Taming the Smoker’s Brain: A Better Way to Quit?

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Any American who has bought a pack of cigarettes since the mid-’60s might have seen the health warnings. One of the first, quaint and timid, said, “Cigarette Smoking May Be Hazardous to Your Health.” By comparison, last year I bought a scary pack of Lucky Strikes that I keep in the freezer for Don Draper-esque emergencies. It says, “SURGEON GENERAL’S WARNING: Smoking Causes Lung Cancer, Heart Disease, Emphysema, And May Complicate Pregnancy.”

Such government warnings work, sort of — research has shown that smokers in countries with strong warnings are more knowledgeable about smoking risks than those in countries where warnings are weaker. But it’s unclear whether smokers who see any warning actually smoke less.

Public-health advocates have known for years that individualized messages are far more effective at getting smokers to stop. For instance, if a doctor reminds a patient that her sister has promised to help her quit, that patient will be much more likely to stop smoking than someone who just sees a general message on a cigarette pack.

It’s obvious that such a personalized message would be more psychologically effective — you think fondly of your sister’s willingness to help, so you decide not to light up. But now there is evidence that individualized advice can also be physiologically effective — that it can actually change your neural pathways.

A recent study published in the journal Nature Neuroscience shows that tailored antismoking messages engage brain regions involved in how people see themselves. Those regions are the medial prefrontal cortex, which is associated with emotion regulation, and the posterior cingulate region, which is associated with basic human awareness and, possibly, awareness of others’ perceptions of us.

The authors of the study, a University of Michigan team led by psychologist Hannah Faye Chua, recruited 91 smokers who wanted to quit. The participants, who smoked an average of 17 cigarettes per day, underwent fMRI scanning for one hour while different messages appeared on a screen. Some messages were tailored to their personal histories (for example, “A concern you have is being tempted to smoke when around other smokers”). Some messages were general antismoking appeals (“Smokers are admitted to the hospital more often than nonsmokers”). And then there was a control group of completely unrelated messages (“Wind is simple air in motion”).

The researchers found that the tailored messages activated the two brain regions significantly more than the non-tailored and neutral messages. In other words, reading a short sentence changed their brain activity — and those who showed stronger activity in those regions were more likely to quit smoking in the following four months.

The reason this paper is important is that it contributes to a growing body of research showing that what is often derided as “talk therapy” can produce real changes in brain function. For instance, a 2006 Molecular Psychiatry paper found that cognitive-behavioral therapy (CBT) quieted the right caudate nucleus in patients with obsessive-compulsive disorder. That nucleus is involved in how we learn behavior. If a patient indulges his compulsions — in effect, learning them over and over — the nucleus becomes more active. Changing behavior through psychotherapy can dial down that nucleus.

Of course, psychiatric drugs also change brain activity, but many studies have found that such drugs are no more effective than evidence-based psychotherapies like CBT. In other words, if you really want to quit smoking, you should commit to a rigorous behavioral-therapy program. It will not only help you stop; it could change how your brain works.


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