Anna Lembke

People who come in seeking help for anxiety, depression, suicidal thinking,

And what we find is that their anxiety, depression, and suicidal thoughts in the vast majority get better without her having to do anything else other than cut out for a period of time their high dopamine substances and behaviors.

Self-binding techniques create both literal and metacognitive barriers between ourselves and our substance or behavior of choice so that we can press the pause button between desire and consumption.

And there are many different ways to do that.

I sort of organize it into time, space, and meaning to give us a fighting chance to be able to abstain.

That looks like, for example, not having the substance in the house, if it's alcohol or potato chips or cookies or whatever it is, not having it in the house is a really simple one.

My patients talk about when they travel, calling the hotel in advance and having the hotel remove the minibar from the room, in some cases remove the minibar and the television set so there's not access to the kind of cable channels that make people vulnerable.

I've had patients use things like the kitchen safe,

You know, so that they lock their device in there.

They can't get it out for a certain period of time.

So this is the way to use time as a self-binding construct.

What I think is really interesting is the way that we essentially organize our time around rewards in the modern world in a way that I think is unprecedented.

You know, we sort of look forward to our coffee in the morning and then we can't wait to get home at night and watch our shows.

And so what I ask patients to do is to be aware of that and then use time to their advantage.

For example, if they've done the dopamine fast and now they want to go back to using their substance or behavior, but they want to use in moderation, they could commit to, for example, only playing video games two days a week, two hours a day.

and specify when that is.

Or if they want to have some mindless scrolling on social media, they can say, okay, I'm going to dedicate a half hour a day, and this is when it's going to be.

And then I know I'm going to do mindless scrolling or YouTube watching, but outside of that, I'm not going to do that.

Or I'm going to wait till I finish this exam or turn in my paper or get this job promotion, and then to use that as a way to bind themselves.

Yeah, so he had to do something called self-banning, where he basically went to the casinos and put himself on a banned list, which is very common among pathological gamblers, pathological sports bettors.