The Mindspace Podcast #20: Overcoming Anxiety with Dr. Judson Brewer

The Mindspace Podcast #20: Overcoming Anxiety with Dr. Judson Brewer


We can teach everybody a mantra and
somebody there was a clinician that was just telling me she was she reported
back that she was teaching this to her patients with good effect and the mantra
was hmm don’t ask me out of spelling welcome to the mind space podcast I’m
Joe Flanders thanks for tuning in the mind space podcast is my personal
in-depth exploration of the science and practice of well being I’m sharing this
journeying with you because I believe we can all lead happier more meaningful
lives by getting the facts in training our minds join me as I learn and share
the most inspiring insights about human flourishing from leading experts because
we could all use a little more of mine space my guest today is dr. Judson
Brewer Judd is a psychiatrist an associate professor of psychiatry at the
School of Medicine at Brown University and the director of research and
innovation at Browns mindfulness Center he’s become an authority on the
application of mindfulness and the treatment of anxiety addictions and
eating disorders in his work has been featured in some of the top medical and
neuroscience journals as well as in the popular media his recent TED talk is
ranked the fourth most popular of 2019 the Judds research and clinical work are
highly innovative in part because of his insightful integration of traditional
Buddhist psychology with modern neuroscience and psychology in recent
years he’s focused on making his work accessible to the general public and has
produced online programs for helping people reduce anxiety overeating and
smoking he’s also the author of the craving mind
from cigarettes to smartphones to love why we get hooked and how we can break
bad habits one of my all-time favourite books on mindfulness our conversation
covered judge theory that anxiety is actually just a bad mental habit the
reward based learning model that explains the development of all habits
and addictions the role of the brains default mode network in anxiety why
episodes of mental illnesses like anxiety tend to recur and how
mindfulness can help us unwind anxiety if you’d like to learn how to
practice mindfulness to help you with your anxiety or any other unhelpful
heaven please reach out to mine space at mind space well-being com or on social
media and if you’d like to be up-to-date on
the latest news on the mind space podcast please sign up for our
newsletter at mine space well-being comm slash newsletter and without any further
delay here is my conversation with Judson Brewer alright I’m here with Judson Brewer
welcome to the podcast thanks for having me now I’m gonna ask you a really quick
question I you introduce yourself to me as Jud I’ve heard you referred to as dr.
Judd dr. brewer how do we go with your name from here
Judd works well okay all right so again thanks for coming and this is really
exciting for me a big fan of your work and have been accumulating questions
over the years as I read your stuff and watch your TED Talks and this kind of
thing so I want to start with you know little brief bio what exactly are you up
to these days and how did you arrive in that professional context I am the
director of research innovation at the mindfulness Center at Brown University
I also founded a company that started out of Yale called mine sciences so
that’s that’s my day and my night job right now and I arrived there in a long
it was a long and winding road I started meditating my first day of medical
school and kind of got the bug and haven’t stopped since shifted my entire
research and even some of my clinical career from studying molecular biology
to learning about how our minds work and helping people change behavior based on
that and it all started with the fundamental question of how the heck
does my mind work I had no idea and I have a little bit more of an idea I do
think one of the things that’s very remarkable about your background and the
kind of thing I love to explore in the podcast is just that you done a deep
dive in both a sort of traditional Buddhist perspective like through the
Insight Meditation approach and through your neuroscience that must be a very
cool set of perspectives to bring to the table do you find that you’re leveraging
both of those points of view or is it you when you’re in the lab you’re a
scientist and when you’re Unruh treat you’re a meditator
yeah I was I have to say I was very fortunate to have not thought about
doing any research on mindfulness for about a decade because it helped me just
focus on the experience components like what’s going on instead of thinking of
what am i doing no it’s my maintain now ok how about this so that piece was
really instrumental in helping me develop a foundation of experience
before even thinking about doing research and as I trained to become an
addiction psychiatrist I was noticing that my patients were actually speaking
a lot of the same language the the Buddhist psychologists were speaking and
I didn’t think that was a coincidence and so wanted to understand that more
and at the same time was realizing that there were really significant
limitations to the treatments that we had for addictions I was really
struggling to help my patients overcome all sorts of things you know from heroin
to cocaine to alcohol even to binge eating and anxiety and really didn’t
feel like we were nailing it at least from what I had been
traditionally taught so there was this confluence of conditions where these
things came together and I started really exploring how you know could
these mindfulness practices actually apply to my clinical setting and just
started researching you know did these things work clinically and what’s the
underlying neurobiology and how can we training people and to to break you know
break that habit so to speak cool so I want to start with a quick anecdote
before we jump into the question here so I’m a psychologist I do lots of
individual therapy in addition to teaching mindfulness based programs and
a few months ago I saw a client middle-aged man who had a very stressful
life and developed an anxiety disorder and I did an assessment with him and he
was about to I think go off on a vacation or something he wasn’t gonna be
available for about a month and we agreed that he would take this time off
and then we would get together when he got
to sort of pick up the actual treatment so he came back about a month later and
he said it’s really nice to see you again but I don’t think I’m gonna come
back I found this app called unwinding anxiety and I think I get it now and I
that had never happened before there was an app and this guy picked it up and he
learned the skills and he was okay and I thought oh my god I need to figure out
what’s going on here and that’s one of the reasons why I actually wanted to
reach out to you so unwinding anxiety is your app to help people deal with
anxiety and I really want to understand what you now understand about anxiety
that helps you be so effective with that program so let’s start with the basics
what exactly is anxiety what do we mean clinically when we use that word that’s
a good question and you know we can look at basic dictionary definitions that
often have to do with like fear of the future or worry but clinically what I
see you know my patients is they have this feeling that’s just really
uncomfortable unpleasant hard to localize there’s restlessness there’s
education general dis ease and they often don’t know where it’s coming from
so it’s different than something like stress where there’s generally a clear
precipitant like oh my boss wants something you know done by tomorrow or I
have a meeting I have to give a presentation or I might to-do list is
too long so that’s that’s how I think of anxiety you know clinically is just you
know is that stuff that comes up that you know it has disease it’s it’s
restless and hard to find hard to pinpoint it a lot of patients you
probably do as well where they wake up in the morning and they’re like a home
yeah just you know I wake up and I’m anxious and it goes from there right so
of course people become very preoccupied with like well what do I have am I
worrying I’m having panic attacks it’s social anxiety or GED or some more of
OCD and if I’m understanding what you’re talking about it these are
clusters of symptoms that reflect the kind of expression of the sort of
underlying disease that you just described is that a fair statement
generally I would say I was describing generalized anxiety I think okay things
like panic disorder have related things but often you know it’s interesting when
you look at the definition of panic disorder
it’s not actually about the panic attacks themselves it’s when we have
enough that we start worrying about having those in the future and that
changes how we live our lives where to start voiding things or you know trying
to do things to to not have a panic attack so I think there are different
flavors like you’re talking about but they all share this common element of
you know this there’s this dis ease whether it’s OCD where somebody feels
the disease when they haven’t acted out a compulsion or they’re stuck in an
obsession and they can’t get out of it panic disorders I just talked about and
then the generalized anxiety where it’s just it’s just pervasive and they’re you
know it’s not associated with places or faces or or you know panic attacks right
can you I know this is probably a big question mate but maybe by way of
summary can you tell us what we know about what’s happening in the brain and
the body or let’s just say the nervous system when people experience that
disease it’s a big question you know maybe I could rephrase this
where’s let’s talk about the pragmatics there’s some pragmatic elements there
around anxiety because often you know somebody has anxiety they just want to
know what it is and then because the undertone there is oh and if I know what
it is then I can fix it which actually sets them into a spiral of worry and
trying to fix and buying tons of books listening that podcasts in the white not
so here it’s an interesting story because I hadn’t actually you know from
a clinical standpoint anxieties come in bread and butter for psychiatry in terms
of it’s one of the most common conditions that we see some flavor of
anxiety but as an addiction psychiatrist I
really was focused on habit change and habit formation and so started work with
alcohol and cocaine use disorder and then smoking and it was actually through
that discovery process that I learned something really interesting and
pragmatic around anxieties I’m gonna get to your question but I’m gonna give a
little bit of background here so for example we were trying to understand
what the mechanisms were that drove smoking and how they they were
perpetuated and how mindfulness could actually affect it and it turns out that
there’s this basic learning process called reinforcement learning or reward
based learning operant conditioning bunch of names for
it they drive the drive behavior whether it’s smoking or overeating and when
tonne basically you know let’s use smoking as an example we somebody sees a
cue like see somebody else smoke and then they they smoke a cigarette and
then they get that nicotine rush you know the dopamine hit to the brain that
says do that again so it gets reinforced and they can also so that’s positive
reinforcement they also can get negatively reinforced if they’re
stressed out that’s the trigger and they smoke a cigarette that’s the behavior
and then the reward is that they feel less stressed out because they’ve just
gotten this dopamine hit so we were we were understanding trying to understand
this from a cognitive neuroscience perspective with smoking and then
realized that this actually applies to eating as well we done some studies with
smoking and found that mindfulness training could actually target the
specific reward based learning mechanisms got good efficacy like five
times the quit rates of gold standard treatment and then went into eating and
we’re seeing the same thing and you can imagine you know we’re stressed we eat
we feel better binge eat those types of things same
mechanism we started developing out based trainings for that got like 40
percent reduction crave and related eating but it was then that I learned
something really interesting two things one was we could see this convergent
mechanism so whether it was smoking or eating mindfulness was actually
targeting this reward based learning mechanism
but the other piece that we were noticing that was really fascinating was
that people are coming to me from our eating program and saying you know I eat
because of anxiety can you actually can you develop a program for anxiety I said
well I’ll look into it and it was there’s this whole literature showing
that mechanistically that worry in particular and anxiety can be driven in
the very same negative reinforcement process that eating is perpetuated that
smoking is perpetuated that any addiction is perpetuated so really just
widen my understanding of how anxiety actually you know it manifests and is
perpetuated that there could actually be a learned and habitual component of
anxiety totally blew my mind but it also gave me a great amount of hope because
in psychiatry we don’t have very many medications that help anxiety you know
the SSRIs and some of these medications can help some people benzodiazepines are
generally you know the the recommendations are not to use dead so
that is opions for longer than two to four weeks for a number of reasons and
so there just weren’t you know weren’t very many medication options and so this
opened up an avenue of exploration where we could really address this learned
component that i had never even considered before i never learned it in
medical school or residency but here was this literature that was actually
fitting and so there there’s the roundabout way to saying you know here’s
how here’s a piece of anxiety that manifests if we think about it from a
reward based learning standpoint you need a trigger so anxiety itself the
feelings of anxiety could be a trigger or fear or something like that and then
the habitual behavior is we worry or we try to figure something out or try to
fix it and then that reward comes with either avoiding the negative emotion in
the first place because we’re caught up and worried
or maybe occasionally we we learn something really going over there maybe
I can fix it but the problem is when we don’t come up
with that solution the worry itself is not very pleasant so it feeds back into
anxiety and then we start worrying that we’re worrying and then we get into this
this you know death spiral so to speak for this you’ll go for the event horizon
into the black hole of anxiety where it’s just you know feeding on itself so
I don’t know if that gets at your question physiologically but from a
cognitive neuroscience standpoint at least gives us a behavioral mechanism
that we can start to look at and then there are specific brain regions that we
can look at as well that line up with these but we can pause there yeah I do
want to pause there because when you presented that idea at a conference I
was at it really resonated with me I just think it’s a really powerful idea
that anxiety is a habit it is in a way an addiction and it’s very counter
intuitive to people because it’s incredibly unpleasant and they there
isn’t the same clear sort of reward so if someone is smoking you know whether
it’s the nicotine or whatever the addictive component is it’s very clear
there’s a nice sort of physiological or experiential moment where there’s either
some relief or some Pleasant buzz or whatever you can make the same case
about eating but to suggest to somebody that they’re addicted to worrying or
that they’ve developed a habit of worrying it can be very counterintuitive
and I just love to unpack this that what you said and if I’m getting it right
it’s the notion that something happens somebody gets stressed out or there’s
some kind of threat cue and then they start to think about the future or think
about trying to fix it and the thinking itself provides the person with the hope
or the possibility that that might resolve whatever is going on let’s say
emotionally and that possibility becomes the reward
and they just move into thinking every time there’s some kind of threat is that
a fair a fair summary yeah I think so I think the analogy that just comes to
mind is you know our you know we’re in trouble in our mind says I’ll save the
day but the reality is it’s kind of like playing the lottery and we think oh
maybe I could get rich if I play the lottery and maybe we can get rich if we
play the lottery maybe we can solve all the whatever our problem is but the
likelihood but the problem is gonna be solved for example with anxiety where
there’s this feeling that comes out of the blue is kind of like playing the
lottery occasionally we’ll figure something out
but it might not even be causally connected it might you know we might
feel a little bit better at the time but then the next time we go and do it again
it doesn’t actually fix it well and isn’t there an important distinction
between situations where we have control we’re problem-solving we’ll actually
resolve the problem and situations that are out of our control and thinking
about an investing more energy is sort of a waste and might create the illusion
that we’re solving the problem but actually is not absolutely I think this
is one of the critical distinctions between planning and worry so you know
we could plan the trip to the airport you know once and maybe double-check it
to make sure we haven’t missed anything but if we go and start redoing that over
and over and then start worrying about the hose there gonna be traffic or you
know maybe the taxi gonna be late or you know maybe there’s gonna be a sudden
snowstorm in June that doesn’t count as planning that counts as worrying and it
isn’t gonna actually help us get to the airport so I agree with you I think
there’s a critical distinction there and some of that is looking to see you know
is this useful is this not useful so planning useful worrying does it
actually help we can ask ourselves right right okay
so again the rewarding aspect of worry is the promise that we might be solving
a problem and we just keep going back to the well
that and occasionally well one of the other hypotheses is that it helps us
distract ourselves from the actual underlying emotional if it’s fear say or
even anxiety okay so the distraction is just sort of a temporary relief of that
unpleasant feeling yeah absolutely so worried can distract us from a feeling
of fear or dread or even of anxiety itself because the worry feels like
we’re doing something whereas anxiety just feels like we’re completely out of
control it’s it’s doing us okay what about these metaphors that people use or
these models of people use around saying that anxiety is this sort of activation
chronically of the fight-or-flight system do you endorse that metaphor in
this context related elements but if you look at fight-or-flight it’s adaptive
and it actually works at a time scale that’s much faster that anxiety does so
if we if we if fight-or-flight we’re working at such a slow timescale as
anxiety does we’d all be dead you know because we wouldn’t actually have fought
or fleed flight if whatever taking flight so there’s a physiologic response
this is hate bus coming get out of the way and we get out of the way and then
we have this wave of fear panic that comes afterwards we’re emotionally we
say oh crap I almost died they’re very different and very dissociable so the
same physiology you know we can feel similar physiology which may be why
people are talking about this chronic fight-or-flight piece but my sense is
that the fight-or-flight does something you know in an adaptive way which
whereas we’re bringing on other brain machinery the HPA axis well the HPA axis
is part of this but that actually you know that brings in this you know the
whole cortisol in all of the adrenergic response and all of this but if we look
from a brain perspective you know these there are there’s this
network of brain regions called the default mode network that has to do with
self-referential processing and that seems to be at play when we get caught
up in perseveration or rumination so when we get caught up in that element of
oh no this could have happened to me because the default mode network is
involved in self reference which is very different than just the physiology of
the being saying hey you know clamp down on your blood vessels you might you know
in case you get attacked and your blood that’s what gets ripped open you know
there will be less bleeding that’s not a this is about me phenomenon
that’s a you know let’s just get stuff done peace so I I see them as somewhat
you know they’re of course related and they can affect each other you know the
feeling of the adrenergic response can lead somebody into anxiety and if that
happens chronically enough you know it’s hard to you know the even the thoughts
of anxiety can trigger somebody to have an addict adrenergic response but if we
look at them from a purely physiologic standpoint you know you can have
fight-or-flight and not be anxious at all right okay so you’ve got this model
for understanding anxiety as it is driven by reward based learning and you
bring mindfulness into the mix here to help people as you say unwind it so how
does that work exactly so it goes back to these these elements
that we’ve been talking about the first piece is really helping people
understand how their mind works you know because if they if they can understand
that then they can work with their minds and in that sense you know they can
start by really just understanding how the process gets perpetuated so if they
have a feeling of anxiety they can start to map out how it triggers a worried
response and how they get caught up in worried thinking and then what the
result of that is which tends to not be you know like oh this is great I want to
do this more so they can just start to see how the
elements that they’re actually adding to it are leading to negative outcomes and
what that does is help their brain kind of recalibrate how rewarding that behave
the worried behavior is itself because that’s that’s what drives future
behavior ROI based learning is based on reward not on the behavior itself so if
it were just pissed on behavior we’d say Oh worry
stop worrying which I’m sure many of our parents have our spouses or whatever
I’ve told us to do hey you worry too much stop worrying oh thank you it
doesn’t work that way we worry that we’re worrying spirals out of control
but if we focus on the results or the reward and say you know that’s not very
rewarding and see that very clearly that’s what mindfulness can then help us
do once we’ve mapped this out we can see oh this is not very rewarding which then
drives disenchantment with the process itself this is actually super clear in
the early Buddhist teachings where you know it’s written in the Pali Canon
where the Buddha said you know it wasn’t until I explored gratification to its
end that knowledge and vision arose and the way I interpret that is he was
really really exploring reward-based learning how rewarding is this behavior
and it’s only when we see that this is you know there’s no juice left in this
fruit that we become disenchanted with the behavior and that then starts to
have us look for other things and I think of this is looking for the the
beabea the bigger better offer so we first have to see how this isn’t serving
us and we’ve learned that by seeing how our minds work and then our brain starts
looking for something better and this is where we can bring in mindfulness
practices themselves and I love the you know that if you think of the second
factor of awakening dumb of Achaia as as interest or curiosity
what feels better you know fear anxiety panic or curiosity you know it’s it’s a
no-brainer I guess to our brains and I see this in my patients with addictions
as well you know curiosity feels much better than craving so when we can then
train them to just be curious about what the feelings of anxiety feel like in
their direct experience they can start to realize a number of things one these
are just feelings these are just thoughts as compared to being identified
with these things – they can see that these don’t last forever and this is
challenging because a lot of folks with anxiety really feel it all throughout
the day and they say well my anxiety does last forever and I say well let’s
explore that does he kid stronger does it get weaker is there worry that feeds
it you know there are lots of ways to explore the impermanent nature of the
feelings and also ways to explore how we resist the feelings of anxiety itself
how we you know we can change our relationship to it and and just hold
that the feelings this physical feelings he’s emotional since it you know the the
emotions the physical sensations we can hold those in our awareness we can hold
them with kindness and curiosity and that holding where we’re providing that
holding environment rather than pushing away or trying to do something helps us
move into a completely different relationship and I’ve had another of
folks report back you know they remember one person who you know said that she
was really blown away by the the curiosity because when she really
trained herself to bring curiosity to the fore when she was having panic she
could you know curiosity just felt better and she could notice that these
were just feelings rather than you know you know something that that she was so
identified with and it really helped her just be with panic attacks
and really unwind from that which you know which helped that whole process
itself unwind does that make sense yeah no I’m totally
with you and I want to keep going with that but first I want to clarify
something I’m a little confused because at first we talked about how anxiety or
worry can be rewarding that’s what sort of drives the formation of the habit
mm-hmm but then as you know someone using your app or someone bringing this
approach to getting over their anxiety they learn that it’s not actually
rewarding so what’s the distinction there so great question so there’s a
there are a couple of pieces here that they can start to unpack one is you know
when they look at the rewarding aspects of worried how good does it actually
feel to worry when they in their direct experience they’ve just thought of
worried as well I’m gonna fix this and it might be kind of you know might feel
a little uncomfortable but I’m doing something so they can unpack the direct
experience of what it actually feels like to worry as compared to you know I
don’t know anything else besides this so I’m just gonna do this and I’m gonna
keep doing it and it feels like the right you’re the only thing to do so in
one sense it gets reinforced because you know it feels like there’s they’re there
in control but the direct experience of quote-unquote being in control can be
explored and they can see well how rewarding is this actually it doesn’t
feel that good does that make sense yeah so in an experiential level it’s not
very rewarding or it doesn’t feel good but that doesn’t change the fact that on
a physiological level the sort of temporary relief whether it’s by a
distraction or the sense that they’re getting something done might be
reinforcing the behavior and then if I’m understanding you’re introducing an
alternative way that has less real downside are you with me on that
summary yeah yeah and I think an analogy here is you know I have a lot of my
addiction patients who are who are working with cocaine dependence and you
know when they first started using cocaine it was pretty rewarding but now
they’re just trying to get back to zero and so they’re kind of using it to catch
up and I think the same is true with worry you know at the beginning it seems
like it’s a good idea to our brains because you know we’re planning we’re
doing we’re getting in there doing something but we don’t realize that it
doesn’t actually help fix the problems it actually just makes things worse but
we haven’t noticed that right so if that I yeah I am agreeing with you yeah so
that’s a really nice new us and I want to come back to where we were in a
moment ago before I asked for the clarification and talk about this new
way so you talk about bringing curiosity and being with this unpleasant
experience in a new way when you start to pay attention to your experience
there are some kinds of experiences that are contracting in their energy and some
kinds of experiences that are expanding and maybe you can just pick it up from
there and how you paying attention to that quality of experience can really
drive a new kind of reward based learning to get over anxiety yeah this
is really live for me right now I’m literally my lab was just meeting
because we’re trying to work out at an operational definition of this you know
kind of this somatic state mm-hmm because it doesn’t seem you know there’s
some some concepts in the literature that seemed to line up but the
experiential component is so clear we see this over and over and over again we
want to have this be something that we can really really explore in a more
fine-grain way so the way we’re thinking about this is is this open enclosed
dichotomy this is related to the emotional feeling of contraction or
expansion and contraction and it relates the somatic experience to the emotional
you know the emotional feelings so for example
if somebody is afraid that would fall into the category of closed or
contracted which makes sense because you know if we’re being chased we want to
make ourselves as small a target as possible for whatever’s chasing us and
the opposite of that would be something like joy where we feel this or love or
connection where we’re feeling this expanded more connected quality with the
world or with somebody else so experientially I think we all know what
these states feel like and from a reinforcement learning standpoint we can
start to look to see how they can help us change behavior because our brains
are as I mentioned our brains are looking you’re they’re always looking
for something more rewarding so if I asked you mm-hmm
and I think you have a pretty clear sense for this now right closed versus
open mm-hmm what feels better closed or open yeah obviously open feels better
I’m going to let you keep going because I have another question about why I
sometimes choose closed even though open feels better but let’s
go back to your yeah so we’ll put a pin in that will come right back to that so
from a rule-based learning standpoint we can actually start to look to see
experientially our people moving from closed to open and does that correlate
with improved outcomes and the theory would be that just simply bringing
awareness in to how painful closed fields compared to how less painful open
fields just helping them see those states clearly and helping them see the
cause and effect relationship between behavior and result would they would
naturally move from closed to open hmm so let’s use a concrete example to kind
of cement this you know if somebody is being mean to somebody else
and they notice they pay attention and notice that that person is suffering
they might feel closed because they hopefully they feel a little bad about
what they just did and then they can compare that to when they were kind to
that person and notice that that feels it feels better we would rather have you
know I’d rather live my life people being kind and certainly would rather be
kind to people than being mean and so we can see that that you know there’s a
natural propensity to move in that direction with awareness when we see how
painful being a jerk is compared to being nice right so I do want to jump in
with an example of what anxiety in the sense that as you indicated earlier when
someone is worrying it tends to be a closed or a constricted sense and it’s
like not open to new ideas not open to different ways of dealing with what’s
going on it’s painful it’s uncomfortable versus bringing a more of a mindful
awareness to that experience there’s curiosity there’s openness there’s
interest and that is more expensive yes and isn’t it the case that that
expansive feeling becomes the new reward absolutely so that’s that’s the magic
hesitate to say magic because this isn’t like Matt waving a wand but I would say
this is this is the beauty of the simplicity of these practices and I
think and we’ve written about this I think that the Buddha actually described
a reward based learning way before paper was even invented and what he was
highlighting were these you know these qualities of experience that just feel
better and so we’re gonna naturally they’re they’re more rewarding so
curiosity is more rewarding you know etc etc etc so that’s it and that’s it’s not
that we have to change anything it’s not that we have to do anything but all we
really need is to simply bring awareness and help our brains link up cause and
effect cause and effect and with anxiety oh when I’m anxious the effect is I’m
working when I’m worried I get more anxious oh
when I’m curious and simply hold my you know bring awareness to the physical
sensations to the thoughts I can start to see that these are just thoughts
these are just physical sensations and that already changes my relationship I’m
less identified and that feels better and so we just rinse and repeat we do it
over and over right so I love the fact that you talk about magic because it
does raise the question and believe me I’ve been through this this loop many
many times myself if it was in a way that sort of that magical where you just
link up cause and effect and the expansive quality of mindfulness and
curiosity and openness is so much better and so much more rewarding why does it
take so long to to get back to a point where any is no longer you know
overwhelming for people and why do people slide back into anxious episodes
shouldn’t it just stick that’s a great question so I think there are a couple
of elements that may be at play here mm-hmm
one is that we don’t see the cause and effect super clearly at the beginning so
it’s it’s hard for people to link this up sometimes you know right at the
beginning where they you know they were like well was that really it or was it
something else and so there’s a lot of noise in the system and it’s hard to get
a clear sense for oh what’s that it or was something else it and so they have
to repeat that over and over and over and you know in science when we repeat
an experiment it separates out the signal from the noise and so we get a
you know a bigger signal-to-noise ratio and we can say oh that’s that’s
significant that’s real sometimes in our own experience we can have you know huge
experiences where we said wow that was clearly linked to this I don’t need to I
don’t need to repeat that a thousand times but with anxiety when there’s been
so much reinforcement of the system it’s hard to really get a clear sense of oh
was that an anomaly was that real and so we have to repeat
it over and over so that’s one piece the second piece is the the amount of time
that we’ve repeated the behavior and become so identified with it it’s like
we’ve dug this deep ditch or this deep groove and we climb out and it’s just so
easy to just fall right back into it just habitually because that’s how our
brains work is that they learn something and they say okay I kind of got this I’m
gonna free up your you know brain space gonna free up this this memories and
learning process I can learn other things and so they just go along
habitually being anxious for example or worrying so it’s really hard to so to
speak convinced our brains to really pay attention because they say dude why
would I change this I’d be doing this for 30 years
you know why change now so I think there are several several of those at play
that make it you know make it challenging for folks to change behavior
there’s one third element that might even be more challenging which is this
whole thing about being identified with our thoughts and identified with our
emotions that that gets reified anytime we look in the mirror oh you know I
shouldn’t say it that way but for see that can get that’s a pretty sticky
thing and to imagine to even imagine which isn’t gonna move us very far
because we have to directly experience this but to even take get us to the
place where we can start to explore oh I am NOT my thoughts I am NOT these
sensations and to even know what it feels like to be aware of as compared to
be identified with can be really challenging for some people and so that
can take a long time to really just get a handle on oh this is what they’re
talking about in terms of you know having awareness of a sensation rather
than being identified with right so this is a really interesting point of
conversation because there’s no question in my mind anyway
that we are now moving towards Dharma territory and of course this has been
more and more recontextualized into mainstream psychology and the Montcalm’s
framework but we’re really now touching on the no self teaching and I know in in
sort of navigating this territory with my clients this can be very
destabilizing so like what do you mean I’m not my thoughts what do you mean I’m
having a craving and that’s not me and you even had this you know sort of
fighting language you’re like a Lobel dude stop doing that like as if we have
a conversation with something like how do you navigate this in a way that
doesn’t suddenly make you seem like an esoteric spiritual guru yeah that’s a
really good question and I think this isn’t a really important one because
sometimes we can inadvertently kind of go down the road if you know well I’m
gonna explain this intellectually because we’re actually hiding from the
tracked experience because we can’t explain it right so here it’s really
important this is a great way to kind of keep us honest in terms of do we
actually understand what we’re talking about experientially I remember if it
was I think it was Joseph Goldstein that described this simple way of exploring
this which is am I taking something personally and that can kind of help
with the existential threat of I do I just I just drank that tea or whatever
that’s not actually the problem drinking tea is not a problem somebody drinking
tea the problem is when we take things too personally
and so that’s something that I find much more accessible for people is to ask you
know well what’s it like when you take something personally I think most folks
can relate to that you know it’s simple example would be so you know somebody
saying well that’s a dumb idea and well the quiet I thought was a great idea Oh
I was attached to that view I took that that suggestion personally and there’s
the contraction around that there’s a closed down Asst there’s a protection
and we can look inside in inward and just say oh that’s what that feels like
to be contracted so on a very pragmatic and experiential level we all know what
it’s like to take something personally and in the same way we can start to
explore our experience of anxiety for example and see are we taking that
personally so if for example when I have you know I’ve had panic attacks before residency training don’t know it says
about our medical training but anyway that’s why I tended to get panic attacks
and you know it was like wow do I worry about you know oh the oh I am having a
panic attack versus do I just bring awareness and and notice the physical
sensations and notice you know that it feels like literally it felt like I was
gonna die you know my breath you know breathing was really short my heart was
racing and I’d literally just like the textbooks got this tunnel vision at the
time you know I’ve been practicing about 10 years so I was really fortunate I was
doing a bunch of noting practice at the time so I would just note what I was
like Oh heart racing Oh can’t breathe Oh tunnel vision and there was this
curious awareness that could observe all the sensations that would happen and
then I was training to be a psychiatrist so after the panic attack went away my
brain would I often wake up from sleep with these so my brain would say Oh
check check check check check oh you just had a panic attack and then I would
go back to sleep because it wasn’t like oh no I just had a panic attack it was
oh so that oh no is taking something personally the oh is a curious awareness
and that helps keep it clean like Oh here is it here was something that
happened I go back to sleep go back to sleep and I could okay so I’m
with you on this that sort of curious awareness it really takes the sting you
know not taking things personally really takes the sting out of these things but
if you are not your heart racing if you are not your mind racing about your
imminent death if you are not the shakes because of withdrawal or some craving or
something then what are you do you want to get there how you would address that you know in
khong in concrete language like many clients end up with this sort of
discomfort as did I add certain points yeah yeah so let’s go there and then
we’re gonna come back to pragmatics because from a pragmatic standpoint with
my patients I don’t often find that it’s helpful to go there right and so they
say what do you mean you know this isn’t me and I stay at the level of you know
taking things personally because and that generally you know people are
generally satisfied with that if they want to go deeper we you know that we
can go a little deeper and so that’s what let’s do that now but then we’ll
bring it back to the pragmatics because I tend to you know I’m you know you get
this as a clinician it’s like well what’s really helpful here we can have a
great intellectual discussion and you know how is this gonna help people say
we’ll make sure we always tie it back there so going there if we so if you
think of reward based learning it’s interesting we wrote a paper about
this a couple of years ago where I worked with a Pali scholar Jake Davis
and explored dependent origination these twelve links of dependent origination
and found this pattern that was just absolutely so lock in step with reward
based learning and I said this cannot be a coincidence and so we explore this and
and it really looks like you know as I meant
the the Buddha discovered this before paper isn’t invented that dependent
origination was really describing operant conditioning a real work based
learning and if you look at dependent origination it talks about the you know
the the details of the twelve links aren’t as important for this discussion
as one element which is you know we we have this craving so Tana so we we have
this craving and then this becoming where we kind of form a sense of self
based on our previous behavior based on our actions and that becomes reified
every time we do that so for example if I you know let’s it’s using anxiety
because we’re going with that one if I feel a feeling and then I associate that
with a thought oh I’m anxious then that gets reified to
the point where we wake up in the morning and the first thing we look
around for is you know our body sensations and then our brain is like oh
yeah you’re anxious and then it’s like boom we those sensations come up you
know again and suddenly we’re and we’re like wow I just woke up and I’m anxious
I don’t know what it was these these habits get formed around the reification
of the sense of self and so if we you know the more we live certain
experiences and the more we reinforce them the more we become identified with
them to the point where they you know they define who we are so we’ve
certainly you know met people like oh that guy’s an anxious dude or that
person’s you know he’s angry you know he’s angry all the time well the more we
do that the more we become identified with those things so bringing this back
to the sense of self we can think of the sense of self just being reified through
habits and I love I see if I get this right there’s a quote from Alan Watts
I’m sure you know who Alan Watts is this philosopher brilliant guy and he said
the ego the self which is believed himself to be is nothing but a pattern
of habits and so somebody says what do you mean
no-self we can look at the you know we can look at well who do we think we are
and you know if I ask myself Who am I well I look in the mirror and it’s like
you know I’m a I’m a man and I’m a you know I’m a scientist well you know that
that idea of scientist or that idea of psychiatrist is you know it’s like I
reapply that every time I say yep that’s me and so we can start to unpack that
and say well in this moment what what is that well it’s just kind of the updating
of memory from the previous moment and then from you know that and that feeds
into the future so we get the sense of self that’s that’s that seems like it’s
continuous over time that is just kind of an update you know it’s like a oh
yeah that’s who I am that’s who I am like an updating or remembering based on
our previous experience and so if we take that premise we can actually say
okay if that’s true what happens if I forget about the past what if it what
happens if I let go of the future well there’s just being and so it’s not that
I’m not being but the sense of self of I am this might just you know rest as a
potential in the moment when it’s not being reified and I’m just simply
resting at awareness and I think this is where these concepts of flow come in
you know me hi chick Simha hi described this aspect of flow using terms like
selfless timeless effortless so if you bring it back to the contraction piece
that contraction that says oh yeah I’m a psychiatrist you know you say that I’m a
bad psychiatrist there’s me being identified with that idea that
reification says you know this contraction says yes that’s me well when
we start to let go of that and expand and expand and expand we start to lose a
sense of who we are experientially because we lose it that boundary between
the self and the rest of the universe and then we move into flow
which is completely selfless yet it’s an experience that’s happening MA I didn’t
lose you at that point absolutely not I I’m fully with you and
I feel like this is an irresistible opportunity to move in to talk about the
default mode Network because what I’m understanding is that it’s this
self-reflection that if I’m understanding correctly is sort of
mediated by or driven by the default Network the self-reflection on oh this
is me now when oh this is me now and oh this is me now we sort of construct the
sense of self by this ongoing story about who we see ourselves as each
moment right yes and so I’d love to hear you talk about you know how mindfulness
really mindfulness sort of helps I don’t know decommission the default mode
Network at least temporarily and and make us maybe a little less dependent on
it or reliant on it on a day to day basis how would you frame that yeah yeah
so let’s just over the clarification to make sure we’re on this image with the
default mode Network there are two main hubs once the medial prefrontal cortex
once the posterior cingulate cortex and they talk to each other all the time the
hypothesis is that the medial prefrontal cortex is more the conceptual sense of
self and a conceptual sense of L’s self is not a problem it’s taking that
conceptual sense of self to personally where you know it’s like I’m a
psychiatrist somebody says you’re a bad psychiatrist and so there’s that
contraction around oh no but I’m a good psychiatrist that
lets me know that’s who I that’s me so the contraction piece is what I think of
as the experiential sense of self and that seems to be most readily identified
or the the most rarely at least what we’ve studied the most is the neural
correlate around the posterior cingulate cortex so we’ve used some neuro
phenomena logic techniques where we can actually line up people’s direct
subjective experience with their posterior cingulate activity
and it seems not to be related to people having thoughts but it’s when they get
identified with or take those thoughts personally or even emotions as well so
the posterior cingulate seems to be this marker of the experiential sense of self
and I’m a mute it’s oversimplified I’m sure there are other brain regions and
networks involved but that’s just the one that we exhumed in on as a marker
and so every time somebody you know does something that threatens our existence
that that contraction says there you are there you are and it get 3:05 so I I’m
just lining up what you just said with where we’re gonna go next mm-hmm so
where mindfulness comes in is it helps with two things so if we bring in the
reinforcement learning process we can say well how does it feel would you take
something personally oh I love getting contracted I love fuming and plotting
revenge and thinking how I’m gonna get that guy the next time it’s a pain it’s
painful it’s a painful process so we can bring awareness in and say you know
how’s that going for you taking things personally not in a you know
i-told-you-so way but in a curious way no wow not so good is it it looks like
you’re pretty anxious so we can start to see the lack of reward in that which
then helps us bring awareness to the next piece which is that awareness
itself can feel better than being identified with ourselves so that kind
curious awareness itself feels better and so when we’re caught up in anxiety
we just bring in that awareness and get curious Oh what’s anxiety feel like so
for example in our unwinding anxiety program on day one
we walk into the ability and the idea that they have this inherent capability
of being curious by saying okay you’re anxious let’s go there where does it you
know so check in your body to see where your feelings I do most strongly
now tell me is it stronger on the right side or the left side and they have to
go hmm is it on the right side more on the right side or left side mm-hmm now
what does do it opens us to curiosity I don’t know and the answer is it doesn’t
matter what side it’s on but what matters is they just touched into their
inherent capacity to be curious right on day one and then they can just go from
there so even that we can take it we can bring this kind curious awareness even
to the worst of anything and start to just you know crack that nut a little
bit with this inherent capacity that we have and it feels better it’s not like
anxiety vanishes but it helps us see oh I can actually be with this which is
better than running away from it I can actually expand a little bit with this
injection of curiosity rather than contracting down and down and down
thinking oh this thing’s out he’s never gonna end
oh this is terrible this is awful yeah that’s that’s really good I know that
we’re sort of coming up on an hour here we got to wrap this up if it’s okay with
you maybe one last question sure we understand more and more that a lot of
these disorders addictions anxiety mood disorders eating disorders in many cases
these are not one-off experiences these are some people say like sort of chronic
illnesses with the with recurring episodes so how do you think about this
process of like always having to rediscover this new way of relating to
difficult experience having to reconnect the the causal chain or sort of
rediscover the causal chain and you know maybe what advice that you would have on
a pragmatic level for people who have been dealing with this on a more chronic
basis so it’s this is a great question and I’m gonna give maybe a little bit of
a controversial answer but I’m happy to do this because I think we’d seen this
enough and it fits with theories that I’m happy to go out alone
and also happy not to be attached to it if it’s wrong so where these might be
chronic is that we’re not actually getting at the heart of the problem the
root of the problem what would be so let’s use a an analogy so for example
when you were a kid and your parents you know convinced under a few word kid went
and your parents convinced you that Santa Claus was real but you know we can
we can all think back to that time where you know it’s like the tooth fairy or
Santa Claus or whatever is real and you know we’re growing up more thing in his
is that guy really real you know I don’t know and then eventually we go to the
mall you know and it’s Christmas and you know we’re getting on Santa Clauses lap
and we reached for the beard and you can see the fear in our parents eyes because
it’s like because as soon as we pull down on that beard it’s game over
mm-hmm you can’t pretend that you didn’t see that so is the Santa Claus problem
chronic no it’s when we see clearly we can’t go back and that’s what we see
over and over and over with with mindfulness we see this in our eating
program you see this in our anxiety program is that over time as people see
this more and more clearly they can’t unsee it so I you know I think people
fall back to habitual behaviors when they forget
but as they deepen their wisdom through seeing things more and more clearly they
they don’t it’s they slip less mm-hmm you know they don’t fall back because
you can’t fall back unless you completely forgotten something and some
of these things you know the Santa Claus thing and you just can’t undo that
mm-hmm so it becomes a question of keeping that insight top of mind or
staying connected to it experientially and as soon as as that sort of flips and
you have that clarity that personalization of
these thoughts and feelings and stuff kind of just dissipates very quickly in
your back to ordinary experience that has sometimes enjoying some time some
pain but you’re just living it through it does and we’ve and we’ve started
incorporating these mental simulation exercises into our eating program for
example to help people like if they’re about to eat a food they can just
imagine what it’s like to eat it and the idea is to help bring up their memory of
what was it like to eat it last time because simulation mental
simulations are based on previous experience and if they get a stronger
craving that suggests that they’re not that disenchanted and it can really help
them say okay let me pay attention as I do this and then as they eat it they’re
like wow that was not that good that memory gets stronger and stronger and
stronger so this type of thing can help us simulate you know how how
disenchanted are we we even see this in the sutras where the Buddha was teaching
his son rahula you know he says reflect on what you’re about to do and if you
can’t reflect on it before you do it do it while you’re doing it and if you
can’t do that reflect on it afterwards that’s all related to or based learning
and helping us really see the rewards or lack thereof of our behavior and if we
can’t remember well the good news is we can just do it again and if we pay
attention when we’re doing it our brain is like oh yeah that was I forgot that
was not good mm-hmm so it’s it’s a whether it’s a matter of
having a Santa Clause moment where we have a really strong experience or just
slowly chipping away at it over time like you know we’re all gonna we’re all
gonna progress at our own rate but as long as we’re bringing awareness and an
attitude of curiosity each moment there’s no such thing as falling back
because if you’ve learned something how can you does that count as falling back
no it’s you’ve learned something you’ve moved forward so it actually kind of
redefines you know is there such a it calls into question I would put calls
into question two steps for one step backwards
I would say there are no steps backward if we’re paying attention and we’re
willing to learn from everything that we do and then it’s just a matter of time
rinse and repeat mm-hmm well thank you for that I think that was really well
said I guess we’ll have to wait for some data on that hypothesis it certainly
sounds plausible well we yes and we you know we’ve had we
just finished a study with anxious physicians whether I’m running anxiety
program we got a 57 percent reduction in clinically validated anxiety scores well
with them that was I was pleased that you know we’ve gotten pretty good
results with our eating program you know 40 percent reduction in craving related
eating and we just finished a study that we published with our smoking program
where we linked up these exact mechanisms with the brain mechanisms
where we saw that reduction in posterior cingulate activity after mindfulness
training but not the control group predicted reductions in smoking so we’re
seeing pretty good results with our app based trainings and I think you know and
this is also where clinicians can be working with this stuff with their
patients and exploring you know helping them understand how their minds work as
a place to start and then bringing awareness with these you know into their
into their daily lives using these very very simple principles not that it’s
easy but really understanding these simple principles can can help you know
quite a bit I think in the clinic right maybe you can just tell people where
they can get their hands on these three apps for slow what they’re called where
to get them and then also where they might find ways to keep up to date with
what you’re up to these days oh sure so I have a completely self reverential
website called dr. Judd comm trj you decom which is a resource website which
has a bunch of you know animations talks our papers and all this stuff although
that’s you know people can access that just to learn things about like
what we talked about on the on this podcast we also just put together a free
web-based training series for healthcare providers where they can learn you know
these are twenty minute videos that they can watch they can even get CME credits
through Brown University and really just unpacks you know how habits are form
without what the evidence is behind mindfulness there’s even a couple of
modules on clinician burnout and resilience and even one on cell phone
addiction so that’s available through the website and folks can also learn
about the apps that way so the smoking app is called craving to quit the eating
app is called eat right now and the anxiety program is called unwinding
anxiety and all of there’s links to all of those on the dr. Judd website as well
so folks can take a look at that resource website and and hopefully
they’ll find something useful there I have no doubt that they will dr. Judd is
there anything else that you think we definitely need to cover before we wrap
this up how about this we can teach everybody a mantra and somebody there
was a clinician that was just telling me she was she reported back that she was
teaching this to her patients with good effect and the mantra was mmm-hmm don’t
ask me out of spelling but experientially I mean what it does is
helps us tap into this openness that we in this curiosity that we all have so
folks can explore that mantra themselves and they can explore using that with
their patients and I hope that it’s helpful in reducing some of the
suffering in this world my understanding is that in some meditation traditions a
mantra is a very expensive thing and one of the best I feel like you you might
just landed on a really interesting business idea I might even turn that
into a little audio clip and make it a social media meme or try to anyway
that’s that was super cool I really appreciate that little bonus moment
there thanks again for doing this Judd I really appreciate it and I look forward
to hearing more of the amazing stuff that you’re doing my pleasure
all right take care you too okay thanks for listening to the mindspace
podcast I hope it was inspiring if you feel the world could use a little more
mind space please consider supporting the podcast the best way to do that is
to leave a review on the Apple podcast app or wherever you listen or share your
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