“Why do we do that?”
Substitute “do that” with any number of behaviors: smoking cigarettes even though we know it’s bad for us, drinking too much, picking up a vaping habit, and you have what Mark Litt has dedicated his life to investigating.
Litt, a professor of oral health and diagnostic sciences and psychiatry in UConn Health’s Division of Behavioral Sciences and Community Health in the School of Dental Medicine, always wanted to go into a helping profession. This instinct coupled with his interest in science led him to start down the path to researching cognitive behavioral therapies. Litt has been interested in how to change human behavior since high school. During college and grad school, Litt’s horizons expanded and he became interested in health behaviors specifically through a connection with Professor Dennis Turk at Yale University where Litt completed both his master’s and Ph.D.
Litt began his research career looking at chronic pain management.
“Chronic pain is modifiable in most cases. People can take drugs, but there are also non-pharmacological ways people can get better,” Litt says. “So, the question is: How do they do that? What is going on in people? When they get better, they must be doing something, behaving, thinking, feeling, differently.”
Litt worked with patients experiencing acute pain after oral surgery to develop cognitive behavioral treatments to help them overcome the pain more quickly. Among chronic pain patients, he found patients with anxiety and depression tended to suffer the most, especially if they catastrophized the pain, thinking it to be far worse than it actually was; but by using cognitive behavioral strategies to cope with the pain, they fared better and experienced less pain and depression.
“Cognitive Behavioral Therapy (CBT) makes people better at coping on a momentary basis,” Litt says. “The next step is to use that momentary data to train people specifically to deal with these crises.”
Pain is a complex process that involves signals from the source of the pain back and forth with our nervous system. These signals are what let us know we are in pain. But there’s also a cognitive element to how we experience pain, and this is the area of focus for Litt.
“We might not be so good at changing pain signals, but we can do a lot to modify people’s thoughts and feelings about pain and use that to improve their quality of life,” Litt says.
People with better cognitive coping methods do not necessarily experience less pain, but they are able to be more functional while experiencing pain. The goal of Litt’s research is finding ways to teach others to use the cognitive and behavioral strategies some people are already using to successfully cope with the same pain.
“What ties all this together is what is at work in people when they change their behavior,” Litt says. “What is happening differently? What are people doing differently?”
This is the strategy he has applied to his work in substance abuse treatment research working with alcohol and marijuana use disorders. These studies begin with participants recording their moment-to-moment thoughts, feelings and actions. This allows researchers to look for patterns and triggers for their substance abuse.
“This was a level of detail that was not previously available,” Litt says. “People are not typically good at remembering events. These recordings of real-time events are valuable because they show what people are doing rather than what they think they’re doing.”
This approached allows therapists to develop individualized treatments for each patient based on their unique behavioral patterns, which is potentially more effective than using a one-size-fits-all approach to treatment.
For people with alcohol use disorder (AUD), drinking is a part of their routine and is often done without much thought. By identifying where in a person’s routine drinking occurs, therapists can work with individual patients to change their routines, whether it be taking a different route home from work that doesn’t go by a bar or liquor store, or if a therapist finds a person only drinks after arguing with their partner, they can work with them to find better coping mechanisms.
Another approach to treating substance abuse disorders focuses on changing the environment that encourages a person’s drinking behavior. Most research on this topic has focused on changing the person rather than the environment, since, as Litt points out: “Is it easier to use an umbrella or change the weather?”
But there are elements of one’s environment that can be altered, one of the most important being surrounding oneself with a sober social support network. One of the biggest problems for those struggling with AUD is that their social network is composed of people who drink, and so drinking, and heavy drinking, is viewed as the norm. This is especially concerning for impressionable adolescents who begin drinking at an early age.
Litt has also been working with behavior surrounding e-cigarettes which have become incredibly popular with teens and young adults, largely because they come in fun, attractive flavors like mango and cucumber.
One study Litt conducted found adult cigarette smokers preferred menthol and tobacco flavors over the fruity flavors young people gravitate toward. These results may have implications for the utility of e-cigarettes as tools for helping people stop smoking.
“If Juul only had menthol and tobacco flavors, the attraction would be significantly less for young people,” Litt says. “If they wanted to appeal to adult smokers only, they would do that.”
In all his work with CBT, Litt has learned a very important lesson: it is incredibly challenging to determine with absolutely certainty what movitates human health behavior.
“The great, humbling moral of that story was for me and continues to be the lesson for the field, is that we really don’t know what’s going on with people,” Litt says. “We may think we know, but we don’t. At least not on a big scale.”
Litt says that while many projects in this field “nibble around the edges” of explaining the rationale of human behavior, the incremental strides still have an impact for the individuals they help, even if they are only small steps forward in the quest to understand why we do the things we do.
“When I go home shaking my head, I can at least think of the people we’ve helped,” Litt says. “I think we’ve done a fair amount of good.”