manner, the patient can be contemplative about the sensation versus simply reacting to it (Muesse’s bee experience is a good example for this step).
*Once the patient acknowledges that the anxiety is not real (“it’s my bad neural wiring not actually germs attacking me”), the patient refocuses on a pleasurable thought – something that is unique to that individual, like gardening, walking on beach, or hiking in the forest. In this step it is important for the patient to initially have a “trigger” that quickly “shifts gears” and re-focuses the brain. This step requires practice. Doidge explains that by refocusing “the patient is learning not to get sucked in by the content (ie the germs) of an obsession but to work around it”. By doing this the “use it or lose it” principle kicks-in, but in reverse – by diverting the thinking process, the old neuronal connections atrophy and new connections strengthen. The patient actually learns to think about and imagine neural circuits being changed in this process.
