[MUSIC PLAYING] KRISTIN MACZKO: Hi. My name is Kristen Maczko,
and I lead the mental health and well-being team
here at Google. We are thrilled to
have you all here today to engage
in our discussion with Dr. Jud Brewer, who
is here to discuss his book "Unwinding Anxiety-- New Science Shows How to Break
the Cycles of Worry and Fear to Heal Your Mind." Dr. Brewer is a "New York
Times" best-selling author and thought leader in
the field of habit change and the science of self-mastery. He blends over 20
years of experience with mindfulness training and a
career in scientific research. As a psychiatrist and
internationally known expert in mindfulness training for
treating addictions, Dr. Jud has developed and tested
novel mindfulness programs for habit change, including
both in-person and app-based treatments for anxiety-- Unwinding Anxiety is the app-- emotional eating-- Eat Right
Now is the app-- and smoking-- Craving To Quit is his app. Dr. Brewer is the director
of research and innovation at Brown University's
Mindfulness Center, where he also serves as the
Associate Professor at the School of Public
Health and Psychiatry and the School of Medicine
at Brown University. So for everyone
listening, please feel free to add your
questions to the YouTube chat as we go along. And we will save the last
15 minutes for Dr. Jud to answer your questions. And with that, let's
welcome Dr. Jud Brewer. Hello. Really good to see you. Thank you for writing this
really important book. As a neuroscientist
as well as someone who personally
struggles with anxiety, I found this book really
helpful and insightful. So thank you. To start us out, I'd
love for you to tell us a bit about your background. So you're a psychiatrist. You have a background
in addiction research. I'd love to hear
about your background prior to this book, how
you define addiction, the range of addictions that
you see in the modern world. JUD BREWER: Yeah. Well, first off, it's
great to be here with you. And I would say,
my background has been that long and winding
road that the more twists and turns there are the
more interesting it gets. So during my MD PhD program,
I wasn't even interested or focused on psychiatry at all. I just started
meditating as a way to understand how
my own mind worked and decrease my own stress. And as I went through that
program, I was thinking, wow, it's really helpful to
know how my mind works. And that prompted
me and inspired me to go into
psychiatry, where some of the things I was
learning from some of the ancient Buddhist concepts
behind the mindfulness training were actually showing
up in my clinic. My patients were speaking the
same language, so to speak. So I became a
psychiatry resident and started learning all the
different ways to practice psychiatry and really fell
in love with addictions and addiction treatments. There weren't a lot
of great treatments. There was a lot
of stigmatization, a lot of self-judgment,
and shame, and all of that. And so, I was
thinking, wow, this is an important area to work in. And I started retooling
to learn neuroscience and do neuroimaging,
and even retooled to do clinical trials
because I'd mostly been doing molecular biology
research in my PhD years. And as I started working as
an addiction psychiatrist, I was really-- [LAUGHS] I mean, I'm sure this
was a lot of my inexperience. But it was really hard. It is really hard
to treat addictions. And all the standard
tools I'd learned weren't really
helping my patients, whether it was trying
to quit smoking, or work with heroin, or cocaine,
or alcohol, or whatever. And the basic standard approach,
which is still applied today, is really based on willpower. And so, maybe we
can bookmark that and talk more about that later. But what got me into looking
at anxiety in particular was this idea around
about one in five patients is helped with an
anxiety medication, like the best ones that we have. There's this term in medicine
called number needed to treat, which is 5.2. And so, I'm basically playing
the medication lottery and [LAUGHS] struggling,
because one in five is still better than
the regular lottery. But I didn't know which
of my five patients was going to benefit and then
what to do with the other four. And so, I started
looking at the mechanisms to see what I was missing. And it turns out,
back in the '80s, this guy Tom Borkovec and
others were starting to talk about anxiety as a habit. And I was thinking, I never
learned this in residency. I never learned this
in medical school. But I know something
about habits. I've been helping people
with habits for a while. And we develop programs. Like our smoking
program, our first study, we got five times the quit rates
of gold standard treatment. And with our Eat
Right Now app, we had gotten 40% reduction
in craving-related eating. So I was thinking, huh,
what if we bring together anxiety and habit
formation and treat it mechanistically that way? So that's the background
that got me into this. It was my own interest
in my own mind and my own suffering and
then also my suffering in trying to help
my patients and not being effective at doing that. KRISTIN MACZKO:
Yeah, absolutely. And I'm really excited
to get back in later in the conversation to talk
more about the distinction between willpower and what
you recommend because I think it's such a different approach. So early in the book, you
share your wife's description describing her own anxiety. And I thought it was one of the
best descriptions I have read, which is she describes it
as a low-grade feeling that has no object in itself. JUD BREWER: Mm-hmm. KRISTIN MACZKO: It attaches
to any particular situation or thought that it can. It's as though my mind
is looking for something to be anxious about. And I loved that phrase. Because as someone who
deals with anxiety, that's exactly
what it feels like. It's like the anxiety is there,
and it's looking for something to attach to. And so, you go on to talk about
the distinction between fear, planning, and anxiety. And I thought it was a
very useful distinction and would love to hear
your description of that for those listening. JUD BREWER: Yeah. That's a really interesting
and important distinction because two of the
three are helpful. [LAUGHTER] KRISTIN MACZKO: Exactly. Yeah. It's the combination. Yeah. JUD BREWER: Yeah. So if we-- let's
start with fear. Our brains don't
like uncertainty. If there's uncertainty,
it signals, hey, you've got to figure out
if there's danger out there. And so, if we-- let's say that you're
asleep at night and you hear a strange noise in
your apartment or your house. And is your brain going
to be like, oh, whatever, I'm just going to sleep? No, our brain-- we wake up. We're hyper vigilant. What was that? I have to go figure
out what that was. And once we figure
it out or at least it doesn't continue
to the point where we feel comfortable enough
going back to sleep, we can go back to sleep. So that is uncertainty
in our brain saying, figure out if that's dangerous. And in this similar
mechanism, you can think of when
we don't have food, our stomach rumbles
and says, go get food. Information is like
food for our brain. If we don't have information,
our brain says, go get it. And that's these
basic fear mechanisms. Really helpful. That's why they're baked in. So if you look at some of the
newer evolutionary processes-- think of them that
way-- is planning. So in modern day, planning
very helpful for survival. [LAUGHS] And also very
pragmatic if we're making-- planning a trip,
it's helpful to plan. Not just to say, oh, I'll
just go to the airport and see if there are tickets
whenever I can get a ticket. So planning is helpful. But when you bring that
present-moment fear together with future-oriented planning
and you mush those together, you get fear of the future. [LAUGHS] And that fear
says, go get information. But because it's in the future,
we can't get that information. And so, that just spins-- gets on this endless
loop of worry. Worry, worry, worry,
worry, worry, worry. Which in fact-- it's like
seizing up our computer-- it doesn't help us plan. It doesn't help us survive. In fact, it's
antithetical to survival. It doesn't-- anxiety is bad
for us physically and mentally. And so, this weird little glitch
in the program, so to speak, where it's helpful,
helpful, when you put those two
together, not helpful. I think it's really fascinating. Because lots of
people say, well, I need anxiety to
help me do stuff. [LAUGHS] And in fact, there's no
evidence to show that anxiety is helpful for getting-- whether it's performance
anxiety or whatever, there are tons of myths on the
internet around performance anxiety. And I wrote a little bit
about it in the book. But there's one called this
Yerkes-Dodson curve, where people say you need some
optimal level of anxiety to perform well, and
too little or too much is not good for you. That's based on a 1907 study
of Japanese dancing mice, where they looked at arousal. Arousal is not anxiety. Arousal is-- if
you're asleep, you're not going to perform well. If you're totally
freaked out, you're not going to perform well. So arousal in
Japanese dancing mice makes sense for an
inverted u-shaped curve, not so much for humans. In fact, there's an
inverse relationship. The more anxious you are,
the worse you perform. And we all can just look
at our own experience and ask ourselves, do I
perform better at whatever I'm doing when I'm anxious? No. [LAUGHTER] And if you look at the
opposite of anxiety, like flow, when somebody
is totally in the zone, they're coding,
they're doing whatever, and they're just like-- time goes away. They go away. They merge. It's the merging
of self and object. That's optimal performance. And flow is just
tremendously joyful. It is the opposite of anxiety. KRISTIN MACZKO: Yeah. One follow-up question on that. Is there a distinction there
between eustress and distress? So eustress being a
healthy, positive stress, distress being a
negative stress? So some level of arousal is
needed to be able to attend-- if you're so disengaged that
you're at the point of feeling bored that you're not
going to perform as well? Is that where the
Yerkes-Dodson curve has value? JUD BREWER: So
arousal, certainly. If you're falling asleep,
not going to perform well. KRISTIN MACZKO: Yeah. JUD BREWER: This is not a
sign of good performance, the nodding. So arousal is certainly helpful. And if you look at some level-- it's interesting if you
look at flow, for example. [INAUDIBLE] talks about this
optimal level of when you're-- you've got to have
some level of where a task is just challenging
enough but not too challenging. KRISTIN MACZKO: Yeah. JUD BREWER: So
that's also slightly different than
the arousal piece. But if you think of
it, it also makes sense, where if
we're bored, we're more likely to have
our minds wander. And that tends to be a
default state of mind. But if we're
totally freaked out, we're also going to
not be able to perform because we're focused on
that freaked out-ness. And when we're freaked
out, our prefrontal cortex, our brain can't
actually work optimally. Our prefrontal
cortex goes offline. So if you look at
flow, they talk about finding this optimal zone. But if you look at
it, what it really highlights is when
we're kind of-- there's this ease, this openness. And when we're bored,
we tend to be caught up in our wandering mind. And when we're freaked out, we
tend to be caught up in that. And that freaked-out peace
relates very well with anxiety. There are neuroimaging studies
showing that this default mode network of the brain, the
self-referential processing network of the brain,
gets activated. The more worried we are,
the more activated it gets. It also gets activated
when we're mind-wandering. KRISTIN MACZKO: Yeah. JUD BREWER: Right? KRISTIN MACZKO: Yeah. JUD BREWER: And I just say that,
because my lab has done studies with expert meditators and
even novice meditators. And we find that that same
default mode network gets quiet when somebody's meditating. And that's where we're
opening to our experience rather than getting
caught up in it. KRISTIN MACZKO: Yeah. No, that's a really
helpful distinction. And the idea that at the low
and the high end of arousal you're in a more self-focused
place, whereas when you're in that mid spot with flow,
you're actually focused on the task that you're doing. JUD BREWER: Yeah. KRISTIN MACZKO: Awesome. So I wanted to
talk-- in your book, I think throughout your
different addiction research, you refer to these three gears,
so first gear, second gear, and third gear in
terms of how people can work with various addictions. So let's start with
first gear, which you have defined as
mapping out your mind, mapping out your habit loops. Can you tell us what
is a habit loop, and how can someone
go about mapping one? JUD BREWER: Sure. So a habit loop is really this
very evolutionarily conserved process. We have these, sea slugs
have them, the most-- I don't want to say-- let's just say the simplest
of nervous systems, about 20,000 neurons. And in fact, Eric Kandel
got the Nobel Prize showing that we learn basically
the same way as sea slugs. So the necessary and
sufficient components are a trigger, a behavior,
and a reward, or a result. So from an evolutionary
standpoint, for our ancestors that
didn't have refrigerators and had to remember where
food was and where to get it, if they're out on the savanna
or in the woods foraging and they see some food,
there's the trigger. They eat that food. There's the behavior. And then their stomach
sends this dopamine signal to their brain that says,
remember what you ate and where you found it. And the same-- and then
that feeds back and says, hey, next time you're
hungry, go there. It's this learning
mechanism that helps us lay down what's called
a context-dependent memory. We lay down a memory that
says, hey, go there for food. Same is true for
avoiding danger. It's we're out on the savanna. We don't know if there's danger. We see danger. We make a note, that part
of the savanna is dangerous. So that's the basis for what's
called positive and negative reinforcement. That trigger behavior
result feeds back and creates a habit loop that
says, oh, if that's good, do it again. If it's bad, don't
do it, avoid that. And that habit loop process-- maybe I can give
a concrete example with how I work with
this clinically is I'll just sit down and
map these habit loops out with my patients. So if somebody
comes in, a patient that I actually wrote about in
the "Unwinding Anxiety" book-- I called him Dave at the time
because he was a patient. Fortunately, he's no
longer a patient of mine because he's
conquered his anxiety. But when he came-- he
was referred for anxiety. And the first thing we did was
map out habit loops around-- he had panic disorder as well
as generalized anxiety disorder. So he had trouble driving. He would get panic attacks
driving on the highway. So we would just map out
what was his trigger. He'd have this thought, oh, I'm
going to get in a car wreck. And his behavior was to
avoid driving on the highway. And then the reward
for his brain was that he wouldn't
get a panic attack. And so, I just pulled out
a blank piece of paper. It was actually a sticky note. He just sent me a picture
of it the other day. He kept it. This was-- so he's like, hey,
here's this sticky note you sent me home with. So I had this sticky
note that said, trigger, behavior, reward. And then, so I drew the
arrows between the three. And he made this
connection that, oh, this is my brain
doing its thing. He had never mapped
that out before. So that's really what the
first step is for anyone to be able to map out
a habit loop is just to see what the trigger,
behavior, and result is. We can do this with anxiety. We can do this
with stress eating. We can do this with
procrastinating, or anything. And in fact, we've
created a free habit map, where I think we the
URL's just MapMyHabit.com. So anybody can
download this free PDF and map out their own habits. Because that's what I
do with my patients. But anybody can do this. KRISTIN MACZKO: That's fair. JUD BREWER: So that's
that first step. Does that make sense? KRISTIN MACZKO: Mm-hmm. Yeah. And I wanted to see if you
could specifically talk about perseverative thinking. One thing that really
jumped out was, I think, you wrote that it was
the single top issue that you see with patients who are
struggling with anxiety and that anxiety
being forward-looking, perseverative thinking,
and depression being backward-looking,
perseverative thinking. So in the context
of a habit loop, what reward or perceived
reward is someone getting from perseverative thinking? JUD BREWER: Yeah. So if we map it out, so that
the trigger could be any-- just even a feeling of anxiety. And the behavior
tends to be worrying. That's what that
perseverative thinking is, where they're thinking--
they're worrying about what might happen in the future. And that worrying-- so
occasionally it will either predict-- well, I'm going to say
predict, but it's actually associated with something that
might happen in the future. So they might say, oh,
I'm worried about this. And then it happens. And then their
brain says, oh, see? You should worry
about that because you predicted that it would happen. But it could be true,
true, and unrelated. Just because they
worried, especially if they worry all the
time, then the likelihood that they're going
to have a thought and they're going to
worry about that thought is pretty high correlation. But simply because
they have the thought doesn't mean that worry
helped with anything. And in fact, the
most solid research shows that perseverative
thinking, that worrying, makes people feel like
they're in control. So somebody feels
like, oh, yeah, see? I told you. That gives them some
sense of control. But it's only a
sense of control. It didn't actually affect-- we can't worry our
family members safe when [LAUGHS] they're out at
night or something like that. We can't worry things to happen. But it gives our
brain something to do. And that is rewarding
enough that it can actually spin these cycles of anxiety
until it gets to be too much. And that's when we can help
people shift out of those. KRISTIN MACZKO: Yeah. No, I think that was really
helpful of this feeling of either distraction
from the anxious feelings or a false sense of control is
what creates that initial habit loop. All right, so let's
move into second gear. This is where it starts
getting really fun. So the second gear is updating
your brain's reward value. So maybe you can tell us
about what is a reward value and how does the brain use it to
decide what behaviors to take? JUD BREWER: Yeah. So our brains have this region
that's involved in a network, but it's one of the
main players is called the orbitofrontal cortex. And it's kind of
behind our eyes-- that's orbito-- and in the
front, the frontal cortex. And the way that this
works is that most habits are helpful for us. But our brain has to set
up a sorting mechanism to figure out what decisions
to make at any one time. It's kind of an algorithm. Where it says, OK, given the
choice between two behaviors, you could either
try both of them and then learn which
is the best one to do. Or you could just set up
an algorithm that says, in general, I'm going
to pick this over this. This is kind of why our brains
will go to cake over broccoli. It's kind of like, our brains--
from a survival standpoint, cake has more calories. But to our bodies, we have all
these associations with cake tasting good and this and that. And so, our brains
will go to cake. And so, we set up these
reward hierarchies. If I eat some cake, or
a piece of chocolate, and broccoli, my brain
compares it to and says, what would you prefer? Cake, chocolate, or broccoli? Chocolate. Let's say I eat
some milk chocolate. And then I say-- because milk chocolate
is not my favorite. So then let's say I eat
some dark chocolate. And my brain compares
dark to milk chocolate. Well, dark chocolate definitely. And then it's like,
OK, is that 70%? Add in 72%, and then some
cayenne, and sea salt. You can get the idea. Where my brain has this
very intricate reward hierarchy of what chocolate. So then if somebody says,
hey, what kind of chocolate would you like? Here's this versus this. My brain is like,
I'll have this, because I've tried all of
those things in the past. So that reward
hierarchy helps us move through life
efficiently and not have to relearn
things all the time. Now, that can be helpful
most of the time. But then, it also can get
set up to the point where we can fall into habit loops
that are not so helpful. So for example, if we've
learned to worry as a kid, or we learned it
from our parents, or whatever, until it
becomes problematic we're just going to keep
doing it habitually. Or if we've learned to overeat. My lab just published
a study where if we have people tap into
that reward hierarchy, we can actually measure
how quickly that reward value changes. So let me dive into
that, double-click on that a little bit. So the only way to
change a behavior is to change the reward value. So my patients come in. It'd be great if I could just
use willpower and say, just stop smoking. Just stop overeating. Just stop worrying. It'd be one-stop shopping
for each of my patients, and my job would be super easy. I could just kick back
and be like, OK, ready? Go. Stop. It doesn't work that way. So our brains-- and we get
stuck in this willpower myth. And we're like, oh,
what's wrong with me? I know cigarettes
are bad for me. I know I shouldn't overeat. What's wrong with me? There's nothing wrong with us. Nothing wrong with our brains. It's just that we've gotten
caught in this societal myth, I want to say, around willpower. It's like, oh, there's
something wrong. I just need more willpower. That's not how our brains work. Our brains work based
on reward value. So what we can do instead-- and this is what I do in
my clinic is I'll have my patients smoke a cigarette. And they're like, my doctor
just told me to smoke. But I have them pay
attention as they smoke. And they realize pretty
quickly that cigarettes tastes like crap. I've had patients--
I had a patient who was smoking 40 years. So he'd reinforce his habit
loop like 293,000 times. We calculated it out. And he came back, and he said,
how did I not notice this? Well, it was a habit. He wasn't paying attention. And as soon as we
start paying attention, we can't unsee what we just saw. We can't unsee that
cigarettes taste like crap. But what that does is it
gives our brain what's called a negative prediction error. So we predicted that
cigarettes were this good. And then it was
below expectations. So there's this error term
that says, brain, says, hey, pay attention. Learn something. This isn't as good
as you expected. And what that does is say,
hey, that's not that great. And we start to become
disenchanted with the behavior. We've done the same
thing with overeating. So with our Eat Right
Now app, for example, we built in this craving tool
that has people pay attention as they overeat. So they're not just
doing it mindlessly. And so, they can really
line up how rewarding it is. So if overeating
is great, they're going to get a positive
prediction error that says, that's awesome. Do it again. Nobody gets that
because overeating doesn't feel awesome. So they get this negative
prediction error. And we can actually
map out and graph out how quickly that reward
value drops below zero. Are you ready for this? 10 to 15 times. It only takes 10 to 15
times for our brains to update that reward
value and shift behavior. Which of course,
if you look at it from an evolutionary
perspective, we don't have 20 times to get
chased by the saber-tooth tiger to learn that it's dangerous. Our brains have to be
tremendously plastic so that we can adapt to our environment. It's just that we
form these habits, and we become complacent,
and we don't pay attention until something really
dangerous happens. And then it's often challenging. Like a big medical-- we have a big medical issue
that comes from smoking, or overeating, or whatever. So here, we can really tap
into that power of our brain and how strong that
learning mechanism is. And the nice thing about it is,
we don't have to get surgery. We don't have to get
some brain implant. All we need is one simple
ingredient, which is awareness. We just have to pay attention. If we don't pay
attention, we're going to keep that old reward value. And we're going
to keep doing it. If we focus on
willpower, we're going to get stuck focusing
on the wrong thing. But if we just pay
attention and ask ourselves, what am I getting
from this, then we can feel into our
direct experience. It's not intellectual, like
I know smoking is bad for me. But it's like, oh, this
doesn't taste very good. When we pay attention
there, that's when that reward value updates. And we start to
become disenchanted with that behavior. Does that make sense? KRISTIN MACZKO: Yeah. I love that. And I that's what's so
revolutionary about the way you talk about this is so
much of habit change is around willpower, or
shaping the environment, or whatever else. And this idea that
you can actually just give your lower brain direct
access to the experience and it will learn in the
way that it has learned for millions of years. And it isn't an
effort of willpower. And I don't know if you want
to just talk briefly-- you talked about how the
prefrontal cortex is evolutionarily newer and
weaker than other brain areas. And so, it's always going
to be an uphill battle to try to use willpower,
and if you want to share a little bit about that. JUD BREWER: Sure. Just briefly, the
prefrontal cortex from an evolutionary
perspective is really the youngest and the
weakest part of the brain. And it's been shown pretty
clearly that it goes offline when we get stressed. And so, [LAUGHS] stress
leads to everything from relapse in drugs,
to eating, to smoking, to worrying. And so, here we are saying,
well, just use your willpower, assuming that it's a real thing. And then it says, OK, use it at
the time when you can't use it. Because the prefrontal
cortex tends to be the seat of
cognitive control. So it's kind of-- we're
setting ourselves up to fail. Even though it makes
a lot of sense-- like, oh, yeah,
just don't do it-- it's not really how
our brains work. KRISTIN MACZKO: Yeah. No, I think that's
what's really powerful, paying attention to
the actual experience. I had one question on
the eating piece of-- another factor I often
think about with food is that when we evolved, we
evolved in an environment where there weren't
enough calories. And so, it was very adaptive
to want as much fat and as much sugar as you could
possibly have. The modern world is a
very different environment where there's an excess
of fat and sugar. So I've often thought
of it that way too, where our instincts
just aren't fully-- our instincts didn't evolve
in the current environment. But are you saying
that if we fully pay attention to our
instincts around when we go from craving
to feeling satiated, that that is enough
in terms of health? Or do we have to
also layer in some of the higher level prefrontal
cortex cognition around, oh, this is probably not
good for my long-term health? JUD BREWER: Yeah. It's a great question. The way I think of this
is, our feeling bodies are much stronger and much
wiser than our thinking brains. And so they know-- if we just give ourselves a
chance to listen to our bodies, we know when we're full. We know when something
tastes crappy. And so, I think of it this way. Let's use eating as an example. If we pay attention,
there's this thing called-- I call it the pleasure plateau,
where it's pleasurable, pleasurable, pleasurable. And then at some point
even the same food's going to taste less pleasurable
because our body says, OK, I've had enough. We hit that plateau. And if we're not
paying attention, we're just going to
zoom off that cliff of-- I call it the cliff
of overindulgence. [LAUGHTER] And then we wake up from
our stupor, and we're like, what happened? [LAUGHTER] And then we go do it again
because we haven't learned to make that association. So it's really good in
that sense in the sense we don't need to have to learn
something intellectually. We don't have to be
a very smart person. We just have to be embodied. We just have to really
pay attention and listen to our bodies. And then we start to
learn to trust them. They're actually
much more trustworthy than our thinking brain,
which is always saying, oh, try this, try
this, try this. KRISTIN MACZKO: Yeah. Thank you. It's really helpful. So the final gear is third
gear, which you refer to as the big better offer. And so, we've been
talking about how-- any time we're
trying to decide what to do, our brain is evaluating
all the different projected reward values of every
behavior, and that we need to update the reward value
of these learned behaviors to say, actually, maybe
that's not-- maybe worrying, or procrastinating,
or having a second piece of cake isn't going to feel as
good as I thought of. So we talked about updating
those reward values. But you also talk about needing
to add in new behaviors that have an even higher
reward value than the ones we've tried so far. And so, can you tell us
a little bit about that? What have you seen
with your patients in terms of what is the
bigger, better offer in terms of new behaviors
that they could try? JUD BREWER: Yeah. Well, one thing that I've
seen that doesn't work is where somebody substitutes
one behavior with another. And that loop is still in place. So I see this a lot with
addiction treatment, where somebody replaces
cocaine with exercise. And so, they say, oh, when I
feel this urge to use cocaine, I'm just going to exercise. Or when I feel this
urge to whatever, I'm just going to eat. The problem there
is that it doesn't dismantle the loop itself
and in fact can lead to-- the simple definition
of addiction is continued use despite
adverse consequences. So people can get addicted
to exercise, for example. And then if they get
injured, their body says, oh, wow, now I'm
craving both my substance and the exercise. And I can't have either. And then it often
leads to relapse. So that tends-- that
substitution strategy doesn't tend to work very well. Certainly, eating
carrot sticks is healthier than smoking
cigarettes for sure. And so that's how some
people will quit smoking. But ultimately, we've really got
to dismantle that loop itself. And so, the way to
do that is to find intrinsically rewarding
behaviors, quote unquote, behaviors. And they've got to be
intrinsically rewarding because then they don't
become habituated. We don't need more,
and more, and more. And we don't spin
those habit loops. The two flavors that
I find most helpful-- and our research
has backed this up-- is that we have this
ability to be curious. And we have this
ability to be kind. So for example, if somebody
is anxious, they can-- anxiety can trigger
them to worry. And then they can
spin out in that loop. Or in that moment when
somebody's anxious, instead of that, oh, no, what's wrong? They can go, oh, what's this? And drop into their
direct experience and get curious about
what that anxiety feels like in their body. Or if they're
habitually overeating, or they have a craving
to eat some junk food, and instead of
indulging that craving, they can get curious-- oh,
what does this craving actually feel like in my body? And then they can compare
what does craving feel like compared to curiosity. Well, curiosity feels better. It's a no-brainer. What does worrying feel
like compared to curiosity? Curiosity feels better. It's a no-brainer. So it in itself is this
intrinsically rewarding mental behavior that we can tap
into that not only feels better than the old
behaviors-- that's why I call it the bigger better
offer, because it's better. It feels better. But it's also helps us step
out of these old habit loops. So it serves-- it's a twofer. And there's no-- you
can't get too curious. [LAUGHS] And there are all sorts of
great quotes about curiosity. James Stephens wrote,
"Curiosity will conquer fear even more than bravery will." So if we're afraid,
we can get curious. Or if we're bored-- there's a quote. Curiosity will conquer boredom. There is no cure-- Or curiosity will cure boredom. There is no cure for curiosity. And so, there's a great
intrinsically rewarding tool that we have that
we always have. And it's just a matter
of awakening it. So that's one flavor
that I think-- I really think of
curiosity as a superpower. And it fits-- if you look at
Buddhist psychology, that's really the heart of
awareness is having this curious, open-minded,
non-judgmental attitude. Yeah. KRISTIN MACZKO: Yeah. JUD BREWER: So that's one piece. We can talk about
kindness in a minute. But I want to pause there. KRISTIN MACZKO: Yeah. And I love the
point that you made that it's a twofer in the sense
that it's the curiosity that's bringing the awareness. So you're realizing, here's how
I feel when I procrastinate. Here's how I feel when I don't. Here's how I feel when I worry. Here's how I feel when I have
a cigarette, or whatever. So it's actually
the means by which you're giving yourself
information about the results of your behaviors. And then, it's also
in and of itself intrinsically satisfying. So I really-- I
like that component. And then, did you want to
add on with kindness as well? JUD BREWER: Sure. So kindness, also superpower. One of the most common
habit loops that I see is self-judgment. We're really good-- KRISTIN MACZKO: Yeah. JUD BREWER: I'll extend that. Judgment in general--
in the Western world, we're really good at judging. So whether we're
judging others-- and social media is great at
piling that on on itself-- or judging ourselves. We get in these habit loops. So we have this
thought, and then we think, oh, why did I do that? Why didn't I do that? All the shoulds come out. I should have done this. I shouldn't have done that. What's the joke? We should all over ourselves. KRISTIN MACZKO: [LAUGHS] JUD BREWER: So that habit
loops gets spinning. And so, we can map-- first gear, map it out. Second gear, ask, what am I
getting from beating myself up? And then we can say, OK,
brain, what do you like more? Beating yourself up,
judging yourself, or being kind to yourself? Another no-brainer. Kindness just feels better. And if we can't
remember the last time we were kind to
ourselves, we can just remember the last time
somebody was kind to us. It could be the simplest
act of kindness, where somebody just
held the door for us. What's it feel like when
somebody is kind to me? Oh. It's like, oh. It's a relief. It just feels good. So we can start
to bring kindness in as a bigger,
better offer as well. KRISTIN MACZKO: Yeah. And it's interesting,
we're doing a lot of
self-compassion training at Google, just realizing how
fundamental that compassion to yourself as a
starting point is for so many other foundational
mental health needs. And one thing that
we'll sometimes hear is, similar to what you were
saying earlier about people seeing the value of
anxiety, there can be a fear if I'm too kind with myself
that I won't work hard. If I have self-compassion,
I won't work hard. So can you speak to that
and the misconception there? JUD BREWER: I would be happy to. I'm so glad you bring this up. This is really important. So this is really the
critical distinction between self-indulgence
and self-care. So if we're-- I don't know, maybe
we have the habit of eating three
helpings of ice cream when we've gone way beyond
that pleasure plateau. And so, our brain could say, oh,
you're taking care of-- you're being kind to yourself
by eating this ice cream, or eating ice cream
when you're stressed, or something like that. But we're not actually
caring for ourselves because it's not getting at
the root of the thing that triggered that behavior
in the first place. So it's really important
to be able to ask ourselves the simple question,
not what do I want because the want drives us. It's that dopamine drive
that says, I want this. Go get it. It's really about,
what do I need? And asking ourselves that
question, and really, really sitting with it
and seeing what comes up. So if I need some
connection, ice cream isn't really a connection. [LAUGHS] It's a habit. And so, we can say,
oh, I'm feeling lonely. I need-- so then we
can call a friend, or go and snuggle with a
pet, or something like that, where we actually meet that need
instead of indulging that want. And that's the
critical distinction between self-indulgence
and self-care. Self-care, really helpful. Self-indulgence tends to
just feed these habits. KRISTIN MACZKO: Yeah. That's a really, really
helpful clarification. So I have two more
questions, and then we'll go to the audience. So reminder for everyone to add
questions to the YouTube chat. So coming back to
anxiety specifically. So you told a really
powerful story about a patient struggling
with anxiety who was really focused on the why. And so, this is a
passage from the book where you said, "She had gone
down the rabbit hole of why. She was desperately trying to
figure out why she was anxious, thinking that when she got
the answer, she could fix it, and her anxiety would go away. We think that if we can
identify these triggers, we can either avoid
them in the future, or better yet, fix them. And then we get stuck in
trying to fix the past." And I think this is
so common for people who struggle with
anxiety and worry, and would love to
hear you tell us what you did with that
patient and with your patients more generally to help her
take a more productive path. JUD BREWER: Yeah. So the first thing
here is to really help ourselves understand why we get
stuck in these why habit loops. And the general problem
is that our brain says, I just want something
that's going to make this go away forever. So if I can find
what that reason is, I can somehow solve it. [LAUGHS] And I laugh because life
isn't-- we can't just solve a constantly changing
experience that is life. And we can't-- if we find
something that triggers us, we can't necessarily--
sometimes we can avoid triggers. But we can't go through
life just constantly trying to avoid triggers. What we can do is
empower ourselves to have those-- be able
to work with something that triggers us. That's what gives us autonomy. That's what gives us confidence. That's what gives
us self-efficacy. So here, I start by
having my patients map out these why habit loops and help
them really see for themselves. So this comes from them,
just me asking questions. Like, well, what is it? What are you looking for? And it basically comes
out to some flavor of, well, if I could just
find this, I could fix it. If I can find it, I can fix it. [LAUGHS] And so, people spend
endless years diving back into their past to
try to figure out-- well, especially with
the past, the problem is, there's nothing we
can do about our past. We can honor our
experience in the past, but we can't change it. What we can change
is the present. And if we change
something in the present, we can affect the future. And that's where things
get really powerful. So here, we can help
people honor their past, get out of those why habit
loops and into the what of the present moment. So when I'm anxious, what
does this feel like right now? And they can bring in curiosity. Oh, what's this feel? Oh, where do I feel this? Oh, do I feel this
here, here, or here? What that does is
help them step out of the why habit loop
in the present moment and not feed it and also feed
that new habit of curiosity. KRISTIN MACZKO: Mm-hmm. That's great. And I found that very
powerful, is like-- and I think at another
point in the book you said, the least important part of
the habit loop is the trigger. The trigger is just
what gets you there. But then it's how you respond
is where all the power is. JUD BREWER: Yeah. If I can just repeat
that, because that's really, really important. The trigger is the
least important part. And it's our brains that want to
come in and try to fix or solve things. Like oh, trigger,
trigger, trigger, trigger. Guess what? Reward-based learning is
called reward-based learning. It's not called
triggered-based learning. It's based on how
rewarding a behavior is, that's what's going
to drive future behavior. That's how reinforcement
learning works. So the triggers
just happen to be the thing that gets associated
with spinning the loop. It's really about focusing on
the behavior and the result. What's the result
of the behavior? That's where we get those
positive and negative prediction errors. It has nothing to do
with the trigger in terms of changing the behavior. KRISTIN MACZKO: Mm-hmm. Yeah. That's very critical. And then final question for me
before we go to the audience is, I think a lot of people
listening to this call are personally struggling
with anxiety or panic attacks right now and today. What advice would
you give to someone-- distilling what we've talked
about in this past 45 minutes, what advice would you give for
someone who's just starting and who wants to start down
this path of interacting with their anxiety
in a different way? JUD BREWER: I would say,
first, you're not alone. Often people feel like, oh,
this is only happening to me. It's not-- there's
something wrong with me. So notice that, and know
that you're not alone. This happens to-- I
don't know anybody that's never had any anxiety. Let's just put it that way. And the pandemic
spiked anxiety levels. Those anxiety levels tend to-- it seems like the trends are
that they're still pretty high. Lots of uncertainty out there. And so, I would say,
don't give up hope. But really focus
on getting curious about learning how
your mind works. And there can be
many ways to do that. And that's why I
like the simple place of starting by just
mapping out habit loops. Just mapping out these loops
is tremendously empowering. It's like we've been walking
around in a dark room bumping into things
our entire lives. And we're like, what was that? What was that? And then we try to avoid those
things, but we're not oriented. Just mapping out these
loops is like flipping on the light switch. And suddenly, we
can see the terrain. We can see the territory. We can see all the things
that we're bumping into. And when we see those and start
to see those habit patterns, that's what gives us the power
to start to work with our mind instead of fighting against it
or bumbling around in the dark. And that's where asking these
questions like, what am I getting from this,
and then finding the bigger better offer, that's
something that anybody can do. KRISTIN MACZKO: Mm-hmm. Yeah. And going back to what you
said earlier about just how intrinsically
motivating curiosity is, just in that moment
saying, how does this feel right now in
my body, and just approaching that with curiosity. Yeah. Wonderful. Thank you so much. So let's go to some of
the audience questions. All right. So from Dirk, "What if
curiosity doesn't help you as a better option? For example, I know what
anxiety feels like in my body. I can't really get
more curious about it or find it to be
any more enjoyable." JUD BREWER: That's a
really good question. So here, one
distinction to make is there are two
types of curiosity. One's called
deprivation curiosity. One's called interest curiosity. Deprivation curiosity
is what it sounds like. When we're deprived
of information, that's when our brain says,
go get that information. Interest curiosity
is just the act of being interested in
something and curious about it. And I think of it-- deprivation is like
the destination, when we get the
information, we've arrived at our destination. That deprivation is gone,
and we're back to baseline. Interest curiosity is
more like the journey. It's like we have no
destination in mind. We're just really
curious about it. So here, if-- it's similar-- and
I get similar questions to what Dirk pointed out. If we can't find that we
can be more curious, we can ask ourselves, what does
it feel like not to be curious? And that creates this
[INAUDIBLE] for our brain, huh, huh, so that we can start
to see what interest curiosity itself really truly feels like. And with anxiety itself,
we have this tool that we call the stress tool
that's built into the Unwinding Anxiety program. We have people feel into where
anxiety feels in their body and then ask a simple
question, like is it more on the right side
or the left side? Is it more in the front
or is it more in the back? And here it awakens
our curiosity. Huh, is it more on
the right or the left? Is it more on the
front or the back? And what that can
do is just help us start to get a taste of
what curiosity feels like. Because when anxiety
is really strong, it often crowds
out that curiosity. And it's not like we
can instantly be like, OK, now my curiosity is at 100. It tends to take some
training to build that up. And that's why with-- the systematic training around
the curiosity can be helpful. It's not just that,
oh, suddenly I can tap into my inherent
capacity to be curious. So for Dirk and anybody else
that's struggling with that, this is-- I love the question of
like, huh, well, what's it feel like not to be curious? And that can start to awaken
that interest type of curiosity that we're talking about. And then, if we can awaken
that, like, huh, I don't know, that huh tends to be a sign that
we're starting to get curious. Another way that we can
get a sense for a signpost is what our mind is saying
in the tone of voice. So it's like, oh, no. There's anxiety. Or we can go, oh,
there's anxiety. And that "oh" is a sign that,
oh, what does this feel like? That's when we're getting
into the interest curiosity territory. It's very different than
the deprivation curiosity, which has more of a driven,
restless quality to it. KRISTIN MACZKO: The
other thing that this reminds me of that you
mentioned in your book is that sometimes-- I think you were talking
about the RAIN exercise. Sometimes there can
be the misconception that if we're having a difficult
emotion and we're mindful, it will go away. And you talk a little bit about
how that's not necessarily the case. And it's more like
changing our relationship with that experience. JUD BREWER: Yes. That's a really important point. Which is, often
we think, oh, I'm going to use curiosity
as the anxiety eraser. [LAUGHS] KRISTIN MACZKO: Right. Yeah. JUD BREWER: It's like, oh, now
my anxiety is gone forever. It's back to that our brain
not wanting to have this. But if there's something
that's unpleasant-- it could be anxiety
or something else-- and our brain says, this
doesn't feel good, we might say. I don't want this to be here. So I'm going to do something
to make it go away. That's a sign that we're
resisting our present moment experience. So mindfulness and curiosity
are about the opposite, where we're welcoming in our
present moment experience. And so, here it's
really important to check in to see if we're
resisting and doing something in order to make
the anxiety go away. That's not what these
practices are about. They're about learning to
relate to our experience differently, so that we
can welcome everything in. And in this sense,
there are these things like, the only way
out is through. We can't avoid anxiety. We can't make it go away. But if we open to it,
if we turn toward it, and we see that it in itself
is just made up of thoughts and sensations, and they aren't
as bad as our mind makes them out to be, suddenly
their power diminishes. And we can learn, OK,
this is unpleasant. But I can buckle my seat
belt. And that curiosity helps me ride it out, instead
of being consumed by it, or being consumed by ways
to try to make it go away. So that's really important. This is about changing
our relationship to our thoughts and emotions. It's not about changing
our experience. But paradoxically, by
changing our relationship, our experience changes. We just can't
force it to change. KRISTIN MACZKO: No. Thank you. All right, next question. From Kiron. "Your colleague at Brown,
Willoughby Britain, has done some
interesting research about the adverse
impacts of mindfulness. Is there such a thing as
taking mindfulness too far? When does that occur?" JUD BREWER: It's a
really good question. So a lot of work has been done--
and Willoughby has been one of the leaders in this field-- around what might
be the circumstances around which somebody
might struggle with the mindfulness training. And she's mostly studied
experienced practitioners, teachers, and people
that have gone through these eight-week
intensive programs. And so, here, if somebody has
a trauma history, for example, it might be a
contraindication for somebody to dive into one
of these courses or even to an app-based
mindfulness training blindly. So here, it's interesting. If you look historically,
people have typically been supported by
teachers when they've started doing these practices. And in the West, where it's more
of a consumerist mindset where we're like, I'm just going
to buy this and do it, the support mechanisms
may not be as strong. So it's really important to-- if somebody struggles,
for example, has a trauma
history, that they've got adequate support as they're
starting to do these things. I think of this as
muddy waters, where things can get stirred up. And if we don't know how to
have the emotion regulation capacities to work
with them, it can feel like things are getting worse. In our studies, we
monitor adverse events and find that there are no
unexpected adverse events. But we do find with
our anxiety program that people will report that
their anxiety is a little bit stronger at first,
a little bit higher. And that we expect that. We expect people to start
noticing what anxiety actually feels like, especially
if they've been avoiding it their whole life. And the good news
is, we can give them that support to be
able to be with it and let that go downstream. So I think of it as-- the analogy I use
is muddy waters, where you kick up the mud, and
suddenly the water's muddy. And you're like, where did
all this mud come from? The water was clear. But if have those emotional
regulation capacities starting to build-- and that's what
mindfulness training really can help us do-- that mud washes downstream. And we have the
capability, so that when the dirt comes in the future,
it doesn't get laid down as mud. And so, we can learn to work
with even very strong things that come at us. KRISTIN MACZKO: Great. Thank you. All right, next question. From Bud, "First, I love your
program and it changed my life. Thank you. Second, how do you
see the correlation of anxiety and ADHD?" JUD BREWER: That's a
really good question. So not being an
epidemiologist, I can't answer the specifics of
how correlated those two are. I would guess that there's
some correlation between them, and especially
experientially, where anxiety has this restless,
driven quality to it that says, go get information. And ADHD has this restless
driven quality to it as well. And for some people, it's
just the emotional flavor of, they're oh, this,
oh, this, oh, this-- with ADHD, where it's
like oh, oh, with anxiety. But that restless
quality I think is a very shared
physiologic experience. I'm glad to hear the
program was helpful. That's always great to hear. KRISTIN MACZKO: Great. Thank you. All right. Do we have another question? From Brendan, "How important is
developing distress tolerance to countering
habit-related anxiety? And are there
concrete strategies to improve distress tolerance
in particular during an anxiety wave?" JUD BREWER: Yeah. I would say, in life in general,
developing distress tolerance is really helpful. And these-- Cornell
West calls our phones our weapons of mass distraction. It's so easy in modern day to
learn to just turn to our phone to distract ourselves. Oh, I'm going to check my email. We rationalize this. It's really good. I'm going to check my email. I'm going to check my Slack. I'm going to go look
at a YouTube video or something like that when
I'm feeling uncomfortable. So we actually learn
to distract ourselves. So that's the opposite
of distress tolerance. So I would say, distress
tolerance is critical, not only for anxiety
but for everyday life. And here I would say,
mindfulness training, one of the common
mechanisms that's been shown over and over, is
that it's a really good emotion regulation strategy. And I think of it is a really
good distress tolerance strategy. So when something
is distressing, our survival brain says,
oh, no, that's unpleasant. Make it go away. And our mindfulness brain--
let's put it that way. When we learn the
power of curiosity, we can go-- instead of
going, oh, no, we can go, oh. And that "oh" helps
us open to it. And when we can
open to something, that is a tremendously powerful
form of distress tolerance. Because we don't have to-- if we're truly
opening our awareness and opening our
arms to something, we don't have to
push against it. We don't have to tolerate, oh,
I'm going to just grit my teeth and tolerate this a
little bit longer. Bring it on. Let it be here all day. We welcome it in. And this goes back-- I love this. There's a poem from
Rumi that's really famous called "The Guesthouse,"
where he talks about-- I'm terrible at quoting
poems, so I won't. But to summarize,
he talks about, welcome all these
negative emotions in. They could be guests
sent from beyond to help you basically sweep your
house clean and help you learn. And so, we even see-- what we think of as a bad
or a negative emotion, we can see it as like, oh,
here's something really strong. And here's something
that can help me learn how I deal with
the world, which I can then generalize and learn from that. And we become wise based
on things like anxiety. So we can even start to see
them as teachers and say, OK, here it is. What can I learn
from this about how to work with strong emotions? Oh, what does anxiety feel like? And so, curiosity, for example,
is a really good distress tolerance tool. KRISTIN MACZKO: I love that. Yeah. It reminds me-- there's
this book called "Care For the Soul." I don't know if you've-- I think it's by Thomas Moore. But it's all about how we just
have this tendency to say, oh, I want joy, and hope,
and happiness, and ecstasy. And I don't want
any fear, or pain, or-- and he just talks
about just the beauty and power of leaning
into it all, leaning into all of the emotions. JUD BREWER: Yeah. KRISTIN MACZKO: All right. I think we have a
few more questions. So let's keep going. "So how does awareness increase,
and does meditation help?" JUD BREWER: So the second
question, how does meditation help, it helps us
train to be aware. And awareness
increases through-- so if you look at the historic,
the Buddhist psychology, and the early suttas, they
talk about previous moments of awareness will be predictors
of future moments of awareness, which kind of seems
like chicken and egg. So if you look at it
from a brain perspective, we're going to keep
doing behaviors. We're going to even do behaviors
more if they're rewarding. And so, here, how can
we increase awareness, and how does meditation help? We can practice being
curious about our experience. And we can notice what it
feels like to be truly present, for example, versus lost. We can notice what it feels like
to be truly present or aware of anxiety and have that
hold the anxiety as compared to fighting against it. And any time we notice
the reward of being aware, any time we notice the
reward of curiosity, it's going to become that
bigger, better offer. And it'll start
to feed on itself. So that develops
a virtuous cycle, where previous
moments of curiosity, when we reflect on them and say,
what did I get from that-- oh, it felt good-- they're more likely to
say, OK, do that again. And our brain is going to start
to get in this virtuous cycle where it says, hey, let's
bring on that curiosity. Let's keep doing that. If we try to force awareness
or force curiosity-- and I can speak from my own personal
experience about this. I used to sweat through
t-shirts in the middle of winter on these long meditation
retreats trying to pay attention. It doesn't work. That's not how our brains work. Instead, we can tap
into that intrinsic-- I think of curiosity as that
an intrinsic superpower. And when we see
that it's rewarding, it's going to be
self-reinforcing. And that's really what
mindfulness is about, is that curious
awareness, that awareness that has that attitude of
non-judgmental curiosity. KRISTIN MACZKO: Thank you. So we'll do one more question,
and then we will close. So final question
is from Gregory. "How can we stop
ruminating on the past or fixating on mistakes that
may have led to trauma?" JUD BREWER: Yeah. It's a really good question. So here, I was just
thinking about somebody that I had a conversation
with who had talked about his childhood trauma. And he had been-- his mechanism as a kid to
survive-- because children don't have control
over their situations. And people who've
had trauma generally don't have control
over what happened. But that doesn't stop people
from blaming themselves or forming some
type of survival-- really a coping
mechanism that's helped, and they feel like that's
helped them survive. And so, this
gentleman, for example, had developed the survival
mechanism of worrying. He would worry. And he was thinking
that the worry was going to keep him
safe throughout life. And he kept this for,
I don't know, 50 years, for a long time. So what we explored
together was honoring that child that was doing
the best that it could. Because he didn't want
to just dismiss himself, his childhood self. But at the same time,
he wanted to move on. And so, we talked about this in
terms of both honoring the past but also seeing how that
might not be helping us now. And one way that
I think about this is, we've worn a
pair of shoes that fits and are very comfortable. But at the time they
fit, they don't fit now. We've outgrown those shoes. And so, in fact, we
keep putting them on even though it's painful. And so, it's actually
not helping us in the present
moment to be doing those coping mechanisms
that might have helped us in the past. So here, we honor the past. And we acknowledge, and we say,
OK, is this helping me now? Is this meeting my needs now? And often, whatever these
coping mechanisms are, sometimes they're not helping. So for this gentleman,
worrying wasn't helping him. And so, in real time-- we
did this on a live group-- basically helped him
start to then say, OK, I can let go of that. And I can move forward
in the present moment and work with the
worry as a habit loop. And that just gave him a
tremendous self-efficacy to be able to say,
OK, I can honor this. And I can work with this. And these are two
very different things. So for anybody
that's struggled-- and unfortunately, trauma
is way too prevalent. There's just way too much
of it out in the world. There is hope where we can
start to really work with these. And of course, having really
good support mechanisms can be very, very
helpful for this. But we can learn to move on. And one of the issues is
getting stuck in the past. KRISTIN MACZKO:
Beautifully said. Thank you. So Dr. Jud, thank you so much. I have really enjoyed
our conversation. Thank you for taking the time. In closing, can you let people
know how they can find you, how they can find your work? JUD BREWER: Oh, sure. I have a website,
DrJud.com, D-R-J-U-D.com. I'm on Twitter @JudBrewer,
J-U-D-B-R-E-W-E-R. But the website has got a bunch
of free resources, the books, the apps, anything else that
folks might be looking for. KRISTIN MACZKO: Wonderful. Thank you so much for your time. JUD BREWER: My pleasure. [MUSIC PLAYING]
