Speaker 1 · 0:04Today 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 · 1:25You can think of anxiety. I think the formal definition is a feeling of worry or nervousness or unease about something with an uncertain outcome or an imminent event. So you can think of anxiety, that feeling of nervousness. And then at the far end of that spectrum, panic, which I think I remember the definition being something like anxiety leading to wildly uncontrolled behavior, because when we panic, our thinking part of the brain, our cognitive control brain, is completely offline. From an evolutionary perspective, if you think of fear being an evolutionarily adaptive mechanism, it helps us survive. If we're being chased by the proverbial saber-toothed tiger and we get cornered, our job is to contract down into the tightest little ball that we can so we can protect our vital organs. So fear actually helps us survive. Anxiety, I think of anxiety in a nutshell as kind of fear of the future. So there's not something that is imminently dangerous right now, but we still feel that feeling, and there's a lot of overlap between that feeling of anxiety and fear. Okay, so let's go on a little bit more and explore how anxiety can actually be driven like another habit. And I have to say, in all of my clinical experience, so I've been practicing psychiatry for a long time now. Something I never learned in medical school or residency was that anxiety could be driven like any other habit. And this was something that was so important for me to learn. This was like, I felt like this was the missing piece in terms of how to actually help people with anxiety. This really goes back to some work that was first published in the 1980s, led by Thomas Borkovic and others. And what this highlights is that anxiety, as an unpleasant emotion, can trigger worry thinking, which makes us feel like we're in control, helps us avoid the unpleasant feeling of anxiety itself, or just feels makes helps us feel like we're doing something. And this can feed back and trigger more anxiety. So we can get negatively reinforced, just like any other negatively reinforced behavior. The problem is that because anxiety doesn't feel very good and worry thinking doesn't actually solve a problem or feel very good itself, we start to notice that the reward is not very rewarding. And the worry thinking can actually spiral back and feed more anxiety, which feeds more worry and so on. And this is where we really can get stuck. This is something that I think if you can understand this piece, it'll not only help you understand and be able to help people work with anxiety, but it'll actually spread out to all sorts of things such as stress eating or procrastination, distraction. We've seen a lot of these behaviors as people start to form these really unhelpful habits around anxiety itself. So, really, we can distill this down to essential elements of learning, you know, reward-based learning. Now, what I'd like to do is kind of see how this fits with some of the early Buddhist psychology, because I think this can inform our learning and our practice and ultimately our teaching. So, three essential, you can think of them as necessary and sufficient components for forming a habit, a trigger of behavior and a result. So this was set up as a survival mechanism. So we'd remember where food is. For example, if we're hungry, our ancient ancestors out on the savannah didn't know where food was. So they would go and forage, they would find some food and eat it. That would be the behavior. And then their stomach would send this dopamine signal to their brain, basically that said, remember what you ate and where you found it. Now, this process is interesting. You know, it's been described in modern times, but I've also found that it's been described as far back as 2500 years ago in the Buddha psychology and the Pali Canon. In fact, in a process that's described as dependent origination, this is the process that the Buddha is said to have been contemplating. And this contemplation is what awoke him, is where he became enlightened, was through this. It wasn't through deep concentration meditation. He certainly talked a lot about concentration practice, like jhana practice and things like that. But it wasn't actually that deep concentration that led to his enlightenment. It was this contemplation of the way things were. So officially there are 12 links independent origination. It can be pretty confusing to look at all of these, but here's the nutshell version of it. Basically, a cue comes into the mind, it gets evaluated as either pleasant or unpleasant or sometimes neutral. If it's pleasant, we have an urge to make that pleasant thing continue. If it's unpleasant, we have an urge to make it go away. This is where craving and aversion come in. This craving officially leads to uh clinging in the dependent origination scheme, but this ultimately leads to a behavior. We're going to behave accordingly. So if you eat some chocolate and it tastes good, you have a craving to eat some more, you eat some more. There's the behavior. If you eat some food that's spoiled, if it's unpleasant, you have some aversion. So you don't take another bite. Now, in the ancient Buddhist psychology, they talked about this birth of a self-identity. In modern day, we think of this as memory. We form memory around different events. And the more we do this, the more this feeds back so that we start to see the world through a certain lens. In fact, this was described as ignorance because we are not seeing the world clearly when we have what's described in modern times as subjective bias. We become biased toward how we see the world. We see the world through certain lenses. You've probably heard of rosy colored glasses. You know, somebody's polyannish, they always see the world a certain way, or somebody wears dark glasses, you know, if they're depressed, they're always interpreting the world as basically depressogenic. So whether it's described as reward-based learning in modern day or as operating conditioning in ancient history in the polycanon, this is basically the same element. This is how all habits are formed, including how we start to identify with our experience. So I'll just talk a little bit about the neuroscience here, and then we'll get into some pragmatic aspects of how you can bring this understanding into your own experience and wisdom and then help others with it as well. So there's a part of the brain called the default mode network. This default mode network, there are two hubs of the default mode network, the posterior singular cortex, the medial prefrontal cortex. This default mode network is named default mode because this is what we default to when we're not doing anything in particular. And it's been shown to be active when we are basically thinking about ourselves. So you can think of it as the self-referential network. If you think back to the Buddhist psychology around that loop of selfing, you can think of this as the selfing, the selfing network, because the more we think and ponder upon things, the more this becomes who we are, and so more identified we become with these things. Interestingly, the more somebody worries, the more they activate the default mode network. Now, the reason I bring this forward is because some of the work that we've done now, we published this 10 years ago. What we found is in experienced meditators, there's less activity specifically in these two hubs of the default mode network. This is with experienced versus novice meditators. So meditation and mindfulness seem to specifically target this self-referential network. And we can actually line up people's subjective experience with their brain activity and show this in real time by giving people feedback. So we can have people meditate, we can show them feedback from their brains in terms of how active a certain network is versus how inactive it is. And then we can line that up with their subjective experience to directly link the two. All right. So I'm going to introduce these three steps of habit change. In my book, I talk about as three gears. You know, it's like driving a car. You start in first gear, and then as you get momentum, you go farther. And these steps are simple. There's something you can write down and apply to your teachings. I find this really helpful in my clinic. When I'm leading workshops, when I'm working with meditation students, is a really good framework to help them start to kind of understand their minds. And the way I think about this is if they don't know how their mind works, they can't possibly work with it. If they start to understand it, they can start to map out their habitual processes in their mind. They can start to see how their mind has unhelpfully tried to help them work with dukkha, with things that are unpleasant, and how they can then reel that back in and find more skillful ways to work with their experience. So the way that I think about this is these three steps of habit change. And I'll go through these quickly and then we'll get into each of them more in detail. So the first step is just awareness of being caught up in a habit loop. The second step is exploring the results of the behavior, asking questions like what do I get from this or what am I getting from this? And then the third step is stepping out of the habit loops. So you can think of this third step as anything that helps us step out of these habit loops, which can include awareness and insight, but any mindfulness practices will generally help us step out as well. So think of step one as recognizing these habit loops. I'm gonna just read you something from somebody using our um anxiety program. This person said, for me, when I get anxious, I tend to spiral into negative thoughts, mostly about myself. The self-loathing and doubt get terrible. And for some reason, the only thing that makes it feel better is basically confessing to someone I respect or love, confessing about whatever way I think I'm bad, in order to have them assure me that I am not bad, that I am a good person, et cetera. Okay. So the first step is basically just mapping out the habit. Like what's the trigger, what's the behavior, and what's the result? The trigger is the least important. So if somebody gets triggered to worry and they can't figure out the trigger is, it's not important. It's really the behavior and the result that are most important. So when we map it out, this person said, So my pattern is feel guilty about some way in which I'm a bad person, and then turn to someone else to reassure me that I'm a good person. Result. This only reinforces my brain's habit that I'm only a good person if someone else said so, thereby perpetuating my inability to get that reassurance from within. I think I've been aware of how anxiety makes me beat myself up for some time, but never made the connection about how the behavior of needing to confess to someone else just perpetuates the cycle. So that's really the first step is mapping out these habit loops. What's the trigger? What's the behavior? What's the result? Once somebody can map this out, they can get into the change. Step two is the really critical piece for change. You can see how this applies to eating, to smoking, to anxiety, to any habit. So orbital frontal cortex is the part of the brain that stores and determines reward value. It actually lays out this hierarchy of how rewarding something is relative to other things. The reason this is set up is to help us make decisions quickly. So we don't have to relearn everything we do every day when faced with making a decision. I'll just use myself as an example. If I eat broccoli versus chocolate, my brain's going to compare those two. For me, chocolate's more rewarding than broccoli. So chocolate goes higher in the reward hierarchy. If I compare eating milk chocolate to dark chocolate, dark chocolate goes to the top of the list. I like dark chocolate more than milk chocolate. And there's a whole mathematical formula for this. Don't worry about the details. But the idea is that the only way to change a behavior, I'm going to repeat this: the only way to change a behavior is to bring awareness in and see how rewarding that behavior is right now. This goes all the way back to the Pali Canon, where the Buddha talks about exploring gratification to its end. Basically, he said in a number of suttas, it wasn't until I explored gratification to its end that knowledge and vision arose. In 1970s, two researchers, Raskorla and Wagner, came up with a formula basically for what the Buddha was talking about, where they basically say, here's your reward value. It's based on the previous reward value, and that will only change based on this error term. And it's called positive or negative prediction. So think of it as you have a certain reward value for chocolate cake. Let's say you like chocolate cake, your brain knows I like this more than broccoli. Let's say you're walking down the street and you see a new bakery that's just opened up and you see some chocolate cake in the display case. And your brain says, Oh, that looks good. You go inside, you eat the cake, and it's the best chocolate cake you've ever had. You get what's called a positive prediction error. Your brain's like, Well, I was expecting to be good, but it was really good. And what that does is says, Hey, remember this bakery, go back to this bakery in the future. This is rewarding. If you went in, you ate the cake, and your brain's like, I've had better, you get what's called a negative prediction error, meaning your brain learns, hey, this isn't that great. I'm not going to go back to this bakery. Now, the way we can apply this to anxiety is that we can pay attention when we worry. And we can ask ourselves, what am I getting from worrying? Is it helping me be in control? Is it solving a problem? Is it making me feel better? What am I actually feeling when I'm worrying? How do I feel? That helps us see very, very clearly just how rewarding worry is or isn't. And hint, spoiler alert, when you work with your students, I haven't had a single student ever come and say that worry feels good. What's so rewarding about this? It's not very rewarding when they look at their direct experience. And when they look at their direct experience and see that it's not rewarding, it helps them become disenchanted, just like the Buddha was talking about. Oh, you explore gratification to its end, you see that worrying doesn't help, and you're less excited to do it in the future. So, this person, I was walking the dogs today, my mind was running through a familiar fantasy. I woke briefly to awareness and asked myself, what am I getting from this? A bit of excitement came back the answer. Where is this excitement in my body? I asked. A little fizzy ball of stuff in the center of my chest. Then it occurred to me how similar this little fuzzy ball of excitement, apparently a good thing, or so my mind seems to think, is to the sensations I experienced that I would normally label anxiety. In fact, I think the only difference is one I apparently like, and the other I apparently don't. This all made me wonder about the link between the two. Is the ever-present anxiety the residue of a well-worn groove of excitement? I know I choose stimulation, exciting activities that we've avoiding anxiety. Am I actually just feeding the anxiety beast? So perhaps not the most clear example of just really feeling into what we get from worrying, but hopefully gives you a flavor for how this second step is really critical, exploring gratification to its end. This really highlights what the Buddha pointed out around cause and effect. When you do a behavior and you see the effect of that behavior, if it's rewarding, if it's actually truly skillful or helpful, you're going to do it again. If it's not, you're going to stop doing it, or you're going to be less excited to do it. And we can look at the direct experience pragmatically, where you can ask yourself, does it feel contracted or does it feel expanded when I worry? For many of you, when you're describing anxiety, at least, it feels contracted. And that's what we see generally in the research. So even focusing on that experience, how good does it feel to feel contracted relative to feeling expanded? So when we start to see how unrewarding things like worrying are, we start to become disenchanted. This brings in the space, it opens up the space for what I call the BBO, the bigger, better offer or rewards that are more rewarding. So if you think of worrying, for example, or anxiety is a negative emotion that triggers the mental behavior of worrying. And we worry and we feel like we get some reward until we really pay attention. What can we bring in instead? And here I like this quote from Lewis Carroll, Alice Wonderland, curiouser and curiouser. I like this because this really highlights this attitudinal quality of mindfulness. It's being aware, but being truly curious. So you can think of curiosity. What if we substitute curiosity in for worry? Which one feels better? If we're anxious, we can worry about why am I anxious? Or we could get curious instead of going, oh no, what's wrong? Why am I anxious? And trying to figure out the cause, we can go, oh, what does this anxiety feel like in my body? And we can bring awareness in and start exploring our direct experience. Somebody said, when I first started the program, I didn't quite buy into the benefits of curiosity. Today I felt a wave of panic. And instead of immediate dread or fear, my automatic response was, hmm, that's interesting. That took the wind right out of its sails. I wasn't just saying it was interesting, I actually felt it. I was so thrilled. Or as this person put it, when I had a full-blown panic attack, looking inside made it just melt away. I was looking at what I was feeling instead of obsessing over why I was feeling it. And just to bring this home, I'll describe what happened with my patient in these three steps. So I have a patient who, when he first came to see me, was about 40 years of age. And just the referral, you know, we get one line in the referral and it said anxiety. So don't know what to expect. Guy walks at the door, check, anxious. He looks anxious, right? You can just kind of feel it. So he sits down and I start taking his history, and he describes how he would be driving on the highway and he would get these thoughts where he felt like he was in a speeding bullet. And he felt like he was going to get in a car accident, even though he'd never been in a car accident. But these thoughts became so distressing that he would start to get panic attacks while he was driving on the highway. And he would have to pull over and calm down before he could keep driving. And these became so pervasive and so distressing that he started avoiding driving on the highway altogether. Even driving a couple of miles to my office was anxiety-provoking for him, even though it was just on local roads. So that's how bad his anxiety was. Now, as we got into his history a little bit more, he talked about how he started to get anxious around the age of 10. Now, in this first visit, we didn't go into his full history. Later in treatment, some of the details came out, but basically he had been nervous, he had been anxious for 30 years, basically straight, like non-stop. He really didn't know what it was like not to be anxious. So this is a gentleman that has full-blown panic disorder that had developed, say, in the last year, and he had generalized anxiety disorder, which he had had for about 30 years. And he wasn't particularly interested in taking medications for these. And I wasn't about to press medications on him. So step one, map out the habit loop. So I literally pulled out a blank piece of paper and I just wrote on the paper trigger, behavior, result, and arrows between the three. And I said, okay, what's the trigger? Well, it's having these thoughts. What's the behavior? Avoiding driving on the highway. Well, what's the result or the reward? Well, I don't get these panic attacks. Just mapping that out, I could see he had this light bulb moment where he started to see how his mind worked. He had not seen this ever. He didn't know how his mind worked. And this started helping him see that. I sent him home with our unwinding anxiety app and said, Hey, just start mapping out these habit loops. Now, this gentleman was also about 180 pounds overweight and had other health-related problems due to his obesity. And I said, Well, come back in two weeks. Let's see what you learn. And we'll go from there. He comes back in two weeks. He sits down. The first thing he says to me is, Hey, Doc, I lost 14 pounds. And what he described was he was mapping out these anxiety habit loops. And he said, anxiety would trigger me to stress eat. And when I was stress eating, I was realizing that he wasn't actually fixing my anxiety. So basically he became disenchanted with it. And he said, So I stopped doing that. And over the course of the next year, he went on to lose over a hundred pounds. He's still actively losing weight as we speak. And he said it's been effortless because he's not forcing himself to lose weight. It's just that he's seeing that stress eating is only making him feel guilty about eating because he knows it's not healthy for him and it's not fixing his anxiety. He went on to incorporate a lot of mindfulness practices to work with his anxiety, learn to really embrace curiosity, kindness for himself. We brought in noting practice, this Mahasy practice, where you just note your experience, thoughts, emotions, body sensations. And about six months later, I was walking out of the School of Public Health at Brown University. I think I just finished teaching a class. The school of public health is on Main Street in Providence. So it's relatively busy street. This car pulls up, guy rolls down his window. It's my patient. I'm thinking, oh, great, he's driving. He's on a busy road. He goes, Hey, Dr. Judd, I'm headed to the airport. I'm an Uber driver now. So I just thought that was a beautiful example of how he really was able to embrace these practices to the point where he was starting to have moments of calm that were long enough that felt uncomfortable to him just because it was different and he had to learn to lean into that change. And now really is anxiety free most days. But I just want to end with this great part of this poem from Rumi where he says, be empty of worrying. Think of who created thought. Why do you stay in prison when the door is so wide open? Move outside the tangle of fear thinking, live in silence, flow down and down in always widening rings of being. And I love this because you can think of step three as having two main flavors. I think of it as curiosity and kindness. When we're worried, you know, he talks about worrying, the empty of worrying, that tangle of fear thinking, it literally tangs us up. It feels like it's contracted. When we're curious about something, does it feel contracted or expanded? It feels more expanded. And so he describes this beautifully, always widening rings of being. As we are resting in awareness, as we're being curious about our experience, we widen as compared to contract. And as we widen, we actually start to let go of this identification with our emotions, this identification with the anxiety, this identification with the worrying. Actually, the more we let go of that identification, the more we loosen up the sense of self and can start to rest in you know just awareness or in flow or uh non-dual experience, however you want to think of it.
Speaker 1 · 26:13Thank 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.
