Dr. Judson Brewer - "The Craving Mind"

HAROLD ROTH: Good evening, everybody. We're starting on Brown time, which is roughly seven minutes after the announced start, just to give people a chance to get here and to follow existing practices. My name is Harold Roth, and I'm the director of the Contemplative Studies program here at Brown. And I'd like to welcome you this evening and say a few words to you about Contemplative Studies-- what it is that we do. I'm also curious about where we're drawing our audience from this evening. So how many found out about this program from our website? OK. And how many found out about it from the medical school? No? And how many of you are medical practitioners in one version or another-- clinicians? That's very interesting. OK. SPEAKER 1: Get the microphone. SPEAKER 2: Yeah, you have to unmute yourself. Unmute the podium mic. Right. HAROLD ROTH: Oh, here. SPEAKER 2: Secrets. There you go. HAROLD ROTH: Podium mic. Testing. So should I redo what I just said? No, everybody heard me, at least at some low level, I hope. So again, I'd like to welcome you this evening and tell you a few words about what we do in Contemplative Studies. We're one of the newest, if not the newest, concentration at Brown. If you don't know what a concentration is, it's what most schools call a major. We're a concentration in the exciting new field of Contemplative Studies. It's a new field that combines scientific and humanistic approaches to studying human contemplative experience across cultures and across time from a number of perspectives. And we include in that-- teaching contemplative practices in a classroom setting. So the reason that we can do this is that unlike contemplative practices that you would learn at a contemplative practice center, such as a monastery, a temple, a mosque, a synagogue, a church-- what we do in Contemplative Studies is we teach first-person engagement with a contemplative practice. We teach the context, the cognitive framework in which that practice is embedded. But we do not ask, we do not require a belief in the verticality of that framework, and that's what differentiates us. We study both still meditations, sitting meditations such as mindfulness. We study moving meditation such as qigong. And we have approaches which include the sciences and the humanities. And the humanities approaches help us understand the cultural context, from which the contemplative practices that we study in our research, have emerged. Tonight's lecture by Dr. Judson Murray is an example of the kind of contemplative science research that we think is extremely important for the academic field of Contemplative Studies. I'd like to also mention that Thursday night, between 6:00 and 8:00, we have an open house for students, or anybody, really, from the community who's interested in learning more about Contemplative Studies, about the courses that we teach. We have three new courses coming up in the second semester and also, learning about the concentration, what it entails, what are the requirements? And to meet some of the people who are involved, both students and faculty members. So that's Thursday. It's just behind here in Smith-Buonanno, 106. And it starts at 6 o'clock, and it is going to be catered by Kabob and Curry, a constant favorite on the Brown campus. So it gives me great pleasure tonight to introduce our speaker Dr. Judson Brewer. Jud earned a bachelor degree in chemistry from Princeton, and an MD in medical science from Washington University Medical School in St. Louis, a PhD in immunology, and did a residency in psychiatry at Yale, spending 12 years in a post-baccalaureate study and research, surpassing the 10 years that the current speaker spent. Once you discover something you love, you try to keep at it as long as you can. So he has been a researcher at Yale and continues as an adjunct assistant professor there. He's affiliated with MIT. He's a tenured associate professor at UMass Medical School. He is the acting director of the Center for Mindfulness, started by Jon Kabat-Zinn, who founded mindfulness-based stress reduction, and is about to be named the head of the division of mindfulness, the first in the country at UMass Medical School. He is the author of 37 articles, and seven chapters, and the book that he will be signing this evening as soon as his lecture is over on craving. And his work really focuses on mindfulness and addiction, mindfulness-based interventions, and the brain mechanisms of mindfulness. So it is with great pleasure that I ask you to join me in giving a warm welcome to Dr. Judson Brewer. [APPLAUSE] JUDSON BREWER: Thank you. Thank you for that warm and wonderful introduction. The field of Contemplative Studies and contemplative science is actually a pretty young field. And what I thought I'd start out with-- I'm sure many of you have seen a lot of hype around mindfulness in the modern day. So what I'd actually like to start out with is just a little bit of a caveat, and let this kind of color how we talk over the next hour or so, about the mechanisms of how our minds work and how mindfulness actually targets these. So what I thought we could-- this is not a negative cautionary note. This is just a cautionary note that there can be a lot of excitement around things. It's funny that this is considered a new thing in the West. It's pretty old when you take less of a Western-centric view. But needless to say, I think one way to look at this, and really explore this for finding what elements are really solid, is looking in a way that I think of as triangulation. We'll talk about that in a minute, where we bring together theory, behavior, and neural mechanisms. And when we find those come together, we have this sweet spot that really helps us understand things, and really bring together some solidity, where there might not be solidity in other places where there's a lot of excitement. And importantly, replication is really important in science. We look to repeat experiments and with those repetitions gain more confidence in something actually having something that's going to last for a while. Science in general-- we see science cycling through itself every 10 or 15 years or so. With some newer sciences, that slows down over time as the field becomes more established. So this is a pretty young field. And most importantly, as an addiction psychiatrist, I like to-- it's really important to me to see these things linked to real-world outcomes. Otherwise, we get stuck in our ivory towers and not much help makes it out to the real world. So just as a way to think of triangulation, you can think of things coming together. This kind of looks like a bio-hazard sign. So I don't mean that-- for it to look off-putting. But where we have things that overlap, we look for this sweet spot in the middle. And where that sweet spot is-- often good things happen. So the other cautionary note that many folks are seeing here in Rhode Island-- we're certainly seeing this in Massachusetts-- is an opioid epidemic. This is just a heat map that shows the evolution over the last decade and a little bit more in how the opioid epidemic has grown. In The New York Times, they said that deaths from overdoses are reaching levels similar to the HIV-- the epidemic at its peak. So I say this because if we can understand how our minds work, we can start to develop treatments that can actually start to reverse these things at their core. So this is opioids. Here's another map. And this just flips back and forth between males and females, where we can also see a growing epidemic that's described as an obesity epidemic as well. This happened over a little bit longer period of time. I don't know if you can see this. This started back in the '80s when they started mapping this. But you can see in 2015 when this came out-- a huge difference in the levels of obesity in the US. I'm just going to skip through this. This is just another map showing some of the epicenters on a more fine-grained level. And you can see in the Northeast, we're really hit pretty hard. So we can ask ourselves, well, how far have we evolved as humans? And so I'm just going to show you a video that's indicative of this. So this is a woman holding her cell phone, and we can see what happened there. So we can tongue-in-cheek say, well, we as humans-- we're really smart. Yet in modern-day New Haven, they've had to paint on the crosswalks, "Look up." Because the students for some reason are suddenly more prone to getting into accidents, and I'm not sure that it's because their level of intelligence is lower. I think more that there are things that are tapping into our neural mechanisms that are really getting in the way. And so I'll use a story of this to kind of illustrate this. I was in Paris for the first time in 2014, and I went to-- of course, went to The Louvre. Many of you recognize this to do some sightseeing. And the reason I took this picture was two-fold. One, this device that you can see in the middle of the picture, which we all know, was named by Time magazine one of their top 25 inventions of the year. Some of you have heard me joke that, to me, it's a sign of apocalypse. But the other reason I took this picture was that the guy in the foreground here is this boyfriend who's now rendered obsolete. So we can imagine how this story gets set up. We're at The Louvre. We're really excited, and our brain says, oh, this is awesome. I want this good feeling to continue, so it says, take a picture. And then it says, no, no, no. I have a better idea. Why don't you take a picture and post it on Facebook? And so, how do we spend the rest of the afternoon? Looking at the artwork in The Louvre, or checking to see how many likes we got? Right? So we can see how this-- our reward-based learning systems get co-opted. And we'll talk-- we're going to dive into that in a second. I just have to highlight that the French-- they always do things in style. Vive la France. And so, how does this get set up? There were some studies that were done a couple of years ago at-- one at Harvard where they put people in an fMRI scanner, and they gave them two options. They said, you can earn money, or you can talk about yourself. And guess what people chose to do? As they were self-disclosing, they were activating the part of the brain called the nucleus accumbens, which is the downstream reward pathway, where dopamine gets spritzed from the ventral tegmental area. This is the reward-based learning system that's known to get activated with every single drug of abuse. So whether it's alcohol, heroin, cocaine, or Facebook, there's something that this pathway gets activated. The second study from 2013 showed that they could actually predict the amount of time that people spent on Facebook, based on how much their nucleus accumbens was activated. So there's something inherently rewarding about this system. There was a study that was published last year where they used adolescents. They scanned adolescents and put their own Instagram feeds in the scanner. The only manipulation that they made was that the number of likes-- they arbitrarily manipulated the number of likes that the pictures got. So some pictures got more likes, and some got fewer likes. With fMRI studies, what we look for is a relative change in brain activity. So we have a baseline and then a comparison condition. So that more "like" condition was really interesting. What they found was not only was the nucleus accumbens activated, but there was a self-referential brain region called the posterior cingulate that was also co-activated. So what this shows is there's this linking between reward-based learning and self-referential processing. We're going to dive into this a bit more as we go through the talk. So here's my interim summary slide you can see so far. Now, it's interesting. Some are now calling this Facebook Addiction Disorder. So if you imagine these two women at The Louvre, they learn. Their brain learns, oh, if I post pictures on Facebook, this feels good. And then when they're back in their little cubicle at work and not feeling so good, maybe it's raining outside, they've had a tough day at work. Their brain says, why don't you go on Facebook and make yourself feel better? Which, of course, doesn't fix whatever their root of the problem was and leaves-- as you can see from this diagram, leads to negative outcomes. In fact, there's a linear correlation between the amount of social media use and the odds-- adjust the odds ratio of becoming depressed. You can see that on the far end there. It's a pretty nice linear relationship. So we can observe real changes in our behavior, in our brains with-- I'm just using social media as an example. And we can then start to ask ourselves, well, mechanistically, what's going on here? And here we actually turned to the ancient Buddhist psychologists, because they had a very interesting observation. In fact, this phenomenon is said to have been described by the historical Buddha on the night of his enlightenment. So he became enlightened by contemplating this thing that he called dependent origination. Now, if this is something that can get somebody enlightened, I'm going to pay attention to that as a scientist and say, what is this guy talking about? So the basic idea here is that some cure, a trigger comes into our mind. It gets interpreted as pleasant or unpleasant. We want the pleasant to continue. We want the unpleasant to go away, so we act accordingly. So we have an urge, or we have a craving for pleasant. It's often described as aversion to the unpleasant. And then we act to keep the pleasant going to make the unpleasant things go away. And the way they describe this in ancient times was that this led to the birth of a self-identity. We become identified with our behaviors. So if I get stressed out and that doesn't feel good, I have an urge for that unpleasant feeling to go away. I eat some chocolate or I eat a cupcake. Then I start to become identified with cupcakes. I start wearing what we describe in modern day as subjective bias glasses, where I start seeing the world through-- if I'm stressed out, I should eat chocolate-- glasses, OK? In ancient times, it's really interesting. They describe this process. They use the term ignorance, which is real interesting. We call it subjective bias in modern day. They called it ignorance, because they're saying, we're not seeing clearly. We're starting to see through these lenses of our previous behaviors, and those are coloring the way that we're seeing the world. So that's really important. The other thing that they pointed out-- they said-- see that loop in this pathway? They called this samsara, which literally translated means endless wandering. And I think that's interesting, because if we eat chocolate to feel better, we're not actually fixing the core root of our problem. So they're saying, well, the more we do these things, the more we're going to endlessly wander, and the more we're going to become identified with these behaviors in vain, as we try to hold on to these to make ourselves feel better. I like this quote from Alan Watts, a modern-day philosopher. He said, the "Ego, the self which he believes himself to be, is nothing but a pattern of habits." And what we're talking about here, if we just break it down into its really simple elements-- the necessary and sufficient components-- we need a trigger, we need a behavior, and we need a reward. So If I'm stressed, it's my trigger. A chocolate-- that's my behavior. And my reward is I feel a little bit better. I'm going to show you a Weight Watchers commercial. This is a one-minute Weight Watchers-- [VIDEO PLAYBACK] - [SINGING] If you're happy and you-- JUDSON BREWER: --commercial. - --know it, eat a snack. If you're happy and you know it, eat a snack. If you're happy and you know it, then your face will surely show it. If you're happy and you know it, eat a snack. If you're saddened and you know it, eat a snack. If you're sad and you know it, eat a snack. If you're sad because you're angry, feeling down, or chillingly bad, if you're sad, eat a snack. If you're bored and you know it, eat a snack. If you're lonely and you know it, eat a snack. If you're sleepy and you know it, if you're guilty and you know it, if you're stressed, eat a snack. If you're human and you know it, then your face will surely show it. If you're human, eat your feelings, eat a snack. [END PLAYBACK] JUDSON BREWER: So I don't own stock in Weight Watchers, but I did think that this was a brilliant commercial. How many of you have seen this commercial? There are very few people, if anybody. Yeah. One of my friends sent this to me from YouTube. And when I was talking to some folks at Weight Watchers Corporate, I said this is really brilliant. You've really captured this learning process. Why don't we see this on television? And she sheepishly said, oh, it makes people depressed. So I guess the point system or whatever Weight Watchers does, doesn't really target that. We'll actually talk about that in a minute. So what we're talking about here, whether it was the ancient Buddhist psychologist 2,500 years ago, describing this process with their terms dependent origination, or modern day, some of you might have recognized, hey, wait a minute. Isn't this positive and negative reinforcement? Isn't this operant conditioning? Isn't this reward-based learning? Isn't this reinforcement learning? All of those terms are for the same thing, and I'm just using some examples here. You can see from the references, this process has been described in modern day, back in the 1800s. Thorndike did some animal studies with this. BF Skinner became famous in the '50s for his Skinner boxes. Eric Kandel got the Nobel Prize in 2001, showing that this is evolutionarily conserved all the way back to the sea slug. So a very, very evolutionarily conserved process and well-known, well-described. So if I'm a cancer researcher and I'm trying to cure a cancer, what I'm going to do is look for a protein pathway like a protein kinase pathway, so that it's mutated. I'm going to target that. And if I can target that, I'm going to have a very effective treatment that has minimal side effects. And what I would say is behavioral researchers and treatment developers-- I would say we should hold ourselves to the same standards. We should really try to understand mechanistically how behavior works and then target that. So here's a really nicely described process. It's probably-- this is not controversial. Operant conditioning has been known for a long time. So let's use treatment examples here. So if we understand mechanistically what's going on, we can develop treatment. So for example, with alcoholism, there's this saying, people, places, and things. Some of you might have heard this. So if we can avoid cues-- if we can help people who drink avoid cues, like avoid the bars, their drinking buddies, the liquor store, they're less likely to be triggered to drink. It makes sense mechanistically. That's a little harder to do with things like smoking where people learn to smoke on their front porch, in their car, outside at work. So there's this development of substitute strategies. So eat some carrot sticks, eat some candy, go for a walk. And we can see how this also can target this mechanism. And interestingly, neither of these actually targets the core loop itself. You can see those orange arrows in there are not-- this doesn't get at those orange arrows. It can help us stop feeding them, or we can treat around the behaviors. But it doesn't actually dismantle the loop at its core. So if we go back to the ancient Buddhist psychologists and say, well, what can we do? They actually gave some very interesting pointers. He said, "Just as a tree, though cut down, can grow again and again if its roots are undamaged and strong, in the same way, if the roots of craving are not wholly uprooted, sorrows will come again and again." That's interesting. If you don't quite make-- can't make sense of that, here's a modern-day interpretation, but we get the idea. So they're actually talking about craving, and not substituting strategies, or avoiding cues, but actually, getting rid of the heart of craving. So again, if we understand mechanistically how something works, it can be very powerful information for us. So just-- for example, the food industry knows this very well. For those of you that haven't seen this expose in The New York Times from a couple of years ago, they talk very critically about and importantly about the food engineers that are employed to make things that look and taste like food. And I say that because I love The Onion, the satirical journal. They had this headline that said, "Doritos Celebrates its One Millionth Ingredient," right? So we can engineer things that have the perfect smell, taste, color, crunch, et cetera, et cetera, to get us addicted. Here's the summary slide for a Cookie Monster, so just an example of how powerful these processes are. And if we understand how they work, how we can manipulate them-- so why am I-- I am not trying to give a talk that's depressing or a downer for us. But I'm just pointing out how important it is to really understand things from a mechanistic perspective. And if we can understand those, then we can start to affect a real process change, OK? So many of you are familiar-- I work at the Center for Mindfulness, jokingly called the house that Jon built. Because Jon Kabat-Zinn really helped jump-start this Western movement of mindfulness, and he's really well-known for this working definition of what mindfulness actually is. And he actually has modified it a bit. He talks about the awareness that arises from "paying attention in the present moment on purpose, non-judgmentally." Now, for the uninitiated, this can seem like a mouthful. So if we bring this back to the mechanisms-- those positive and negative reinforcement mechanisms-- and then really highlight that craving piece, there's awareness that can arise. And then we can be sucked in, or we can be pushing things away. What mindfulness is about is this awareness that has a balance or equanimity with it, where we're not sucked in. We're not rejecting what's happening. We're simply being with something in a way that I like to use the term like curiosity, or that really helps unpack what we mean by non-judgemental awareness. So again, we can start to bring triangulation together, around what mindfulness is, for example. And so we can-- what we like to do is really understand the theory of how these practices work, bring this together with behavioral and neural mechanisms, and then, importantly, see how this affects real behavior change. And that's what I'm going to go through some examples of now. So bring this back to the theory. Here's a mechanism. The theory is that mindfulness comes in and drives this wedge of awareness in, such that we have space. Instead of habitually reacting, we can take a pause, and mindfully, or with awareness choose a behavior rather than habitually reacting. But this might seem like that's a tall order with regard-- can we just pay attention? Will that actually help us change behavior? It might seem somewhat paradoxical. So I'll give you an example from one of our first smoking studies, where we randomize people to get mindfulness training or gold standard treatment. We didn't even tell them that they were getting mindfulness training when they came in, because we didn't want to bias them. And on the first day of training, we told them to smoke. And they looked at us like, is this the experiment that you guys are doing? Because I came here to quit smoking. You're telling me to smoke. But importantly, we're telling them, OK, go ahead and smoke, but pay attention as you do and see what happens. And here's an example of what people typically wake up to. This person said it "smells like stinky cheese and tastes like chemicals. Yuck!" So the critical piece here is not that they're trying to convince themselves that smoking is bad. They all came into our program trying to quit smoking. What we're having them do is really tap into reward-based learning. So if reward-based learning is so powerful, can we actually hack it? Can we really help people see the results or the rewards of their behavior? Reward is in quotes, because those rewards might not be as rewarding if we pay attention to them, just like this person pointed out. So what we're-- reward-based learning isn't actually driven by behavior, which seems kind of odd. We always think of, oh, if I could just change my behavior, if I could just change my behavior. Well, the truth is that behavior is driven by reward. So what if we not necessarily change the reward, but help our brains see those rewards really, really clearly, OK? Or as Yogi Berra put it, "You can observe a lot just by watching," right? So how well does this stuff actually work? I'm not going to go through the details, because we've published these studies a few years ago. But just to show you, in our smoking study, we got five times the quit rates of gold standard treatment. We were actually looking for a signal. This was a pretty strong signal. We weren't expecting it to be this strong. So for us, that said, wow, that's really interesting. Mindfulness-- we can see behavioral change, OK? And so if we can see behavioral change, we can then go back, and start looking at it mechanistically, and say, what's going on here? And our hypothesis was that mindfulness would decouple craving and the behavior. So for example, smoking-- I used the analogy. And actually, this is an analogy found all the way back in the early teachings. The idea is that we should see a dissociation between craving and smoking before they both subside. So if you think of craving as a fire and that fire is burning every time you add fuel to it, every time you smoke a cigarette, you're adding fuel to that fire. When you stop adding fuel to that fire, that fire continues to burn, until the residual fuel is consumed. And we can actually test this mathematically. So we should still see craving, but that should be decoupled from smoking itself. So when we look at baseline, we can see a strong correlation between craving and smoking, just like other people have found. If you crave, you smoke. If you crave, you smoke. At the end of treatment, we found that that correlation was completely abolished-- was completely gone. And when we looked and did all the fancy math around that, we found that it had nothing to do with baseline craving or cigarette use, but it had everything to do with informal mindfulness practices. And these were formally moderating the decoupling of craving and behavior. So if you bring it back to this mechanistic loop, as theorized, it does seem to be driving this wedge in where people can act. They can have a craving without acting on that craving, I should say. And so in this sense, it may actually affect longer-lasting change. So again, bringing this back to the triangulation question, it does seem like the theory is lining up with our behavioral mechanisms and also, lining up with behavioral outcomes. So for example, these five times quit rates that we were seeing. Now, as we were developing this first program, I was looking out my window. We were on a smoke-free campus, and I was looking at my patients. And they were out in the parking lot smoking. And so they had a cigarette in one hand. And what did they have in their other hand? Oh, actually, sorry. I meant to go through this, so I'm going to skip. That slide is slightly out of place. So this is what I meant to say-- was what we were seeing was people in the parking lot. They were distracting themselves with their phones as they were smoking. And so we said, well, can we-- if we understand how this thing works, the system is actually set up. So we would remember where food is. Operant conditioning is reward-based learning. If we're looking for food sources and we find a food source, we're going to lay down a memory that says remember what you ate and where you found it. So if people are learning through context, event, and memory, they don't actually learn to smoke in my office. So if I'm trying to teach them to quit smoking in my office, I'm already adding one level of artificiality there. So what if I took my office and delivered it to them? And this is where we started trying to develop evidence-based training and deliver it through a cell phone. So I'll show you some examples. We now have three that we're testing-- one for smoking, one for emotional eating, and now, one even for unwinding anxiety. And I'll walk you through some of the clinical trials that we're doing. The basic premise here-- and I'm just using an example from our anxiety program-- is that we can take these trainings and deliver them in bite-sized pieces, so people can get short trainings in the moment. And they can go back to those trainings each day, so they can make sure they reinforce them. We can directly link, helping people understand how their mind works and link that to mindfulness. We can also have these modules delivered in a way that are accessible. It's really hard to get somebody to come into my office once a week, twice a week. Forget about it. And for an hour a week is already challenging. So can we cut this into bite-sized pieces? Can we give people in the moment animations that can help drive the key points home? I'll show an example of this. And then, can we give them in-the-moment exercises? So they can-- in the moment that they're craving for a cigarette, or a cupcake, or they're caught-- wound up in anxiety, can we give them a practice that they can use? And most importantly, can we embed experience sampling, so we can track progress and test efficacy? So I'll just show you an example from our Craving to Quit program on how we can use animations to drive key points home. [VIDEO PLAYBACK] - Today we're going to explain cravings through the metaphoric screaming child. I know you've heard and seen a child throwing a tantrum. Perhaps for some of you, it was your own child. This child is screaming because he wants something. And you as the parent want him to stop screaming. All your child wants is a lollipop. So in this metaphor, think of your cravings as the child's tantrum. The lollipop is like the cigarettes. But what should you do? Yell at the child? That might make things worse. Gag the child? That will stop the screaming in the short-term, but you know what will happen as soon as you take the gag away. You could just give him a lollipop. Congratulations. You just taught your child to scream for lollipops. In other words, you've just taught him that screaming is a good way to get what he wants. What will you do instead? Here's a novel concept. Just let him scream himself out. What? Have you ever seen a child scream forever? Sometimes they scream so hard and so long that you think their head or your head might explode, but it never does. What happens instead? Eventually, the child gets tired and stops. [END PLAYBACK] JUDSON BREWER: So just an example of how we can drive these key points home in using simple analogies. So as we were developing this program, we were finding that people were reporting that they're actually changing their eating behavior, which was pretty interesting. Because when people try to quit smoking, they tend to gain weight, on average 15 pounds. And in fact, this is one of the key reasons that women in particular won't quit smoking-- is that fear of weight gain. So I don't know if anybody can relate to this. But we said, OK, can we actually apply this to stress and emotional eating? I'll give you an example from somebody I saw in my clinic. This is a woman. And she was-- who was at a very unhealthy weight and come in to me. She met Binge Eating Disorder criteria. She was binging on entire large pizzas 20 out of 30 days. And what she reported was that her mom had been emotionally abusing her since she was eight, and that she was eating in order to numb herself from her feelings. So we developed this program. It's delivered in a similar way to the smoking cessation program, to help people change their relationship to eating, so they could pay attention. And just like paying attention, when you smoke a cigarette and see that it doesn't taste very good, they could pay attention and see what it's like when they eat a bunch of food at once, because that is something. And instead of numbing themselves out, actually get curious about what that actually feels like. And then we start to look. So clinically, if we really want to see something stick, we want to see behavior change language that they are reporting on their own. They're not just mirroring or puppeting things back to us, but they're actually describing this stuff in their own terms. So what we could do is look at people's journals from our online community and see what they're actually reporting with regard to their relationship to eating. So here's an example. This person said, "I understand why I go to food-- to avoid, or cover up, or distract from uncomfortable feelings such as anger, sadness, or restlessness. Who wants to feel those things? Trigger-- uncomfortable feeling. Behavior-- eat something that temporarily diminishes the feeling. Reward-- still have to deal with the unpleasant feelings, plus the sugar headache. I can clearly see how I got caught in this habit loop, trying to escape difficult feelings with food, but that ultimately, it doesn't work." So here is somebody describing this habit loop, understanding this, and then starting to get disenchanted herself. And that disenchantment piece comes when we tap into these reward-based learning systems themselves, rather than using some cognitive strategy, or trying to force ourselves to change our behavior. So how well does this work? So we've got some theory. What are the behavioral results? So just a couple of weeks ago, actually, one of my colleagues, or collaborators at UCSF just finished up a study that was published. And the idea was to see if we could see the same type of behavior change with eating as we could see with smoking. Here we found a 40% reduction-- craving-related eating, using experience sampling and about a 36% reduction in eating to cope with negative emotions. So we're starting to see not only behavioral outcomes, but we're starting to also see those line up with mechanism as well. So we see this in smoking. We see this in eating, which is really nice. If we're seeing a triangulation with different types of behaviors, but the same type of training, that gives us a lot of confidence that it might be working. But again, most importantly, are they talking about this stuff in their own lives? So here's another example from somebody's journal. This person said, "A shift is happening. I'm choosing more healthy foods. The sugary things are less attractive. Satiety is now coming into focus." So reward-based learning-- it's a really powerful mechanism, and something that we can start to tap into. And I just want to highlight a collaborative piece that-- and actually, a couple of folks in the room were involved with this. So we can actually start to take that behavior, look to see where that's also described in the ancient literature, and develop modern-day questionnaires that we can use to start to personalize development, and deliver treatment in a targeted way. So for example, there's this fifth-century commentary where they actually describe three different types of behaviors. And roughly, they line up with fight, flight, and freeze, which is what we're talking about with operant conditioning, so approach, avoid, or freeze. And they described-- this is really interesting in this commentary. They described posture. They described how people ate, the types of food they ate, the types of clothes they wore. And this was actually done in-- we'd spent a week in developing these questions right here, right off the Brown campus and then validated the questions in a large cohort of folks, where it came down to 13 questions that we can actually start to use to match someone's personality, or behavioral tendency with mindfulness practices. So Jared Lindahl, Willoughby Britton. I think Yuan was-- you were not involved in this project. He was always around, so I associate you with this as well. But there were some folks within this very campus who led this project, and we came up with something very interesting. So the idea here is that if we understand things mechanistically, it gives us a lot of power to affect change. So what I'd like to do, just for the last-- maybe 15 minutes or so, is talk about neural mechanisms. What's actually going on in the brain as we start to change behavior with mindfulness practices? So I'll use a story. Some of you have heard me talk about this before. This woman is Lolo Jones, Olympic hurdler, favored to win the 2008 Olympics, and in fact, was in the lead in the finals at the 9th and 10th hurdles, and then said in an interview with Time magazine-- she said, I was just in an amazing rhythm. And I knew at one point I was winning the race. It wasn't like, oh, I'm winning the Olympic gold medal. It just seemed like another race. And then there was a point after that where I was telling myself to make sure my legs were snapping out, so I overtried. That's when I hit the hurdle. So the point here is not-- this is one of the misconceptions of mindfulness-- is it's not about ridding our minds of thoughts or of thinking. It's about changing our relationship to them, so having those thoughts come up as objects-- being aware of them and not being pushed or pulled by them. A simple way to think of this is, "Your me is in the way." And we can even think of this as a behavioral continuum as being caught up in our relationship to objects. So daydreaming, for example. You can get caught up in daydreaming, and then we can snap out of that quickly. If we get caught up in stress, it'd be great if we could just say, hey, you look stressed. Snap out of it. Oh, thank you. Boy, that's much better. So we can imagine when we're caught up in stress. It's a little harder to disengage from that. And of course, on the far end of the spectrum-- addiction. I like the simple definition-- continued use, despite adverse consequences. So when we're so caught up in this behavior, we know we're doing it, and we have no control over it. That is the epitome of addiction. And if this is happening all the time, we can actually map this on a neurobiological level. And this is where a network of brain regions was discovered, actually back in 2001, called the default mode network. This was serendipitously discovered by Marc Raichle's group at Washington University in St. Louis, where they were actually doing a baseline task. So again, with neuroimaging, we have a baseline and a comparison condition. They had given people the simple task-- lay still and don't do anything in particular. And they figured, well, it's not going to show anything in particular. And in fact, they were getting reproducible results that ended up being the most reproducible results in all of neuroimaging, where they found this network of brain regions constantly co-activating. And what they found, eventually, was when we're not doing anything in particular, we're actually doing something, on average pretty often, which is thinking about ourselves, right? So this was the self-referential brain region network that was getting activated. And you can see these two yellow circles here-- the medial prefrontal cortex and the posterior cingulate cortex. So just to remind you, the posterior cingulate cortex is that self-referential brain region that gets activated when we are seeing pictures, that we get a bunch-- are pictures that get a bunch of likes. Now, this brain region is interesting, because it also gets activated when you show people, who are addicted to cocaine, pictures of people smoking crack cocaine. It also gets activated-- it lights up like a Christmas tree in people who are addicted to cigarettes, when you show them pictures of people smoking. In fact, you can see this activated in people who are pathological gamblers, when you show them pictures of gambling scenes. And in one of my favorite studies, as done by a friend who's on faculty at Yale now, she did this as her PhD thesis where she put people in a PET scanner. And in PET scanners, you can actually feed people and still get good imaging results. So she gave people their favorite chocolate, and she fed people chocolate. And she had them rate how well they liked that chocolate, and you can see this rating scale. It went from really delicious-- plus 10 to-- this is off at minus 10. What she did was fed people chocolate. She says, how's that taste? And they're like, this is great. That's why I picked this chocolate. This is awesome. That's a 10. And then she'd feed them another piece and say, how is it now? It's still pretty good. Feed them another piece. How is it now? Well, I still like it. How is it now? All right. I think I've had enough. How is it now? How long is this study going? Why did I sign up for this? And she'd feed them until that very piece of chocolate that made people ecstatic made them sick. They were like, stop feeding me. I'm going to call the IRB and report abuse. But the interesting thing here was there was only one brain region that got activated on both ends of the spectrum, so when people loved the chocolate and when they hated the chocolate. And you can see here was the posterior cingulate cortex. So this brain region gets activated when people are loving it and when they're hating it. And in fact, we can see this across a bunch of different studies. I'm just going to show you a list of a bunch of different studies that show activation in the posterior cingulate cortex. Not that you have to memorize this list. The idea here is just to see all the different things that can activate the posterior cingulate cortex. So we started asking the question, well, what's actually going on? How does this line up with somebody's experience? And we came up with this hypothesis that the posterior cingulate was involved in getting caught up in our experience. So Lolo Jones who got caught up in her own thinking-- when we get caught up in craving, we get caught up in loving chocolate. When we get caught up in hating chocolate, this brain region might be involved, and we can test that. So just to bring this into an experiential level, there was a study that was done a couple of years ago, and actually induced a bunch of emotions in people, and said, where do you feel those emotions most strongly? So for example-- we can all do this together here. If you remember a time when you were really afraid and you can just-- if you care to, just take a moment to feel what it feels like where you feel fear in your body, and you can mentally point it at-- and then I'll show you how you line up with the study of 800 people when they did the same type of induction. So if this was the case for you, where you felt it in your chest, that's pretty congruent with what this population sample showed and in fact, across a number of emotions. So for example, fear and anxiety-- we can see this hot spot right in the chest. So we can start to feel where we feel it when we get caught up in emotions, like fear, emotions like anxiety. So if we get caught up in things, what's the task of mindfulness training? Well, you can think of it as a way to not get caught up, not to get caught up in fear, not to get caught up in anxiety, or anger, excitement, or caught up in anything. And again, here we can start to bring in our triangulation. So what we did was said, well, if we took three different type of meditation practices, can we triangulate where we see those practices activating in the brain? And we might be able to find areas of commonality. So again, lining up the theory with the mechanism and the behavior. So what we found-- actually, we didn't find a single brain region that was increased in activity. But we found, shown here in blue, was these two main hubs of the default mode network were deactivated. They were quiet-- inexperienced versus novice meditators. So this was really interesting. It wasn't what we were expecting, but it started to make sense. With meditation it's not about getting caught up in our experience. It's about letting go of that experience. And we're seeing, if the posterior cingulate lines up with getting caught up, we're seeing it getting quiet with these practices, regardless of what they are that help us let go of it. And as I mentioned at the beginning, replication is really important. So these were some of the first studies that had kind of shown this, and so we wanted to look to see if this was replicatable. We did a replication study. I won't show you the details, because it's not that important. And there was a recent meta-analysis that showed not many brain regions that are convergent across a bunch of different studies. But you can see here the posterior cingulate is one of those that actually lines up. And when we look specifically at loving kindness practice, for example, where we're offering well-wishing to ourselves and others, you can see in particular the posterior cingulate gets really quiet. Again, blue is deactivation. So importantly, replication is helpful, but we wanted to take this one step further. And one of my colleagues at Yale had developed a methodology, where he could actually deliver feedback from somebody's brain in real time, as a way to help us really line up subjective experience directly with brain activity. And so what we can do is we can have somebody meditate where we can study their-- we can measure their brain activity and actually present it to them, basically with a short delay, close to real time. We can do a bunch of control experiments to make sure that we're not fooling ourselves, and they're not fooling themselves. And the way this works is that we have somebody lay on the scanner. They're meditating with their eyes open. And what they do is check in with the feedback graph every couple of seconds and see how well that graph, as it fills in, would represent increased and decreased activity in the posterior cingulate cortex-- how well that lines up with their brain activity. And you can see a couple of runs here. You see a lot of variability. Variability is actually helpful for us, so we can see-- line that up with subjective experience. We can ask people, how well does that increase in activity line up with your subjective experience of mind wandering, or getting caught up in your experience? And how well do the decreases correlate with you being on task? In this case, we're using breath awareness meditation, I think. Here you can see a novice's very strong correspondence between subjective experience in brain activity. You can see the same reported correspondence in experienced meditators, but you can see how these brains are pretty different. Just to give you an example of the really rich phenomenological self-reports that we can derive from this, here's an example of somebody who-- they report directly after each run. This person said, "I caught myself. I was trying to guess when the words were going to end--" that was our baseline task-- "and when the meditation was going to begin. So it's kind of like, ready, set, go. And there's this additional word that popped up, and I was like, oh, shit, and there's a red spike. And then I was sort of settled in. I was really getting into it. And then I thought, oh, my gosh, this is amazing. It's describing exactly what I'm saying, and then you see this red spike. And then I was like, OK, don't get distracted. And I got into it, and it went blue again. I was like, oh, my gosh, this is unbelievable. It's doing exactly what my mind is doing." So he was laughing at this point. He said, to the next point, it's a perfect map of what my mind is going through. So here in a single subject, they can say this maps perfectly with my experience. But for us as scientists, we want to say, well, what exactly is this mapping on to? And so here is where we do things like torture undergraduates and have them actually transcribe all of the rich phenomenological descriptions and in a blinded manner, line them up with brain activity. So I'm going to have to give a shout-out to Juan Santoyo who did all of this work as an undergrad here at Brown. And we did this work in collaboration with the late Cathy Kerr, who is an amazing person in general, and also an amazing collaborator to work with. So we were very fortunate to work with her on this study. And the way this works-- you can see all of the different ways that people describe their direct experience. And these are coded and described as open codes, which then move or link together in central codes and then theoretical codes. And then we can line these up with brain activity, which gets really, really interesting. So for example, when people reported a fair amount of distracted awareness, this replicates a lot of other work that people had done, showing that the posterior cingulate cortex gets activated when we're mind wandering, when we're getting distracted. So we could think of this as a positive control for this experiment. But in fact, we found this whole other side of things that we named controlling. So when people were efforting or when they were discontent, it was also activating the posterior cingulate cortex, which wasn't in the literature, so that was really interesting to us-- a new discovery. And here's an example. This person said, "I worried that I wasn't using the graph as an object of meditation. So I tried to look at it harder or somehow pay attention more," because when it went red. So this trying-- it's like you're hearing the sound of my voice during this lecture. Trying to hear it harder doesn't really make sense, because your ears know how to hear as long as you don't have hearing problems. So the trying piece is actually optional, and this person discovered this. Here's some other examples of deactivation lining up with brain activity-- I'm sorry, with subjective experience. So again, undistracted awareness. We saw lots of instances of concentration. This, again, replicated previous literature when people were on task. Their posterior cingulate gets quiet, so nice, positive control. Again, another category emerged that was kind of the opposite of the effort, which Yuan named effortless doing. So when we're not trying to do things-- when we're content, we're also seeing a deactivation of the posterior cingulate cortex. Here's some examples. This person said, "Toward the middle, I had some thoughts, which I don't see in the graph, maybe because I let them kind of flow by. I noticed the more I relaxed and stopped trying to do anything, the bluer it went." So great, now I understand what Yoda was talking about, right? So it's about-- these practices can be challenging in terms of trying to meditate and in fact, what the theory and what we're seeing with this brain activity is suggesting-- it's not about trying. It's about setting up the conditions. So we might be asking, OK, great. You guys studied a bunch of very experienced meditators. How does this actually apply to me or anybody else in real life? These folks on average have been practicing, just coincidentally, about 10,000 hours. We weren't trying to surpass that Malcolm Gladwell's popularized 10,000-Hour Rule, which may not have a ton of great science behind it. But these folks happened to be practicing about 10,000 hours. So we could be asking, does it really take time? I'd better start meditating right now. Excuse me if I leave the lecture hall, because I'm going to start meditating for the rest of my life to try to catch up. So here I think it's really helpful to say, well, what are these data actually showing us? And this is where-- I'm sorry to use a sports person to describe this, but Vince Lombardi-- he was the guy that they gave the Super Bowl trophy out-- the Lombardi Trophy. He was the guy that won the first Super Bowl-- Green Bay Packers coach. He talks about perfect practice, not just practicing. And so just as a personal example, I grew up playing the violin. And if I practiced my scales out of tune, it was actually worse than not practicing at all. Because I would learn incorrectly as compared to practicing correctly. So what is this perfect practice about? What is it about mindfulness? And we can think of this as bringing ingredients together as compared to forcing ourselves to be mindful. So we hear this thing-- paying attention, so pay attention, pay attention. Here's a novice meditator. So these are three-minute runs. So just learn to meditate. We put him in the scanner. We give him the feedback. And his job is just to line up his subjective experience with his brain activity. This person said, "I feel a lot more relaxed, like it was less of a struggle to prevent my mind from wandering." After three runs, his brain activity looked completely different. We didn't give him a brain transplant. He just was actually using this as feedback, even though that wasn't part of the experiment. What he was describing-- if you go back to the ancient theory, it is what's described as the fifth factor of awakening. Passaddhi-- I'm not a Pali scholar, so from what I understand, this is translated as relaxation or tranquility. And what this person discovered was if he stopped trying to force himself to pay attention to his breath, his brain activity was completely different. It was actually easier for him to pay attention. Here's an example of an experienced meditator who described focusing on the breath and in particular, the feeling of interest, wonder, and joy that arise in conjunction with mindful breathing. Look at this brain activity. So here-- what this person is describing is one of the second factors of awakening, or the second factor. There's only one. Interest or curiosity. And even that joy-- it can roughly line up with another factor-- the fourth factor of awakening where there's joy that arises. And we can even start to line this up with reward-based learning, because joy itself can be rewarding. Here's another novice meditator who said, I don't think your feedback works, because it was red, and I was thinking about my breath. Well, look at the very next run. Look how different his brain is. And he said, oh, I get it. Feeling the physical sensation, instead of thinking in and out. So here-- think of this as dropping the self, getting out of our own way. So you can see here some examples of people learning to change their brain activity in as few as nine minutes. So the graduate student I was working with at that time said, why don't we actually translate this to something more pragmatic? Because fMRI-- it costs about $1,000 to run anybody through our scanner for one of these paradigms, so that's not going to be clinically pragmatic. He said, well, what about EEG? So we just published our first paper, showing that we can actually do similar things. It might not be quite as good spatially, but the temporal-- the time resolution is even much better with EEG neurofeedback where we might be able to start moving this into the clinics. We just got a grant a little while ago from the Fetzer Trust to try to develop something that will actually move into the clinics a little more readily. And in fact, a couple of years ago, we had somebody come into the lab to try this out. Some of you might recognize him. I'll just show you the short video. [VIDEO PLAYBACK] - This is just the next generation's exercise. We've got the physical exercise components down. And now, it's about working out, how can we actually train our minds? - Dr. Brewer is trying to understand how mindfulness can alter the functioning of the brain. He uses a cap lined with 128 electrodes. - We're going to start filling each of these 128 wells with conduction gel. - The electrodes are able to pick up signals from the posterior cingulate, part of a brain network linked to memory and emotion. - This is all just picking up electrical signal from the top of your head. - Since attending the Mindfulness Retreat, I've been meditating daily. I was curious to see if it had an impact on my brain. - We're going to have you start with thinking of something that was very anxiety-provoking for you. - When I thought about something stressful, the cells in my brain's posterior cingulate immediately started firing, shown by the red lines that went off the chart on the computer screen. - Just drop into meditation. - When I let go of those stressful thoughts and refocused on my breath, within seconds the brain cells that had been firing quieted down, shown by the blue lines on the computer. - That's really fascinating to see them like that. - Dr. Brewer believes everyone can train their brains to reach that blue mindfulness zone. And he says all the technology we're surrounded by makes it difficult. [END PLAYBACK] JUDSON BREWER: So here-- just an example. I think where we can start to now bring in neural mechanisms, and even have that synergized with what we understand, about how the mind works with reward-based learning. And here I think it's like-- this obviously doesn't take the place of a meditation teacher, or learning how to meditate. But we can provide these mental mirrors, perhaps, that can help people see very clearly, and link up their subjective experience with their brain activity, and learn from that. And here I think if we bring all of this back together in triangulating the theory with the mechanisms with the behavior, we can even say, well, how do we actually use these practices to hack this very reward-based learning system that is the strongest one that's known? So for example, if the typical behavior is-- let's use stress or anxiety as a trigger. The behavior is whatever we do to distract ourselves, whether it's this behavior, or eating something, or smoking a cigarette, or drinking, or whatever we do to make ourselves feel temporarily better. And that reward is that temporary relief. We can start to look at these and say, well, wait a minute. These are externally-driven behaviors. I need my smartphone. I need that cupcake. I need that cigarette. And I get a temporary relief. What if we provided a substitute strategy, something that is always available that's intrinsic? So if that trigger is anxiety or stress, what if we got curious about what that felt like in our body in that moment? Suddenly, we've got an intrinsic behavior that's always available. And in fact, the reward is pretty different. So instead of that excited reward of eating that cupcake, we start to tap into things like curiosity and joy which feel different. Experimentally there's more of an expansive quality to that as compared to the contractive quality of some dopaminergic reward. Now, importantly, we look for behavior change language, to see if this is actually true when people are going through this program, for these different types of programs. So I'll just end with a couple examples to see if this is actually true as we start to collect more and more data. So this is somebody from our smoking program that said, "I'm able to somehow ride out the craving pretty quickly. I think of it as a new kind of habit loop. I go from wanting a smoke to either automatically recalling the bad sensations, or automatically connecting the cigarette with more fuel for my addiction," so tapping into that negative piece of the reward-based learning, seeing clearly what those results are. Here's an example from our anxiety program. This person said-- somebody who's riding out full-blown panic attacks, which obviously, not expecting. "When I had a full-blown panic attack, looking inside made it just melt away." So they were drawing their awareness to the physical sensations of panic-- said, "I was looking at what I was feeling, instead of obsessing over why I was feeling it." This obsession piece is really important, because with anxiety the thinking behavior-- at some point, planning is helpful. And then our brain starts to learn, oh, I can think my way through this. But in fact, worried behavior just compounds the anxiety as they go over this event horizon, I think of as into that black hole of anxiety. So instead of obsessing, they were just dropping into the physical sensations and then riding out full-blown panic attacks. Here's an interesting one. This person said, "What's most interesting to me is how we define the rewards. In the past, the reward of eating right had been weight loss. But it was more often than not short-lived, because I hadn't made real process changes in my daily life. Here it feels like the reward is defined differently, and weight loss is a side effect. The reward here is, for lack of a better expression, a more balanced life or inner peace." So they're tapping into this balance, this peace that comes with bringing awareness to whatever is with us and finding that that's actually intrinsically-- perhaps even more motivating, more driving. A better reward, so to speak, than these externally-driven rewards such as weight loss. So just to bring it back to the story of my patient and to end here, this person went through our eating program and came back to me a couple of months ago. She had lost 40 pounds, but more importantly, she said, I feel like I've got my life back. I can eat a single piece of pizza now and actually enjoy it. So I will end there. And hopefully, there's even a pragmatic element that we can all take home from this-- is just starting to simply see-- become aware of whatever our own habit loops are and see what happens when we actually bring a curious awareness to those things in the moment. We don't need 10,000 hours of practice to see what it feels like to be caught up in some habitual reaction versus-- be curious about that and what that feels like in our bodies. All right. And I'll stop here and say, I get to stand up here and talk about this stuff. Because there are a bunch of people that put a bunch of work into this and importantly, the folks that funded this, including-- most of our funding is from the NIH as well as I mentioned the Fetzer Trust and the Mind and Life Institute. And I'd actually like to just end by saying, yet again-- and actually, dedicate this in the memory of Cathy Kerr, who is just such a wonderful person for any of you that knew her here, and such a beacon in terms of curiosity, generosity, and kindness. So I will stop there, and I would be happy to take questions. Thank you. [APPLAUSE] I think this is recorded, so they're going to ask you. If you have a question-- probably to go to one of the mics. Is that right? SPEAKER 3: Yes. JUDSON BREWER: So I saw a couple of folks with their hands up. If you could just go to the mics, then I won't get in trouble. SPEAKER 4: Make sure you push the button at the base of it for a few minutes, and then I'll turn it back on. JUDSON BREWER: That sounds like a plan. Please. AUDIENCE: I was wondering what you thought about the application of the neuroscience of mindfulness to athletic performance. I also wanted to ask if you've heard about such technologies as the FocusBand or The Fluid Motion Factor Program, things like that. JUDSON BREWER: Yeah, great question. So applying mindfulness to athletic performance. Certainly, it's popular, like the NFL. There are a number of teams now that have mindfulness coaches. I think one of the first was the Seahawks. Michael Gervais-- he's a well-known mindfulness coach there. The Indianapolis Colts. Some of the other teams now have those. So certainly, speaking from that perspective, the NBA is actually way ahead of the NFL. George Mumford, who actually is on our board at the Center for Mindfulness, had been coaching-- had been teaching. Let's see, it started with the Bulls. They won three championships in a row. It helped Phil Jackson move to the Lakers. They won three championships in a row-- could be coincidence. Who knows? So I think we certainly see examples of that in high-performance athletics. And in fact, one of the most well-described or highly sought after states in sports is flow or being in the zone. Mihaly Csikszentmihalyi described this back in the '70s, talked about sports. And there are folks that write popular books about these types of things, like Steven Kotler has written some stuff around flow. So I think the concepts line up pretty well. We actually had-- I didn't show it here, but we had an experienced meditator get into flow in our scanner and report that, and we actually watched. We were doing a real-time scan, so we watched her brain activity in the PCC plummet. And I wrote it. It ended up being a chapter in my book. So I think there are pieces here that line up beautifully. And Csikszentmihalyi actually talks about meditation as a way to train flow. So if you think of-- like we get contracted around fear. So let's use sports, like performance anxiety. And they have names for this in all the sports. So in golf, they call it the yips. And they-- freezing-- it's analysis by paralysis. All this stuff that they talk about in pro sports. So if you think of getting caught up in our experience, or Lolo Jones as an example, getting caught up in trying to make herself-- make sure her legs are snapping out-- if you take the opposite of that-- if you just take that expansion to infinity-- if this is telling us, this is who I am and the rest of the world is outside of me, you expand to infinity. And now, you lose the difference. You lose that boundary between self and other. And so then we move into selfless experiences and flow. So I think meditation lines up beautifully with that. I wouldn't recommend any of the commercially available things right now. I'm not sure that the science is quite caught up with the popular appeal and the willingness to pay a ton of money to improve one's performance. So I don't know. I haven't seen a lot of great science. And we've tested a lot of these machines in our lab and haven't found good stuff there. So I would say, be cautious with the things that are out there. And hopefully, down the road there will be things that are a little more scientifically based. So hopefully, that gets at your question. It's a really interesting and a growing field of interest in terms of research. It's hard. Sometimes the commercialization outpaces the research. That's where we are, Josh. Thank you. Please. AUDIENCE: I just want to say this is absolutely tremendous and learning a lot, really trying to absorb it. But this is kind of just a down-to-earth observation of my years on this planet. I've never seen anything like what's going on with the iPhone right now and the addiction, including my beloved young children who are not here right now-- unbelievable addiction to needing to look at that email, hit that latest headline, what happened on Facebook? What is going on? And then I can go on and on. I was riding the train-- 90% of the people looking down. Airport-- 90% of the people looking down. People walking into poles. Something dramatic is going on here, and I don't know. For some reason, I'm feeling like maybe you're throwing a little lifeline out here. I think this is major. And I would just love your observations on, what's going on? How is it affecting? And how the hell are we going to deplug? And that's the short. Believe me, that's the short. JUDSON BREWER: Help me, mindful, when you're my only hope. Yes. So I could-- I'll say something completely self-referential, which is I wrote a whole chapter-- several chapters about that in my book, because I agree with you. It's crazy. And there's this great Ira Glass episode of This American Life where he's talking about these-- he's talking to these pre-teens who are talking about how they have to market themselves and check their Instagram pictures before they post them. And their job every morning is to wake up and just go, like, like, like, like, like, like, like, like, like for all their friends, like that's their job, and then they wake up the next morning. Because they're all expecting everybody to do that. So you don't actually have to read the chapters in my book. I'll just tell you what they're about. And the idea here is there's this perfect storm set up with these. Somebody described it once as the weapons of mass distraction. I love that-- these weapons of mass distraction. So not only do we have constant availability of distraction, we've never ever had that before. So there's one piece. Another piece is self-referent. So we get to talk about ourselves in all different ways-- Twitter, Facebook. It's called YouTube. It should be called me tube, right? So we get to post videos and get all this stuff, talk about ourselves. That's sticky. That's rewarding. Gossip is sticky. And then you bring all these together with the formula that the casinos use to get people addicted to gambling, which is called intermittent reinforcement. So we never know. So if you have your alerts on your phones, you never know when you're going to get that next alert. And that is the most rewarding type of learning known. That's what we use to get addicted to anything. So you don't know when that next beep, or bing, or text, or tweet is going to be there. So you bring all this together-- the constant availability, all the self-related stuff, the intermittent reinforcement, and you've got these weapons of mass distraction. It's really interesting. I'll stop on the social commentary, but I'll say one thing. People are asking me, well, what about kids? What's going to happen to kids? Kids learn from their parents. And parents are learning to regulate their emotions this way as compared to dealing with their emotions. And so when they don't have this thing, or this thing doesn't work, their head explodes, because they don't know how to handle-- and then they throw tantrums. And then, what are their kids learning? So I think there is hope in a sense of understanding how our minds work. If we can really understand how they work, then we can actually fight back against the guys who are spending sleepless nights at Facebook to try to get us more addicted, right? AUDIENCE: That was 60 Minutes. JUDSON BREWER: Yeah, so Anderson Cooper is very interested in this. He just did that thing. AUDIENCE: There's a link to that site at Anderson, and he did the other story. It was amazing. JUDSON BREWER: Yeah, that just came out recently where he's talking about-- where the industry won't talk about it. So they're doing everything they can to engineer. And so all you need is a large sample size, so you need a large population. It's because-- how many billion? There are more users than there are Catholics on the earth. That was one statistic that I saw a while ago. They would actually-- there are probably no other marks to surpass, because there are a lot of Catholics on the earth. So you can take this huge sample and in a half a day, you can do A/B testing where you can say, is this more, or this more addictive? And then you can turn around, and do another one, and do another. And they're constantly experimenting. Most major websites that we go to were doing an experiment, so that's the way it works. So this isn't to scare us and say we shouldn't use the internet, because we're not going to stop using the internet. But if we can understand and see how this works, then we can start to regain control. Instead of being the slaves to these things, we can ask ourselves, what do I get from this? And start to step back and then bring choice back in as compared to habitual reaction. So thanks for asking the question. And hopefully-- I agree. I don't know what else we're going to do, because they're tapping into the strongest learning processes. If we don't tap into those, it's not even a contest. So we have to tap into those, and understanding them, and awareness. Our brains know how to learn. And they're going to see really clearly, oh, this isn't actually that great. And then we're back in control, and then we apply it to everything. Yeah. So sorry to go on and on about that. But I think it's really incredible. AUDIENCE: I think you're really on to a major frontier. I think this is much bigger than people are even aware of 20 years down the road. We have no idea the ramifications of where this could lead. Seriously, it's a big deal. JUDSON BREWER: It is a bit. Yeah. Yes, thank you. Thank you. Yes, please. AUDIENCE: Hi, you said that the neurofeedback technology is obviously not a substitute for having a meditation teacher. That doesn't seem so obvious to me. And I'm wondering if you can say a little bit more about why it seems obvious to you. JUDSON BREWER: Oh, sure. Well, I've been thinking about it a lot. So it probably-- so thank you for asking the question. The analogy here is you all probably heard the idea of-- if you give an infinite number of monkeys an infinite number of typewriters, we get Shakespeare by sheer chance. So feedback-- I think we could hook our heads up to these feedback machines and eventually, we're going to trip into states that we're like, wow, that's-- oh, let me reproduce that. But I think the critical piece here is we don't need to wait for that. Because these practices have been honed and actually individualized across a bunch of different traditions, even within traditions to even personalize these practices for people over thousands of years. So we can actually bring those two things together and optimize delivery of training. So we can bring a good teacher together with neurofeedback in a way that the teacher can give some instruction, and the student could even be doing a practice with neurofeedback to see if they're-- I hate to say this, but practice incorrectly. But here we don't know what correct practice is, just by random chance. So here, if we bring in something, we can actually drive the process much more quickly and efficiently. And I haven't seen anything better than teachers be able to do that. So that's why I'm-- so I didn't mean to say, oh, it should be intuitively obvious to the casual observer here. So I'm glad you asked the question. Here I think we can bring the best of both worlds together, which is really skilled teachers who come up through traditions who have learned these practices and developed their own wisdom around that, and then bring that even together with technology, because technology is only hopefully getting better. Yeah. So thank you for the question. Please. AUDIENCE: Hi. I know almost nothing about your field. I'm here because my girlfriend wanted me to listen to you speak, and I'm glad that I did. JUDSON BREWER: I honor your honestly. AUDIENCE: I know. I say it because it's actually-- it's important to the question. I don't say it to flaunt my ignorance. When you were talking about things getting into neural mechanisms on purpose, I had actually heard that before. I have a friend who-- he makes video games. And a lot of what you said at the beginning of this speech-- I had literally heard him say it, and he hates it. He absolutely hates that about his industry. He loves video games, and he would prefer that they be more, I guess, pure, which is perhaps a little childish. But I was wondering, given that the field is very much aware of the mechanisms that it's tapping into-- and it is doing it on purpose-- have you ever thought about having a meeting of minds, a crossing of disciplines, perhaps, with people like my friend who understand how to use those things, but would prefer that games bring people joy and do distract them from things in a good way-- it's essentially to make it so that they're healthier and not quite as destructive to the minds of the young people that play them? JUDSON BREWER: I think that's a great question, because there's no question that people are going to play video games, whether they're 10 years old, or 30, or 50 years old. We see this. It doesn't stop when you're suddenly an adult. So I haven't had those conversations. I certainly welcome them. I know that we've been contacted a fair amount by-- in particular, people are really jazzed about virtual reality right now. I've tended to decline those types of relationships. We're trying to just get people to pay attention to reality. So we're going to start there, and we'll see. I mean, VR is not going away, so eventually we will. We can't ignore that. We can't be Luddites in that sense, but there I don't see a clear connection with virtual reality. But I think with the gaming industry, it would be very interesting to see, what intrinsically joyful things can we tap into with video games? So on a very simple level. And it's not a really simplistic-- but simple. If we can train people to notice this versus this, we've now calibrated this machine as a feedback machine, and we don't need any fancy technology. So if a video game could help people-- because video games are doing this. They're trying to get people dopamine, dopamine, dopamine. So if somebody could tap into the intrinsic rewards-- you would think if they could do that well, they'd actually make a video game that would outsell the others, because this ultimately is more intrinsically rewarding. That being said, when people tap into this, they realize they don't need a video game to do it. So it might be-- so I think there are pieces there that are going to be interesting. Because ultimately, it's about ending all addiction in that sense. And when we end addiction, we're not dependent on something that we're going to pay for. And that makes it challenging for people that are looking to make a lot of money from this to want to do those things. So there's an inherent tension there, but I would welcome those types of conversations to see. At least it's a start. How can we train this in a video game? That would be awesome. So thank you for the question. AUDIENCE: [INAUDIBLE] JUDSON BREWER: Yeah. Great, thank you. AUDIENCE: Thank you for your talk. I was pretty excited by a few of the therapeutic avenues that you're working on. JUDSON BREWER: Step up a little. There. AUDIENCE: I just wanted to ask, are you worried about off-target effects as far as this goes? I mean, all of the focus seems to be on the posterior cingulate cortex. And that same region is also involved in activation when people think about loved ones. You only focused on negative things it gets activated in. Oddly enough, the example you used-- the art. I quickly looked. [INAUDIBLE] visual art also activates people's posterior cingulate cortex. JUDSON BREWER: Visual art? AUDIENCE: Yeah. So is there a worry that if we're decreasing that? That loop is going to be involved in good things, too, right? Feedback loop lets me know. When I make fun of my girlfriend's shirt and she gets mad, don't make fun of it again, right? So are we targeting specifically through mindfulness the part of the posterior cingulate cortex that is somehow activated in my consuming food? Or am I going to be decreasing seemingly on the diagram-- we're looking to decrease the entire activation of that loop, which is an important loop? JUDSON BREWER: Yeah, it's a good question. And part of this is-- so the default mode network gets activated quite a bit with a lot of things. And I've seen more than a couple of studies where they hit this fallacy of correlation equals causation, and that's problematic. So we've seen, for example, studies where people-- they correlate default mode network activation with creativity. And so on average, we're getting lost-- 50% of the wake-life-- 47%. So 50% of waking-life, we could either be aware or not aware. And if we happen to have some creative moment-- OK, creative moment pops up. By random chance, we could associate that with something being self-referential or not. And then we associate correlation with causality. So I think we have to be really careful about that. And that's where the neurophenomologic studies are really important. So for example, during art, somebody could be looking at a picture of art and then thinking about themselves, right? So it doesn't mean that the default mode network is associated with aesthetics or something like that. That's where we have to do really, really careful science. And in fact, with the default mode network, it's been shown that increased PCC activity decreases performance, et cetera, et cetera, et cetera. So I have not seen studies showing that the default mode network in the PCC in particular is particularly beneficial in one sense. And somebody actually said, can you just zap that part of my brain? Not sure I would do that. But we can start to see this caught-upness versus this. And this may actually be a timestamp that links us, so that the conceptual sense of self with events. And so that's probably helpful. And it's like, I almost get hit by a bus. Bam! Contraction. And then I remember, OK, look both ways before I cross the street. So I think-- I'm not saying that the default mode network is all good or all bad. I'm just saying if we understand what it's actually doing, then we're going to have much more power to work with it. So for example, that timestamp of kind of having a sense of self-- probably helpful. When we get caught up in that and we get caught up in rumination, for example-- less helpful. So that same mechanism kind of spins on itself. Does that kind of get at your question? AUDIENCE: I suppose. Is there any fear specifically, sort of off-target affects something? Maybe a more similar example being there are moments where you're excited about being distracted, like your child surprises you at your house-- you didn't expect, and you get all excited. Are you worried about the reverse happening there that you're mindful, and you think that this isn't something I need to be associated with-- you're separated from that moment? Or do you feel like the therapy is separated? And then, how do you get that to actually show up in your mechanism? Because currently that isn't showing in the mechanistic explanation. JUDSON BREWER: You're talking about separated? Describe that a little bit more. AUDIENCE: Just separated out. What would be positive examples of the activation of these regions versus negative examples? So either the therapy has to lose in these positive examples, or we're missing a mechanistic step where mindfulness allows us to choose when to be mindful. JUDSON BREWER: So let me make sure I understand. So for example, there's a level of connectedness that arises when we're not thinking about ourselves all the time. Generosity is a simple example. When we're truly acting in a selfless manner, there's a feeling of expansion. So we can all think of times when we've truly just done something generously and not looking for something in return. That type of thing is correlated with decreased default mode network activity. So there's a positive-- so I think of connection as a positive piece of this. And you brought up love. There's some really nice studies. Actually-- mentioned some of them in my book around differentiating out maternal and even long-term, stable, romantic love. So the reward-based learning pieces with the ventral tegmental area and the nucleus accumbens-- those dopamine-- they're probably more opioid in that sense. But there's a rewarding quality with romantic love that can actually be separated out by the level that somebody is obsessed with their romantic partner. So the level of obsession correlates with increased PCC activity, whereas folks that are not kind of caught up in that stable relationship-- they still have the joy that comes with being with their partner. And they're still activating the nucleus accumbens types of reward systems, but that's separated from the PCC. So I think these self-referential networks-- I might have been confusing folks in terms of saying self-referential equals reward. What we're seeing is the reward pathways. And those can link up with self-reference, but they don't necessarily have to. So we can have the reward of love. And there are these types of love, so just agape is different than eros. And they actually can differentiate these with their own imaging now, where the eros-- the contracted quality of, I want. The beginning of a romantic relationship looks a lot like addiction. So we can actually start to separate out that contracted quality of the experience of love from the joyful, flowing, connected quality as well. So maybe those are some more examples where we can actually separate out the positive qualities that come from the connectedness. That would decrease default mode network activity. But I really love your question. I'll have to think more about that as well. AUDIENCE: Thank you. JUDSON BREWER: Yeah, thank you. SPEAKER 5: If there are no other questions, please join me in thanking Dr. Brewer.

Channel: Brown University

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Keywords: brown, brown u, brown university, brown providence, providence, rhode island, ivy league, brown university youtube, brown u youtube

Id: 8oXm94Mj6-Q

Length: 88min 31sec (5311 seconds)

Published: Tue Dec 05 2017