Speaker 1 · 0:03Today is our distinct honor and pleasure to welcome Dr. Judson Brewer. So we're really grateful for his presence and for agreeing to join us. Dr. Judd is going to be talking about unwinding anxiety. Dr. Judd Brewer, for those of you who aren't familiar, has spent over 20 years at Yale, MIT, and Brown University researching how our brains form negative behavior patterns, bad habits, and addictions. And he's researched the specific techniques needed to create lasting change. His latest best-selling book is called Unwinding Anxiety. New science shows how to break the cycles of worry and fear to heal your mind. And he offers a clinically proven step-by-step plan to break the cycle of worry and fear that drive anxiety and addiction habits. And so I just am very, very grateful for Dr. Judd's work on researching the science behind how we can unwind anxiety in ourselves and others. And I hope to share these teachings far and wide. Dr. Judd, welcome. It's a pleasure to have you. Thank you.
Speaker 2 · 1:25I see this very, very commonly in my patients with generalized anxiety disorder, where they say basically, I wake up in the morning and I'm anxious. And I don't know why, but it's I'm awake and I'm anxious, and that's what I know. And then they start worrying about what's causing my anxiety because they can't identify it. So it is extremely common and often gets people stuck in rabbit holes. I actually wrote a chapter in my book about the why habit loop, where I use an example of one of my patients who came in my office and she would get anxious and then she would start asking herself, why am I anxious? Why am I anxious? And she would go down this rabbit hole of trying to figure out why she was anxious. I've seen people get stuck in psychotherapy for years trying to figure out why they're anxious. The truth is, and this can be hard for some people to take, the why doesn't actually matter when it comes to working with the anxiety because it's something that might have set it up, but how behavior changes is not based on the past and one of the mathematical models of how behavior changes. There is not a term in that model for childhood. Now, this isn't to say that childhood trauma or childhood experiences, you know, don't put people at risk or aren't important. I'm not saying that, but I'm just saying if you are asking the question, how do I work with a behavior? It doesn't actually matter. There's a patient story that I use in my unwinding anxiety book where this is the guy that was referred to me and had generalized anxiety disorder and panic disorder. Later in treatments, when he started becoming less anxious, it was really strange to him. And he would actually get anxious that he was calm because it felt strange to him. If our baseline is something and it's happened so much that we don't even know differently, this is the way we see the world. It's kind of like people with tinnitus, for example. If the ringing in their ears is constant, they soon forget what it's like not to have that. And if somebody is anxious, it's amazing how quickly that can become their baseline where they don't know what it's like not to be anxious. And it's just part of our adaptive mechanisms where our brains are actually best at looking for change in things rather than things that are constant, because change can signal danger. Whereas if something's constantly happening, well, if it were dangerous, you'd already be dead, basically. And in Buddhism, they are pointing out, hey, that's a problem that causes suffering. Because the only true thing is that there is no permanent thing, right? The only permanent thing is impermanence, the only unchanging thing is change itself. And so I think those two can be related. The more identified we are with some unchanging entity of us, you can think of that as the ego. And that can be related to any aspect, any facet of the ego. So it could be somebody identified with a certain position in life. You know, let's say they are the boss, and the more identified they are with that, and trying to stay the boss of other people at a company, the harder they're gonna fall when they get fired or they have to retire. And they've been so identified with it that it's really hard to let that go because they're like, this is the stable thing. You can apply that to anything, basically. So that's the way I relate that to ego, in the sense of the brain is basically trying to predict the future and trying to be as certain as possible. And one way that it fools itself into doing that is by saying, I am a stable entity, I'm not changing. Now, the more we can see that holding on to that identity leads to suffering, the easier it is to let it go. And the more we can lean into change, the more we can be comfortable with change, and then our brain doesn't try to hold on to things not changing as much because we see that it's more rewarding. You know, really the sense of self forms based on how we interpret our experience and how identified we become with it. I like the simple quote from Ellen Watts. He says, the ego, the self, which he's believed himself to be, is nothing but a pattern of habits. And in fact, if you look at the Pali Canon from Majamana Kaya 19, the Buddha talked about, he said, whatever a person frequently thinks and ponders upon, that will become the inclination of his mind. So the more we fear the future, for example, the more that becomes a habit. Now, here's somebody that was in our unwinding anxiety program who described this really nicely. She wrote an email to me and said, What I'm struggling with is the kind of anxiety that comes from who I perceive myself to be. And the seemingly impermeable blanket of not good enoughness that it just wrapped in deep etched in the bones anxiety. So she was so identified with her anxiety. She described it, you know, impermeable blanket of not good enoughness. And so if you think of the Alan Watts quote, and you just replace the ego with the term anxiety for identified with anxiety, anxiety the self, which he believes himself to be, is also nothing but a pattern of habits. There's this whole concept about performance anxiety, where somebody feels like they have to be anxious to be able to perform or to get stuff done. The image that's coming to mind is this kind of like, you know, somebody feels like that anxiety is the fuel that they have to have to put in their engine to get them going through their days. The reward actually comes from that feeling of being in control or that feeling of distraction. It's the feeling of control. So I want to be super clear about that. It's not that we're in control, it's that we have this feeling of control. And so if you think about worrying, if we don't look at that carefully, it can feel like we're more in control than not because we're thinking about all the things that could happen. And somehow that helps us control the situation. When you look at it carefully, it doesn't actually increase our control at all. But it makes it feel like we're doing something. And so there the reward is probably more related to you can think of it as distraction, because it feels better to do something than sit there and do nothing. This is for the untrained mind, right? So the opposite is true when the mind is trained, but often that reward gets diminished pretty quickly to the point where people don't even, you know, they're like, I'm anxious, I don't see anything rewarding here. But it's when it drives something else, the anxiety itself drives something else as that habit loop. You can think of that definition of anxiety, that feeling of worry is a feeling, right? It's a physical sensation. This can trigger a mental behavior, and that mental behavior can be worry itself. So a feeling of worry can trigger a behavior of worry. And I think that's really important to point out because a lot of people think of behaviors as eating or drinking or smoking or, you know, going on social media. But mental behaviors are just as valid and can drive habit loops just as much as physical behaviors. Uh, and in fact, in psychiatry, I learned this great saying don't just do something, sit there. And this can be really helpful for us as teachers as well. You know, somebody comes at us and they're all anxious and they're distressed, they are just sneezing on our brain that social contagion of anxiety. And for us to kind of mentally mask up is not to do something, but it's to sit there and be with it and not catch that contagion. Because if we do something, we might be doing something to make ourselves feel better, because it feels better to be doing something for somebody that's in distress, but that might actually be worse than sitting there and bearing witness and being with somebody's distressing experience and modeling. Oh, I can be with distress. I, as a teacher, can be with distress, even if it's somebody else's distress. And that in itself begins the modeling process, and then we can work with them and their anxiety in a moment. So here it's really interesting. Our brains love to make associations. That's what they do. That's how we try to predict the future, is they associate this with that. In graduate school, I learned one of the most important things I learned from my PhD mentor, his name was Lou Muglia. And he said, you know, Judd, you have to prove to me when you're doing an experiment whether this is correlation or causation, because correlation does not equal causation. And the way he described it was, is it true, true, and unrelated? As in X happened and Y happened. Like I'm anxious, I'm worried, and I got my to-do list done today. But did the anxiety, did the worry actually cause it to happen? So this could be true, anxious, true, got the stuff done, but it doesn't mean that the anxiety caused it to happen. So that's why they talk about correlation does not equal causation. Correlation, you have to prove that without the anxiety, the to-do list wouldn't get done. And what has been shown repeatedly, and I actually wrote a bunch about this in my book, because this is one of the biggest misnomers around anxiety out there, is that you know, there's this inverted U-shaped curve, and you've got a certain amount of anxiety, helps you get stuff done and all this stuff. Books have been written about this, TED Talks have been given about this. This is based on a study of Japanese dancing mice from 1908, and they shocked these mice. And they say, you know, it's like a little bit of shock. The mice are like, eh, you know, I'm not going to go through the maze. You shock them a little bit more, they're like, whoo, okay, I'll go through the maze. And then you shock them a lot and they're like, ugh, and their performance goes down. And they interpreted this as you have to have a certain amount of arousal to have good performance. And the study was largely ignored. In the 1950s, it was cited like four times between 1908 and 1950. Some famous psychologist, and it's in my book, I forget his name. He gave a talk at some conference and started correlating, he's saying, Oh, anxiety. And he was you, he was speculating that anxiety, you need a certain amount of anxiety to perform. So he was kind of using it interchangeably with arousal, but without evidence. I don't know the official definition of arousal, but the way I think of it, just pragmatically, is what's a low level of arousal when you're asleep. And high arousal is when you're really alert, let's say. Alert is does not equal arousal, but when you're not sleeping, whatever. I can look up the definition, but I that's just kind of how I pragmatically think of it is your energy level is up where you can pay attention to something. It doesn't mean you are paying attention to something, but you're alert enough that you can. The energy is there to do that. I wish I could give you a better scientific definition, but that's just the pragmatic way that I think about it. And then one of his graduate students did another rat experiment where you know, basically the same thing, except here he held rats' heads underwater. And he interchangeably used anxiety and arousal. So animal torturous side. So apologies for that. I'm just describing what these people did. This became what was called Yerk's-Dodson law. So Yerkes and Dodson were these researchers from 1908. Somewhere around 2000, with the internet getting up there and people probably being able to do internet searches, people started to cite this paper and say that you need a certain amount of anxiety to perform well. And then books and all this stuff, and now it's off and taking a life on its own. There was a guy that wrote a great review article on this showing that, at least in business performance, the only thing that's replicable is that more anxiety leads to worsened performance. That's a linear relationship, it's not an inverted U-shaped curve. And if you think about it experientially, who performs better when they're anxious, no matter what level of anxiety they have. I know nobody that performs better on whatever they're doing in relation to when they're calm, when they're at ease. And if you think of the highest level of performance flow, when somebody is totally immersed in what they're doing, they don't even have a sense of self. So they can't even conceptualize anxiety because there was no one there to be anxious. And that's when people are just crushing it when it comes to their performance. So we have direct evidence in the scientific world to show that at the highest level of performance, you can't even have anxiety. We also have evidence that there's an inverse relationship. The more anxiety you have, the worse you perform. And then these memes that get spread on the internet based on Japanese dancing mice being shocked. So, long story short, this correlation leading to causation, the cause for that is probably the internet, in my opinion, because you know, somebody can search something on the internet and it's not based on the truth, it's based on how many times some page has been visited. It's based on popularity, just like Yelp reviews. You know, suddenly everybody is a uh restaurant critic, even if I would probably go to the folks that have trained themselves to really be able to taste food, to really trust. But this, I think the same is true. So I'm gonna briefly present just some of the studies that we've done. You know, mindfulness training has been shown to be in a number of different realms, whether it's mindfulness-based stress reduction, mindfulness-based cognitive therapy, or even some of the digital therapeutics that we've developed. Mindfulness training works really well for anxiety. So if you remember nothing else, just remember that. And if you're teaching and somebody says, Well, show me the evidence. There's a great website called Google Scholar where you can actually look up the papers and see how many times they've been cited as an example. That's actually a kind of the number of citations suggests that something is actually solid as compared to something, somebody puts forward an idea and nobody cites it, means they're not reading it, not paying attention to it, and not believing it, basically. So, just to give you a sense for some of the ways that we've been studying this, my lab has we developed this app called Unwinding Anxiety and have been studying it. The way it works is that we give people a bunch of short modules, you know, that are about 10 minutes a day on a daily basis so they can learn how their minds work and they can actually use this to start learning mindfulness training. We use animations to drive key points home. We give people in the moment exercises, and then we can embed things like experience sampling or ecological momentary assessment to study these to see how well these actually work. Our first study of this program, we looked at anxious physicians. They tend to be challenging populations to work with. So we figured let's start with the challenging populations, and if we can get results there, we can take this into larger trials. So we did a single arm trial, which just means no control group. We wanted to see if there was a signal, and we measured this clinically validated measure called a generalized anxiety disorder seven measure, which is seven questions, hence the name. So, in our population, unfortunately, there are a ton of anxious physicians out there. This was very easy study for us to recruit for. It took a single email from a hospital system to get all the physicians that we needed. And these folks had moderate to severe anxiety. Basically, after three months, they showed a 57% reduction in anxiety. So this looked pretty good. And they also showed significant reductions in burnout because anxiety and burnout are correlated. And we also found that in this study. We replicated this in a randomized control trial of people with generalized anxiety disorder. They've got moderate to severe anxiety, a little bit more than the physicians. At one month, you start to see a difference between the groups, and in two months, there's a big difference between the groups. These folks showed, I think, a 14 or 15% reduction because it was clinical care. You'd hope you'd see a reduction in anxiety. But with the folks that got the unrunning anxiety app, we had a 67% reduction in anxiety. The number needed to treat for medications is 5.2. In this study, that number needed to treat was 1.6. So that was pretty promising for us. We could actually go and look at the mechanism. I won't go into the mechanism just in the interest of time, but I'll show you another study that we just finished in people with anxiety that contributes to problems with sleep. So a lot of my patients describe when they go to bed, their head hits the pillow, and then it says my turn, and they start worrying about all the things they need to do tomorrow. Then they look at the clock and they see that they're not getting sleep and they start worrying that they can't get to sleep and they get more aroused. So there's this is where arousal comes in. So they get hyped up, they get energized, and they can't get to sleep. So we did another randomized control trial. We found in this study, so in people who are having anxiety that was affecting their sleep, in this study, we found a 46% reduction in anxiety at two months in the active group. And at four months, the control group caught up with the active group. So, what was going on here? Well, at two months, we gave the control group the unrunning anxiety app to see if we could replicate these results. And so within two months, they'd caught up with the active group, and the active group had maintained its gains. So that was promising. How about their sleep? When we look at their sleep, at two months, the active group does much better with less anxiety affecting sleep. And again, they maintain their gains at four months, and the control group catches up within two months. So we see this 33% reduction in anxiety interfering with sleep. So all of that to say that if you really target these habit loops, these mechanisms of how anxiety forms in the mind, whether you look at the Buddhist models around being identified with our emotions and getting caught up in behaviors that are trying to make our anxiety go away, but actually make it worse, like worry, if we can target those mechanisms directly, we can actually affect significant change that amounts to big clinically relevant changes. There's actually a reference, I think, to this type of thing in if I remember Majima Nakaya 20 in the suttas. And I just mentioned that because I think there's historical precedent for this, where the Buddha basically gives a list of I think five things. And he basically says, if you can't be mindful, do this and then this, and if you can't do this, do this. And basically the last one is great, he's where he says, basically, with teeth clenched and tongue pressed against the roof of your mouth, crush mind with mind. And he what he's highlighting there is how dangerous it is to get caught up in unhelpful, unskillful behaviors. He's saying, if nothing else, just force yourself not to do it because that's better than doing it. And so, you know, sing and dance or whatever can be a helpful distraction. It helps us step out of the habit loop. So think of it as a third gear practice or a third step practice because we're not perpetuating the habit. And if that's all we can do in the moment, it's better than doing it, right? And then what we can do is go back and reflect on the experience and see what we can learn from it. I call this retrospective second gear, where we can go back when we've got a clearer mind and say, okay, what was it like? Or what in the past have I gotten from worrying? When we can actually examine it a little bit more and contemplate it. And that helps us become disenchanted after the fact, as long as we can feel into how unrewarding it is, and that can be really helpful then as well. And if singing and dancing, even in our head, is better than yelling at somebody, game on. And we can combine that with developing insight because the insight is going to be what really helps us become disenchanted so that we don't need to turn to anything else. Because our brain just says, if I compare yelling at somebody versus being kind to somebody, for me, it's a no-brainer. Like, why would we ever yell at somebody if it hurts so much more when I look at it afterwards, sometimes in the moment, but afterwards, I'm like, oh man, that hurt, you know, me, even me yelling, and I can only imagine what it was like for that person. And so that's where the insight and the true change happens. And that fits beautifully with the modern neuroscience that explains, you know, if you like math, the mathematical modeling of Rascoiled Wagner from the 1970s is still true today. And if you look at that, I love how it just lines up so beautifully with the polycanon from 2,500 years ago. The way I train people to use this program, we actually train facilitators to do this, is to really rely as close to 100% on inquiry, where we are bringing forward curiosity and just trying to explore and understand somebody's experience. So if I map a habit loop out with somebody, I'm asking, help me understand what is this? Help me understand what do you get from this? And help me understand when you do something differently, what that's like. Just asking questions in a way that a thoughtful friend would do. And that reduces the risk of something untoward happening. Because if somebody doesn't want to go somewhere, they're not going to. And we're just asking questions. The other piece there, this framework isn't one that's just about, hey, just wash somebody through these steps. This is really about exploring these ourselves as teachers, so that we can actually do skillful inquiry with someone and know where to be curious and where to kind of let back. With some eating disorders, like anorexia, for example, has a really high morbidity and mortality rate. And so it's something that's really somebody has to be really careful with working with. So really knowing these gears and knowing these steps from our own experience is the best way to be able to feel into where our boundaries are and where to say, oh, let me refer you to somebody or, you know, let me help you get somebody that can help here, because this is beyond what I can do. So that's a really critical piece, is this is not just about, okay, take those three steps, plug and play, just do it, you know, force people into it. This is about explore this yourself, know this in your bones. And then when you see this in your own experience, it'll just start to emerge naturally when you're working with somebody, especially doing inquiry. I'm honestly, I'm trying to see how much of my life I can live every day, only asking questions. I've started doing this more and more and more to just see how far this can go. And I would love to be able to live the rest of my life, not making declarative statements unless I'm giving a lecture. And I think that's possible. Or at least that's something that I'm exploring myself. And I feel like that makes my teaching better. It also makes my life better because I'm not making assumptions about other people and asking questions, which helps me see where my assumptions are. So if that's helpful for any of you, I would encourage you to play with that as well. The more you we can practice just being curious and non-judgmental, I mean, which is really what mindfulness is all about, the more we'll be able to implement the neuroscience that I talked about today that I find really helpful.
Speaker 1 · 25:52Thank you so much, Dr. Judd. I personally just gained a lot of value, and I think we all appreciate your time, your research. You've been at this for decades. You're sort of presenting new science and methodologies around this. You're referencing the Buddha a lot, and you're referencing like new science, new habits that we can take, most of which like back up what the Buddha said too. But it's really nice to hear these practical tips and presenting it in a very kind way in which we can explore this ourselves and with others with this caring curiosity. I recommend his app, Unwinding Anxiety. It's just unwindinganxiety.com. And so I encourage people to check that out and share it with others. Yeah, this has just been so rich, and just deep vows of gratitude for your practice, Dr. Judd, and for helping us become better mindfulness practitioners and teachers, and sharing all these tools.
