Making Sense with Sam Harris - #179 — The Unquiet Mind

Episode Date: December 17, 2019

Sam Harris speaks with Judson Brewer about addiction, craving, and mindfulness. They discuss the nature of reward-based learning, the role of subjective bias in addiction, the neuroscience of craving, the neural correlates of the sense of self, real-time neuroimaging, effort and effortlessness in meditation, smoking cessation through mindfulness, the difference between dopamine-driven reward and happiness, how to make meditation a habit, working with anxiety, and other topics. If the Making Sense podcast logo in your player is BLACK, you can SUBSCRIBE to gain access to all full-length episodes at samharris.org/subscribe.

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Today I'm speaking with Judson Brewer. Jud is the Director of Research and Innovation at the Mindfulness Center and Associate Professor in Psychiatry at the School of Medicine at Brown University. He's also a research affiliate at MIT. And before that, he held research and teaching positions at Yale University and at the University of Massachusetts Center for Mindfulness. Judd is also the founder of a digital therapeutics platform, Mind Sciences, and the author of the book, The Craving Mind, From Cigarettes to Smartphones to Love, Why We Get Hooked, and How We Can Break Bad Habits.

And in this episode, we talk about mindfulness and addiction, and the nature of reward-based learning, the neuroscience of craving, real-time neuroimaging, smoking cessation through mindfulness, the difference between dopamine-driven reward and real happiness, working with anxiety, and other topics. And now, without further delay, I bring you Judson Brewer. I am here with Jud Brewer. Jud, thanks for joining me. Thanks for having me. So give us the potted biography of your intellectual interests and what you're doing professionally now before we dive in. I'm an addiction psychiatrist and a neuroscientist.

I'm the director of research and innovation at Brown University's Mindfulness Center and the founder of Mind Sciences, which makes app-based mindfulness training programs for habit change. So what is your background in meditation? How did you get interested in it and what sort of training have you done? I started meditating my first day of medical school through the background of suffering. You know, with that 10,000 hours rule, I certainly achieved that early on in my life with regard to 10,000 hours of suffering. So I can say I'm an expert there. But started meditating, yeah, I was really struggling at the beginning of medical school, figured it was a, you know,

starting something new in my life. And I started meditating to see what that would be like and to see if it could help with some of the stress and started practicing. I didn't know that there were different traditions. So I joined a local sangha in St. Louis where I was going to medical school, which turned out to be led by first by a Zen practitioner and then a Theravadan practitioner. And then I found a teacher in, you know, in the Midwest and started practicing Theravadan, you know, the Theravadan tradition and have largely focused there over the last 20 plus years. Most recently, I've been studying with Joseph Goldstein, who has an eclectic style, has studied with a bunch of different teachers, and I've also been doing some collaboration with Dan Brown, who's more in the Tibetan lineage. So

I've been learning a fair amount of Dzogchen, both from a practice perspective, but also to help make sure that the research that we do is accurate. Nice. And when you went into medical school, did you know immediately that you wanted to go into psychiatry or was that a later epiphany? Let's say later, as in it was the last thing that I thought I was going to do. Let's say later, as in it was the last thing that I thought I was going to do. When I was in this MD-PhD program where you do a couple of years of medical school and then you do your PhD for long enough to forget everything that you've learned in medical school. And then you go back into the wards. And so when I went back into the wards for my third year of medical

school, I figured I would do psychiatry as a way to remember how to interview patients. And then I realized that what my patients were talking about was really using the same language as the Buddhists. And also that psychiatry was in tremendous need of good treatments, especially for addictions. And that seems to be a sweet spot of the Buddha, you know, craving and clinging. Yeah, the lens through which the Buddha looked at the whole problem of unenlightenment is really one of craving and its consequences. And there's a very helpful analogy drawn here between addiction and these ancient methods of practice. And you do this in your book, The Craving Mind. So let's talk about that. Maybe that's the right way in. Before we get to the esoterica of how mindfulness can help,

what is addiction and how should we be thinking about it? I like the simple definition of continued use despite adverse consequences. I learned that in residency training and the American Society of Addiction Medicine just came out with a definition that very much parallels that, you know, continued use despite adverse consequences, which not only points out that we can be addicted to chemicals, but we can be addicted to behaviors ranging from, you know, our cell phones, these weapons of mass distraction, to thinking. We can be addicted to our own thoughts or our own views. Right. I sense that many people will balk at that definition. It seems somehow, or can seem somehow, too capacious. Are we really saying, or do we want to say, that

addiction to something like cigarettes is precisely on the same continuum as addiction to smartphones or thinking or shopping or gambling? I mean, isn't there some significance to the fact that in one case, someone could be using a chemical, the cessation of which would lead to withdrawal? Or is there a biochemistry that kind of holds people hostage in a way that behavioral addictions don't quite? Or is it really just, you know, once you get in there, it's just neurophysiology, whether you have exogenous compounds on board or not, and really it's the same mechanism? I think there are two aspects here. One is that we can look at physical dependence, where we, you know, certain, you know, if you jack the

brain with dopamine, which every known drug of abuse has been shown to do, you know, certain, you know, if you jack the brain with dopamine, which every known drug of abuse has been shown to do, you know, it's going to lead to receptor modulation. And that, for example, with alcohol or nicotine or, you know, opioids or whatever, you're going to see, you know, receptor up and down regulation, and that can take a while to normalize. So I think that piece hasn't been, that physical dependence piece can be separated from the continued use despite adverse consequences. And so I think that's where the playing field gets leveled. Somebody can be drinking alcohol and not have consequences. Somebody else can be drinking alcohol and can be having severe consequences. Somebody could be using their smartphone, same thing. They could be texting

while driving and getting into an accident while somebody else uses their smartphone responsibly, let's say. Right, right. I guess there's a little wiggle room in the definition or in the who is defining the adverse consequences, right? I mean, they're probably people who, by any outside estimation, are addicted to whatever, their smartphones or gambling, and yet they have a problem admitting that they have a problem. Yeah, and I think we see this in psychiatry where it's helpful to get information not only from the person who might be referred to us or come in to see me as a psychiatrist, but also from collateral where it's family, friends, coworkers, whatnot. And like you're pointing out, somebody might not think they have a problem, no matter whatever the substance or the behavior is, but it might be causing significant

adverse consequences to all the people around them. And so I think of despite adverse consequences, meaning not just what somebody thinks is happening, but really having as much of an objective perspective as possible, and that includes many points of view. as possible, and that includes many points of view. Yeah, and perhaps the most subtle addiction here, and many people, again, will find it strange to be conjoining these concepts, addiction and thinking, but you mentioned one being addicted to thinking, and this is really something that you encounter when you try to meditate, especially intensively on silent retreat. Just the automaticity of being lost in discursive thought, the fact that it's our default state, despite our most heroic efforts to pay attention. In this case, we've deranged our lives and gone into silence with the goal of paying attention moment to moment, and yet the thoughts don't stop.

How do you think about thinking in light of this sort of addiction framing and just, I guess, the underlying mechanics of reward-based learning and processing? Well, I guess I should say, hi, my name is Judd. I'm a thinkaholic. How many days sober do you have? None. I'm on day one. I remember my first seven-day silent meditation retreat. This is when I was in medical school. And by day three, I was crying uncontrollably on the shoulder of the retreat manager because I didn't think I could do this. I could pay attention in my breath, you know, because that's always encouraging a psychiatrist to weep openly on the shoulder of a stranger. Yes. So I think in terms of, you know, what I've seen from my own experience and also what I've now begun to understand scientifically, you know, and this is also is how mindfulness comes in. You know,

there's this idea that we can just control ourselves. And thinking is a great example of really not having any control because we can't just stop our thoughts. We might be able to create conditions where the mind is quiet, but if we just get up there and hold up the stop sign and say, okay, thoughts, take a break, they come at us like zombies and it becomes the thought apocalypse. So that's one, I think in terms of addiction, I also remember being on, you know, I was on a month-long retreat and it took me a full day or came up and then do the same thing. And I was like, wait a minute, this is my mind, just not wanting to meditate. addictive perspective. It might be helpful just to even think about what the general framework of reward-based learning is, because that can also explain where addiction can move, you know, not just from alcohol and the typical ones, but even to thinking and views and things like this.

So there's a, you know, there's a very simple framework that has three components, a trigger, a behavior, and a reward. And this framework is set up to help us remember where food is and how to avoid danger. So basically, if you see food, that's the trigger. You eat the food, that's the behavior. And then your stomach sends this dopamine signal to your brain that says, remember what you ate, where you found it, there's the reward or quote unquote reward. It's from a brain perspective. It's basically, it lays down context dependent memory. Same for avoiding danger. You see the danger, you run away. And then the reward is that you're alive to tell your buddies, don't go over there. That's kind of dangerous. So that's the basic framework for

reward-based learning. Now, there are a couple of important components that really explain a lot of modern-day maladies that we don't quite understand with this. Reward-based learning is based on rewards, not on the behavior itself. And I mention that because in modern day, we try everything from dieting to trying to make our minds silent when we're meditating. to trying to make our minds silent when we're meditating. But we use the brute force method where it's like, okay, just stop. That's what I was trying to do. I used to sweat through t-shirts in the middle of winter at the center, the Insight Meditation Society up in Massachusetts, where it's cold. I'd sweat through t-shirts trying to force myself not to think and to just stay concentrated in my breath. Well, this is the same thing that people do when they're trying to lose weight and they

use a traditional diet, which just says, you know, make sure you eat salad instead of cake. Well, you know, it makes sense. The formula is correct, but that's not how our minds work. So the reward-based learning reminds us that it's not the behavior, it's the reward, how rewarding a behavior is, and that's what's going to drive future behavior. And understanding this is really key, not only for my lab in developing, you know, app-based mindfulness training programs, for example, but also understanding the underlying neural mechanisms of what was going on. And also, personally, it really helped me be able to pay attention to my breath or pay

attention to an object of meditation rather than trying to force it. And it's also more the anticipation of reward than it is the actual landing on the object of desire, right? It's both actually. So the dopamine fire is the first time we get a reward. And if it happens repeatedly, that dopamine firing, and that's that anticipation piece that feels like, that dopamine firing shifts from receipt of reward to anticipation of reward. So it actually starts firing when we have a trigger or when we have a thought can be a trigger where we start thinking about getting that thing. It motivates us to get off the couch and go do that behavior. Because remember, this is all set up to motivate us to eat and to motivate

us to run away from danger. So that anticipation piece is go do something. So you're saying that it's initially encoded by the actual reward, but if in future instances, it starts prior to the reward, just when we're actually engaging the routine that would reliably deliver the reward? Yes. So for example, you know, the first, if I, and usually this has to do with unanticipated rewards. So if I'm, you know, walking down the street and suddenly I find, you know, a chocolate bar that, you know, it's my favorite chocolate bar. My brain says, oh, wow, that was a surprise. And that, oh, wow, surprise says, oh, you just won the chocolate lottery. And so then the next time I walk down that street, my brain will say, oh,

I wonder if there's another chocolate bar there. And so the trigger of the context that walking down that street says, oh, go look for chocolate. In your book, you draw an analogy between the cycle of learning, which is in the behaviorist literature, going back to Skinner, what was called operant conditioning. There's an analogy to draw there between that mechanism and the Buddhist framing of dependent origination. I don't know if you want to unpack that for us. Yeah, I'd be happy to. So dependent origination is reportedly what the Buddha was contemplating on the night of his enlightenment. Now that sounds kind of important.

This is what the dude was contemplating, and then he became awakened, then he became enlightened. So I worked with a Pali scholar, Jake Davis, because as I was studying dependent origination personally, I was studying behavior change professionally as an addiction psychiatrist and was starting to see the importance of operant conditioning, which is basically that reward-based learning cycle that I talked about. And we looked at the parallels and it was striking how similar these two frameworks were. There were slight differences in terminology in terms of some language that the Buddhists were using and some language that the behaviorists were using. But basically, it was the same process. the Buddha had basically discovered what we now think of in modern day as rule-word-based learning before paper had even been invented. And this discovery in modern day science, just to put it in perspective, was so huge that Eric Kandel won the Nobel Prize in the year 2000, showing that

this process is evolutionarily conserved all the way back to the sea slug. So a critically important concept, whether it was the Buddha becoming awakened or Eric Kandel getting his Nobel Prize, showing that this is a very, very fundamental learning process. So in the Buddhist framework, there's this capacity of the mind to notice the feeling valence of a stimulus. So you can notice whether something's pleasant or unpleasant, and craving follows from that. There's craving and identification with it., I think we now know something about the neural correlates of these processes. What does your work tell you about what the brain is doing when we're

feeling desire for a stimulus and that desire is made actionable because there's no distance between, you know, attention and the desire itself. Yes. So why don't we start at the vedana, the pleasant and unpleasant aspect. In Buddhist terms, vedana, pleasant, unpleasant, or sometimes neutral. In operant conditioning or modern day psychology terms, you know, pretty similar terms are used. You know, something feels pleasant, something feels unpleasant. And what both frameworks show is that whether it's pleasant or unpleasant, both of them lead to a craving. So we want more of the pleasant and we want less of the unpleasant. So you can think of an anti-craving or aversion. We have a craving and aversion. And then that leads in the Buddhist terminology to

clinging or upadana, which can be also suggest a translation can be sustenance where we're fueling that fire of craving. And by behaving, we start to become identified with that behavior. So if it's eating chocolate, I can start to become identified with eating certain types of chocolate, like dark chocolate versus milk chocolate. Or if I have a certain political propensity, I could start becoming identified with a certain type of view or set of views where I am this versus not that. And the more we perform the behavior, whether it's eating chocolate or thinking, you know, this is the right view, the more we become identified with that. Now, interestingly, in ancient Buddhist terms, they said that the cycle

is perpetuated through ignorance. And in modern day, I think of this as that cycle is perpetuated through, I use the term subjective bias. And so the term ignorance and subjective bias, I would suggest are basically the same thing, meaning that it through these lenses of our previous behavior. So if I see chocolate, I'm going to see it through the lenses of, oh, I like or I don't like that type of chocolate based on my previous behavior. So the subjective bias, the Buddhists would suggest, is ignorance because we're not actually seeing clearly. And I like the interpretation of the term vipassana, which literally means seeing clearly. It's as though we're taking off those subjective bias glasses. and something that seems far more recent in acquisition in evolutionary terms. You're talking about political views, right? So the fact that one's sense of identification, the sense of self, can be an emergent property of kind of contracting within the domain of either of these things, whether it's the taste of chocolate, the wanting

of it, the preference for one form or another, and just holding to an opinion that one has entertained and become attached to. This can sound surprising, but just in evolutionary terms, we didn't add entirely new modules to the ape brain to become human, right? I mean, the only way we acquire new abilities is by extending the processing reach of structures that, you know, were already there. And so the same circuitry that's encoding, you know, disgust over being confronted by something toxic that you don't want to get into your mouth. It's that same processing that is underwriting moral intuitions and even judgments of, you know, the truth or falsity of ideas. From the side of experience in meditation,

From the side of experience in meditation, this really isn't surprising. You can feel in yourself the difference between identification, attachment, the sort of cramp of self around any of these things. Wanting another bite of cake. We've all had this experience of you're eating some dessert, which you're very happy to be eating, You're eating some dessert, which you're very happy to be eating, and someone, usually your spouse, will ask for a bite of it when you're down to the last bite, right? And you feel viscerally that something in you, some homunculus in you, has not budgeted for the possibility of having to give up that last bite. Your pleasure extended to the remaining bite. You would have happily perhaps given an earlier bite,

but surely not the last one. That feeling of kind of emotional impediment, you know, that is tied in the middle of virtually everything that feels like me. Do we know much at this point about the underlying neuroanatomy of these processes? I'm glad you brought in these terms around, you know, contraction and, you know, basically clinging the closed down quality of experience, because that's something that my lab has kind of serendipitously fallen into studying. fallen into studying. And if you think about it from an evolutionary perspective, fear, for example, feels contracting, right? And the idea is to make ourselves as small an object as possible, protect our vital organs from whatever it is that's about to eat us.

Now, that's very different than the feeling of, say, joy or connection, which feels much more expansive or even curiosity. So just anchoring us on that framework and that feeling of contraction versus expansion, my lab was studying experienced meditators. This is back in 2009, 10, 11, yeah, almost a decade ago, where we were just trying to understand what the basic brain activity looked like in experienced versus novice meditators. And we were actually looking for convergence. So we studied a bunch of different types of practices. So we had people practice like a concentration practice, like breath awareness, a loving kindness practice, more of a connection practice,

and then a choiceless awareness practice where they were not focused on any particular object, but just whatever came into their awareness was the object of their awareness in that moment. And we looked to see what was common amongst those three meditation practices. What we found was very striking. One was we didn't find a single brain region that was increased in activity in experienced versus novice meditators, which was a little shocking to me. And I think went against my primary hypothesis was that there must be some brain region activating because I'm sure working my ass off. This is back before I really, you know, I was only 10 years into practice and still didn't have quite a clue about what force was like. But the other thing

that we found was that there were particular brain regions that were deactivated in experience versus novice meditators. And these had to do with this network called the default mode network that has to do with self-referential processing. So when we take something personally, basically this network of brain regions gets activated. So for example, let's use your example of the cake, you know, it's like, oh, I want that last piece of cake and we're kind of holding on to it. We're clinging to it, so to speak. Also happens when we ruminate, when we're depressed. It happens when we perseverate, when we're anxious, when we're worried about the future. So there are a bunch of different

things that when we take them personally, when we're worried about the future, when we regret things in the past, when we want that piece of cake, they all activate the default mode network. And lo and behold, this same network was deactivated in experienced meditators. Now, I've spoken about the default mode network before in this context. Is the finding the same for the medial prefrontal cortex as the posterior cingulate, or are we mostly talking about the posterior cingulate for these deactivations? Yeah, it's a great question. We've done most of our experiments in the posterior cingulate cortex, and that's because that was the brain region that had the most deactivation in experience versus novice meditators.

And also, pragmatically, when we started doing real-time neurofeedback experiments, we didn't have the techniques to be able to give feedback from multiple brain regions at once. The two are pretty highly correlated, but most of the work that we've done has been with the posterior cingulate and there's also a theoretical reason for that which is the medial prefrontal cortex part of the prefrontal cortex which is a younger part of the brain has been more linked to the conceptual sense of self whereas the posterior cingulate cortex and this was actually through some work that we'd done and others had done, seems to be more linked to an experiential sense of self and is also directly anatomically connected to brain regions involved in memory, like the hippocampus. So the posterior cingulate is what we've been focused on primarily, but a fair number of the studies have shown that the both are pretty

intimately correlated. So we wanted to actually understand what this deactivation meant, because there's a big issue in neuroimaging and neuroscience around reverse inference, where if you see a brain region activated, you assume that something is happening based on what other people have done in other experiments, but you can't make that assumption accurately because it could be doing something else and we just don't know it. So the best way to reduce that likelihood is to do real-time experiments where you can measure brain activity and show people their brain activity in real time while they're doing a particular task. In our case, we were having people meditate. And that way you

can link up the subjective experience, their first person's subjective experience with their brain activity in real time and really know what's going on. So we did a bunch of these experiments with novice and experienced meditators. And we found something that was really striking, which was that this activation in the posterior cingulate cortex was correlated not just with things like mind-wandering or craving, but it's the degree to which people get caught up in that experience. And we found this because not only were things like craving or mind-wandering activating these brain regions, which other people had found before. But we found that other experiences were also activating it, such as when people were trying to meditate harder, as one person put it. They were looking at the graph as an object of meditation. They said, I tried to be more aware of it or force it, basically. And that actually induced an increased activity or

increased activation of the posterior cingulate cortex, whereas other people were reporting that the more they let go and stopped trying to do anything, the less their posterior cingulate was activated. So you mentioned that you gave people three different practices to do, and two of them were essentially mindfulness, but one was to focus exclusively on the breath and the other was choiceless awareness, which is to say you just leave your attention wide open and notice whatever you notice. Were those different in terms of the activity of the posterior cingulate? They both showed deactivation in experienced versus novice meditators, as in when people were focusing on that object, whether it's the breath or just anything coming into their awareness,

the less they tried, the less they got caught up in doing and were just resting in awareness, the more deactivated their posterior cingulate got. Right, right. You can feel this subjectively. I mean, this is the difference between feeling like the meditator, right, where you're strongly identified with the aiming of your attention. You're the locus of attention in the head, and you're now pointing attention strategically at the breath and trying to get closer to it and noticing the competition between doing that. If you'd like to continue listening to this podcast, you'll need to subscribe at samharris.org.

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