Tara Brach - Unwinding Anxiety with Awareness (Part 1): A conversation with Tara and Dr. Judson Brewer

Episode Date: June 8, 2023

Unwinding Anxiety with Awareness (Part 1): A conversation with Tara and Dr. Judson Brewer - Anxiety is spiking around the world and we need the radical medicine of awareness to unwind it. In this two-part conversation, Tara and Judson Brewer look at how anxiety is a habit that can be unlearned as we cultivate a curious and kind mindful presence. Jud offers the scientific grounds for this "unwinding", drawing on his experience as a pioneer and leading researcher in the field of mindfulness and addiction. Together they explore the power of particular mindfulness-based strategies, including noting what is happening, recognizing our habit loops, arousing curiosity and cultivating self-care. They shine a light on the genesis of worrying, how it perpetuates anxiety and ways we can become disenchanted with the habit. If you'd like to join an online community that is dedicated to reducing stress and easing anxiety with the power of renowned neuroscientist, Judson Brewer's 3-step methodology, check out the new Mindful Friends Groups at Cloud Sangha.

Greetings. We offer these podcasts freely and your support really makes a difference. To make a donation, please visit tarabrock.com. Namaste. Greetings, friends. Very glad to be with you and to have with us my colleague and friend Judson Brewer and by way of introduction, Judge a psychiatrist and an internationally known expert in mindfulness training for treating addictions. and through his research, and it's been really leading research in the field. He's developed in-person and app-based programs for smoking, for anxiety, emotional eating, and he's written a best-selling book, Unwinding Anxiety. This is a super high recommend, really.

There's another soon-to-come. It's called Eat Right, which, again, I've read and loved. So, Judge is the Director of Research and Innovation at Brown University, Mindfulness Center and he also serves there as associate professor in the School of Medicine at Brown University. He's a long time mindfulness practitioner. And so he brings his, you know, bright mind and good heart to relieving suffering. So Judd's a real inspiration to me and countless others. So welcome, my friend. Welcome, Jud. Thank you for having me. It's a real joy to be here with you today. Yeah. Well, me too. And so let's

just jump right in. I think where I'd like to begin is more on the personal level. You know, really what makes us a live domain unwinding anxiety for us. And just in reading your book, right towards the very beginning, you described panic attacks in med school, which I think makes you totally normal. Yes. And how meditation helps. So could you just give us a little sense of that? I'd be happy to. It turns out I was pretty anxious in college and didn't even know it. It was kind of showing up in my GI tract. I'll bury the details. But for anybody that is familiar with irritable bowel syndrome, I wouldn't wish it on anybody. And that was my body telling me, hey, you can't just be this, you know, type A and like, you know, be vegetarian, exercise, play violent, do all these things. and then that's going to protect you from anxiety.

And so it wasn't even in my vocabulary, yet I knew there was something up. And the circumstances would have it that my first day of medical school, I started meditating. And what that helped me realize was that I had no idea how my mind worked. So it was really helpful for me. And I had, as I was going through my MD PhD program, I had eight years to really just deepen practice as I was going through school. So it was a wonderful time for me. I loved, loved every, every moment of being able to be a, you know, be a learner and also be a learner about my own mind. So when I started residency where, you know, you get all of the sleep deprivation and tons of uncertainty and, you know, feeling like you have no idea what you're doing and the imposter syndrome and all this stuff, I started getting these panic attacks. And I wake up in the middle of the night, full blown panic attack.

And because I was a resident training to be a psychiatrist, after the panic attack was over, I'd go through the DSM checklist and be like, check, check, check, check. Oh, I just had a full blown panic attack. The reason I could do that was that when I'd wake up, so I'd wake up, you know, totally disoriented, feeling like I was going to die the whole nine yards, you know, tunnel vision, heart racing, shorter breath, literally the thoughts like, I'm going to die, I'm going to die. And what kicked in in those moments was that I had been doing noting practice, this, you know, this practice popularized by Saido Upandita, this Burmese teacher. And I'd been practicing that to the point where it had become habitual.

And so I wake up, I'm having this full ball and panic attack. And then my mind kicks in and starts noting, oh, thoughts of death, oh, shortness of breath. Oh, racing heart. Oh, you're all sweaty. And this noting practice helped me have that distance, that perspective to be able to observe, oh, here's a panic attack instead of being sucked into it and so identified with it that it's like, oh, no, I'm going to die. I need to go to the emergency room or, oh, no, I'm having a panic attack.

I shouldn't be having a panic attack. I'm a psychiatrist. You know, what am I going to do? Is this going to ruin my career? And, you know, have my mind spin out into the future where I'm, you know, whatever the worst case scenario was would play out. And also, you know, panic disorder comes from people worrying that they're going to have panic attack. It's not the panic attacks themselves. So it was a lifesaver for me in terms of whenever I have a panic attack, my brain kick right into noting practice.

Note, note, note, note, no, note. You know, oh, check, panic attack, go back to sleep. Probably because I was sleep deprived. But also, it really reinforced for me just how powerful. these practices are. Because literally, you know, panic, if you look at the definition, wildly unthinking behavior. So if you're going to be stuck in wildly unthinking behavior and you're going to fall back on your old habits, it would be amazing if that habit could be one that is mindfulness, right? And so that said to me, wow, this can get established as a habit. And this can help with the

worst of the worst, at least when it comes to, you know, the mental health aspect of things. So I was, After that, I was sold. I was absolutely sold on that. And I really, you know, I actually shifted my entire career from studying molecular biology to saying, hey, I'm going to study this stuff. You know, I see this for me personally. We need, we really need this help for people with, with addictions. And that's where I really dove in and started doing research on mindfulness for addictions. Oh my. It really is striking. Just if you go deep into where the suffering is and find some medicine. It's like, why not organize your life around it? And I'm realizing that the parallels for us, I mean, my first realization of anxiety, I was in my 20s and I started practicing meditation

coming more into my body and realizing almost every time I did, there was some background hum of fear. It's like I could feel some clutching most of the time. And it reminds me of a story I heard more recently of mother sends her son an email and she says, start worrying details to follow. It's like I was just anticipating something going wrong and it was just an existential clutch that was there. But it also would circulate around upcoming events. Like I could imagine you having a panic attack and part of the grip of it is how am I going to operate? you know, tomorrow, professionally, whatever. And I'd find myself approaching an event or presentation and the uncertainties of would I do well? Would it be okay? Would it work out? Will they like me?

You know, would set off anxiety, that fear of failure. And the irony was, Judd, that I was on my way typically to teaching about the power of mindful presence. So I had a very explicit, dedicate to working with that anxiety. And in the early days, I often just built it into whatever I was sharing at the time. But what it got going was, as you've described, this kind of habit, this habit of practice where I'd know what was going on, okay, this is it, this is that clutch. And I'd actually on purpose not follow my thoughts, I'd come right into my body. And that became my pathway is just to keep getting familiar with the experience of anxiety as sensations in the body and more and more, I wasn't so identified with it. I was more the ocean aware of the

waves, which of course is where the freedom is. So it's very similar. It's become a life path to be teaching about the power of waking up awareness in this way. And I'd like to move this right into because we're talking about anxiety. If you help us along with some definitions because there's a lot of confusion, I think, between anxiety and fear and you parse it out really cleanly. Well, I think that's a really good place to start. So if we think of fear, you know, it's generally about the present moment. Am I in danger right now?

right and with anxiety if you look at the definition it's this you know feeling of nervousness or unease about something with an uncertain outcome you know so it's basically fear of the future i think this is really interesting from a neuroscience standpoint because fear is a very helpful survival mechanism right nobody's going to argue that you know we step out into a busy street we almost get hit by a car and we realize oh i should probably put my phone away or whatever it was that made us not look both ways before looking, you know, stepping out into the street. And so we learn, fears that is helpful in the present moment, helps us, you know, run away from danger, you know, the fight, fight, flee thing. But it also helps us learn through negative

reinforcement. So if we're afraid and we can say, well, why am, why was I afraid? What was a situation? We can learn to avoid those situations in the future, like, you know, walking out in the street, look at our phone instead of looking at the street or something like that. there's another helpful survival part of our brain, which is about planning for the future. Also, you know, nobody's going to dispute the planning to go on a trip. It's helpful to plan as compared to not the plan. You know, you can't just walk into the airport and expect to buy a ticket for where you want to go. But if you bring those two together, there may be an evolutionary bottleneck. So fear, helpful, planning helpful. And if you think of planning as future, when you bring fear of the

future together not so helpful. That's where anxiety comes in. So we start worrying, oh, no, this could happen, this could happen, this could happen. And what has been shown pretty definitively is that anxiety doesn't actually help us. It's not a helpful survival mechanism because worrying about things, one, it affects our physical, two, it affects our mental health. So it's detrimental for both of those. And it doesn't actually help us plan for the future. because that newer part of our brain, the prefrontal cortex, goes offline when we get anxious. So we can't actually plan. We can't actually reason through things when we're anxious.

If you think of the far end of the anxiety spectrum with panic, wildly unthinking behavior, right? We're not thinking. Brain's offline. So it's really interesting, you know, that we, it may be this evolutionary bottleneck where, you know, fear is helpful. But when you bring those two together and you get stuck in these habits of being, being anxious, not so helpful, more problematic, actually. So a couple of questions, because I've really been taking that,

taking in how you're defining it. And people talk a lot about fear of death. And would you call it anxiety about death? That's a really good question. If people worry, because I think worry, you know, that feeling of worry is this cardinal feature of anxiety, I would say if they're worrying about something in the future, like if death is the object that they're worrying about, I would say that falls into the category of anxiety. Yet I think there's fear of death that can be very present moment

that is just fear of death, like, you know, fear of dying. And there can be different flavors of that. So I think it could be simply fear. And I think it could also spill over into anxiety. But I'd be curious, what, how, how, what's your experience? experience with that. How do you see those? Yeah, well, because I like that you're describing fear as adaptive and anxiety with the worry as as not so adaptive. There's, of course, not adaptive fear. When fear becomes a habit itself, we actually think that what we're seeing

and experiencing is an immediate threat. So there's non-adaptive fear, which is pretty widespread. It's not just anxiety about an uncertain future. It's like I'm right about to talk to Judd and this could be the worst experience of exposing my ignorance and I could ruin my career. So it could be very, I didn't think that today. So there's an interesting thing for me about just the proliferation of worry as being the key thing, not even that it's an immediate. threat because, you know, I have a friend that had fourth stage lung cancer and her death wasn't immediate. It was, you know, down the road a bit, but there was certainty about it and she was worrying. So I think there's a few different ingredients. And as you

teach, the actual biology and felt sense is the same. So let's double click on worry. And I'll tell you why in a minute, but if that's okay, let's go there because I think you're touching on something really, really important. So when I was in medical school in residency, I was trained to prescribe medications for anxiety. Okay. And the best medications out there, you know, there's this term called number needed to treat, which gives us a sense for if you treat X number of people, one person's going to show a significant reduction in symptoms. So the smaller, the number, the better. And this is, you can calculate this for basically any medication or even many treatments as well. That number for the best medications in psychiatry is 5.2.

So one in five people is going to show a significant reduction in symptoms with medication. So some people really benefit from anxiety medications, you know, 20% of people, 80% of people, not so much. And the reason I bring that forward is that when, you know, when we were developing some of our digital therapeutics, our E right now program in particular, somebody was mapping out her eating habit loops and said, you know, anxiety is driving me to eat, to stress eat. Can you, can you develop a program for anxiety? And I was thinking, well, I'm a psychiatrist. I prescribe medications for that. But two things that happen there. One is it put a bug in my ear because

I had been playing the medication lottery, you know. Talk about uncertainty. I didn't know of the next five patients that came into my office, which one of them was going to benefit, and then also what to do with the other four. So I was, you know, I'd get anxious about helping my own patients with anxiety. A lot of this has to do with uncertainty. So there, I was, I had a pain point. I was struggling with helping my own patients. And so I went back, you know, as a researcher, went back and looked at the literature. And it turns out that in the mid-1980s, this is when Prozac was introduced, you know, ironically, this medication is that used for anxiety that's in the class of the best ones. And also at the same time, this guy, Thomas Borkevac, had suggested that anxiety could be driven

like a habit. Now, going back to what I said about medical school, I never learned that in medical school. I never learned that in residency. I just learned to prescribe medications. But when I saw that and started reading the literature, I was thinking, oh, he's saying this could be driven like a habit. And I've been studying habits for 10 years at that point. It was like, oh, you know, we could get good habit change with smoking, good habit change with eating. Oh, I didn't think of anxiety, like that it could be driven like a habit. So why don't we start applying it here? So this is where worry comes in. The way that works. So any habit can be perpetuated through three key elements, a trigger, a behavior, and a result, or a cue. Sometimes people prefer the word cue. So a cue or a trigger triggers a behavior.

behavior can be physical or mental. So typically I think of a behavior is like stress eating or drinking alcohol or smoking marijuana or some, you know, some behavior. But that behavior can be mental. And the mental behavior that's most common with anxiety is worrying. So it's interesting, you can think of worry as a noun, right? The feeling of worry, right, which is baked into the definition of anxiety. So you feel worried. And that drives the verb form, the mental, behavior of worrying. And that's why I wanted to double click on what you were talking about in terms of worrying. You know, in the example you gave was great, that worrying is what feeds back and drives more anxiety because it gives us the result of feeling in control or at least feeling like we're doing

something because let's be honest, worrying doesn't really make us any more in control. It might even make us less in control because it's harder to think and plan. But it feels like we're doing something and doing something often feels better than doing nothing. This is how negative reinforcement works. If there's something rewarding about a behavior, which could be continuing something pleasant or making something more pleasant or making something less unpleasant, that's what negative reinforcement's all about. So if anxiety is unpleasant and we start to worry and that either distracts us from the feeling of anxiety or makes us feel like we're doing something, that less unpleasant quality of worry can be rewarding enough that it feeds back and drives anxiety cycles. So the next time we feel

anxious, our brain says, hey, why aren't you worry? You know, it felt better than not doing anything last time. And then we get stuck in these cycles. Ironically, it actually feeds more anxiety and doesn't even feel very good itself. I like this because you're again talking about kind of that evolutionary bottleneck where we learned a habit that we needed people. And it's a need a pieces of it. We needed to plan. We needed to try to take control to some degree, but then it locked in. It gave us some reward. And now in current times, our worry takes over. It gives us a temporary feeling of control. It keeps the whole cycle of anxiety in our body alive. And it doesn't really serve us. So I want to come back to that, because this is the core, I feel like, of what the power of what

you're teaching judge is to see that looping and then say it's a bottleneck we have to retrain ourselves and so that's what I want to come back to but I want to just broaden it for a moment because it feels important to ask it's so big currently and it seems bigger than ever anxiety this the habit that people have of feeling the anxiety feeling worried worrying and so on and it's very collective you know it's all over the world. So just to hear a little bit from you on how it is that we're caught in it more than ever. Well, there are two elements there. And I think we all went through a naturalistic experiment that none of us signed up for called the pandemic.

Now, the reason I say that is that the hypothesis is that uncertainty drives anxiety. It doesn't have to, but it often does. And the way that works is that uncertainty drives our brain to do something, right, which is to reduce that uncertainty. Because uncertainty says, hey, I'm not sure how this is going to go. You've got to figure out if this is dangerous or not and how to predict what's actually going to happen. So we can do our best to collect information to predict the future, but we can't always predict

the future, right? Sometimes we can predict it pretty well. Sometimes we can't predict it very well at all. With the pandemic, nobody had a freaking clue what was going to happen, right? They were working, everybody was working like crazy in their respective lanes to try to help reduce that uncertainty, whether it was how contagious it is, how deadly it was, what was going to happen, you know, what were the best public health measures to take. All of these things were uncertainties that we, the people were working.

on to try to reduce. Anytime you add a piece of uncertainty into equation, that can ramp up anxiety and worry because uncertainty says, oh, no, you know, this could happen, this could happen, this could happen, or oh, no, I don't know what's going to happen, which just gives our, leaves our brains on, you know, gives them free reign to think of the worst case scenario. And that's often where our brains go. So that's one piece. And it's not like uncertainty's gone away now that, you know, where the tail end of the pandemic. But it, it, the pandemic really highlighted there were just layers upon layers of uncertainty. And every time a new layer of uncertainty came out, whether it was a variant, whether it was

something about the economy, whether it was what, how we're going to deal with schooling, you know, and our children, those layers just highlighted we just, you could just watch the anxiety go up collectively, right? And the worry go up. So that's one piece. The other piece is there's this. phenomenon called social or emotional contagion. And with emotional contagion, you think of it as, you know, just, you know, the passing of affect or emotion from one person to another. So,

you know, just like the COVID-19 had this or not, it had a certain contagious value, right? Other emotions have a certain value of contagion. So for example, fear is very contagious, right? That's where panic comes from. Joy can have some level of contagion, but it's not quite as contagious as fear. This is where the negativity bias comes in. These negative things where if we're more likely to get hurt or die, those things tend to be most contagious. Anxiety is pretty contagious. If somebody walks into a room and they start spewing anxiety, you know, we're likely to catch that if we don't, let's say, immunize ourselves from that emotional contagion. So one way to spread, so, you know, you can socially distance from somebody to prevent

yourself from catching a physical contagion, like a virus, but emotional contagions can spread all over the world through the wonders of the internet and social media. So somebody goes on social media and they start saying, oh, no, you know, what was it? There's so many things in the pandemic. Like, oh, no, everybody's buying toilet paper. You know, nobody, this wasn't a GI bug people were getting. You know, it's not like there was a reason for there to be a run on toilet paper at the grocery stores. Yet there was, at least in certain parts of the world.

Why? Social contagion. You go to the grocery store. You see somebody, you know, buying a bunch of toilet paper and you think, oh, no, I better buy some toilet paper because we're going to run out. And then surprise, we run out of toilet paper because we're not prepared for that. So two things, you know, just to summarize, uncertainty, big driver of anxiety and social or emotional contagion can also drive any type of emotion. And in this case, fear, anxiety, they were, they spread like wildfire over, over the internet. Totally resonates. And I'm also thinking pre-pandemic, because I remember, I think it was 2017, somebody had that hashtag.

this is what anxiety feels like, which I'm sure you, you know, and they were talking about the United States of Xanax and, you know, everybody having fidget spinners. And I remember one of the cartoons I saw had people in a mall and somebody's having a panic attack and says, you know, does anybody have Xanax? You see you're surrounded by like a crowd, a willing stranger. So this is like, this has been going on for a while. And, you know, the pace of change keeps speeding up in a way. it's very hard to compute. So when you talk about the brain as a predicting machine and uncertainty, it's speeding up and the flow of information is so big. You know, it's really too much information, TMI. And, you know, so I've been thinking a lot about especially teens where anxiety and depression

is at an all-time high, but it's not just post-pendemic. In fact, the data showing, you know, started around, I think it was 2010 or 11. And when you talk about social media and contagion, oh my gosh, Judd, it's like, and this is what it seems to be pointing to in the surgeon general saying, you know, oh my gosh, watch out, social media, iPhones. But I think of teens and I think of how the thing that most sues anxiety is connection, relationship. I mean, anxiety comes from a sense of being a separate, isolated, vulnerable self. And so in the moments that you and I can say, okay, here we are together, there's going to be some calming of the nervous system. But social media, less sleep, less human contact, and it just charges up that sense of isolation, comparing,

feeling deficient, all the things we get anxious about. And so that feels, you know, I guess the reason I'm naming this is because it's very easy to take anxiety personally and forget it's the waters we're swimming in and that every one of us has a nervous system that, as you described it, is getting washed through with this energy that's fraught with uncertainty and we have all sorts of addictive hook, so it's very easy for it to hide in our addictive behaviors because, you know, now substances and everything else are so well engineered to addict us. It's a big deal. And it's going to be, it's, so I'm just wanted to bring it beyond the pandemic because it feels so collective and so big. Yes. And if I could highlight one or two things here that can

help people understand why this is the case. One, with social media, it's interesting. because there's this paradox. So with social media, it can be engineered, you know, through things like intermittent reinforcement where you don't know when you're going to get a like on your post or, you know, how many likes you're going to get. Yet that can provide a level of certainty where at the end of the day, after you're, you know, you post something and your run is done because somebody else is, you know, running afterwards. and everybody's attention is somewhere else,

you can, you get certainty as to whether, like, that was a quote unquote, good post or a bad post, right? You can judge yourself based on how many likes you got. So there's a quantification,

our brains love quantifying things. And they can say, okay, how many likes did you get? Well, I got this versus this, right? When you have face-to-face interaction, there's a huge amount or there's the potential for a lot more ambiguity,

you know, you might interpret somebody's facial expression or their body posture, their body expression, or their tone of voice or any certain, any number of, you know, communication factors in ambiguous ways. Because they're not like likes. They're not as quantitative. And so there can be this draw to get things that are certain, you know, like this draw to certainty. Like, oh, I got, you know, that either worked really well or that bombed. Yet when you look at, and there was actually a study published in 2016 from UCLA, where they actually looked at Instagram posts from teenagers.

And they, the one variable that they manipulated was the number of likes certain pictures got. And the interesting thing there was that quantitative piece really, you know, that's love, you know, our brains love that. Yet when you look at the brain activity, so they were scanning these teenagers' brains as they were showing them. different pictures with different your number of likes. When you get a bunch of likes, it activates the reward centers in your brain. So, you know, it seems kind of intuitive like, oh, there's something rewarding about that. That's why it's addictive. Yet they were also activating these self-referential networks. This network in particular called the default mode network, which is this network that I think of it as the me network. You know, it's like, oh, they've liked

my, you know, my picture, me, me, me. And so there's something rewarding that's tied into the self. And so we can literally get addicted to things that are related to ourselves. And at the same time, we can get addicted when when things don't go the way we want them to, it can cause a lot of pain and suffering, which is where a lot of this social comparison comes in leading to anxiety and depression in particular, you know, we've seen with teens. But this is, this goes across the board. That is so interesting because it really explains why, you know, we're in search for the rewards and connection, but we go for social media instead of that in-person contact because there's more certainty, more, you know, clean reward, except for that it's an inferior reward. It's a reward,

though, so it addicts us, but it's inferior because it actually amps up the sense of comparison and self-focused. So it doesn't give us the healing, the deep reward of real connection. And this brings, again, you're really explaining with neuroscience how the looping goes that we would feel anxious, we'd get hooked on social media rather than seeking out a real human contact. And so I wanted to take it the next step. I wanted to ask you to go a little deeper into anxiety as a habit. And I love the way you started chapter three of unwinding anxiety, which is, I hate to tell you this, but you're addicted to something. Yeah.

And yeah, so if you could speak more to how anxiety hides in unhealthy behaviors and how that ends up perpetuating the looping, that would be really helpful. I'd be happy too. So the first thing I want to say is I'm not suggesting that habits are bad or unhelpful. In fact, most of our habits are really helpful. You know, imagine if we had to relearn everything every day, we'd be exhausted before we got to breakfast, right? So the habit of learning how to walk, put on our clothes, make breakfast, you know, all those

things, very, very helpful. Just turns out that that process can get co-opted in ways that aren't so helpful, aren't so observogenic, so to speak. And the way that works is, you know, our brains are, this is these survival mechanisms. Our brains are set up to remember things. So remember something that's rewarding. and I think of it as set and forget. So you remember something that's rewarding

and then you just set it up as a habit so you do it automatically. The same is true for remembering things that are not rewarding. So you avoid them. So that's the positive and the negative reinforcement side of things. And so when we learn things that help us avoid

unpleasant experiences, like we talked about worry and anxiety. So worry being that mental behavior that feeds back and drives anxiety, but it's set up through negative reinforcement. We can also look at it. all the other habits that get set up in the same way. So let's use stress or anxiety as an example because most people can relate, you know, I've never met anybody that's never had any anxiety in

their life. Let's just put it that way. Maybe people out there, I just haven't met them yet. So if you think of anxieties that trigger, right, and I see this in my clinic and I'm sorry to keep going back to the pandemic, but I saw this like ramp up during the pandemic because people were close to things that could give that could give them that brief relief. And what I mean by that is we're anxious, maybe we learn, oh, if I eat some chocolate, I'll feel better, right? And that eating chocolate, so not only can chocolate, you know, cause a number of neurochemical cascades that are literally pleasurable, like chocolate is pleasurable, but it can also help us avoid the unpleasantness of anxiety simply through distraction. So we eat some chocolate,

we drink some alcohol, we smoke a cigarette, we go on social media, and we go on social media, we go, or for people that are stuck in procrastination habit loops, we go and clean the bathroom. It's like, well, I've got to clean the bathroom anyway. So I might as well just, you know, I don't feel like this project is really making me anxious. I'm going to distract myself for a bit and the bathroom gets clean. So we can think of all these different behaviors that are set up through negative reinforcement to help us move away from or avoid the unpleasantness of something that triggered them. Well, when we do that, they get reinforced through negative reinforcement.

So we see this, you know, this very helpful survival mechanism gets co-opted, especially when you can make things that are really good at getting us to do them. Social media, you know, engineered for addiction. Food. There are a lot of food-like objects, you know, that are engineered for addiction. I like my favorite peer-reviewed journal, The Onion. They had a headline that said Doritos celebrates its one millionth ingredient, right? that is a completely engineered thing to get us addicted. For me, it was gummy worms.

I write about this in the hunger habit, so we don't need to go there now. But the idea is like, you know, these food-like objects are designed not for nutrition, but for consumption to get us to consume more. You know, this is where the low-fat fad came in. Food industry love that because what they found was if you make something lower and fat, people will eat more of it because they don't feel full, right? So these things can get built in where we've got all these habits that get formed from this

survival mechanism that is ironically becomes anti-survivable. So that makes sense? Totally. As you speak, you know, reflecting on what my habit loop was that got exactly. exacerbated during the pandemic but was always there, which is, you know, feel anxiety and then do more work, prep more. And in some way, the screen is the addiction. Like if I'm near my screen, I'm actually doing something. And then that temporarily gives me a feeling of in control, but then it deepens the sense of, okay, I'm not connected with myself. I'm, you know,

gets me anxious more. So, and that increased during the pandemic. you know, because screens became so paramount. Yes, yes, essential here. Essential for so many people. Yeah, yeah. So let's move on to the answer. You know, we're talking about how does meditation, how does mindfulness help us to unwind?

And you have fantastic three-gear system that is so intuitively resonant. Please share. Well, it all comes down to one thing, which you and I are very familiar with, which is awareness. Okay. So that's the bottom line. And to build that a little bit, this first gear or the first step that I think of is just being able to map out a habit loop. So if we can't map out our habit loops, we can't work with them. We're going to be on autopilot.

That's what habits are all about. I'll give a concrete example. I had a patient, and I write about him in the unwending anxiety book, the patient who was referred to me for anxiety. This is this is pre-pandemic. And he, you know, he basically was 40 years of age. He met all the criteria for generalized anxiety disorder and panic disorder. And so when I was taking his history, started describing how he'd get panic attacks driving on the highway that led him to avoid driving on the highway, et cetera. And so after I, after I took his history, I pulled out a sticky note and he actually took a picture of it and emailed it to me a couple of

years later. It was beautiful to see. So I, I pulled out this 4x6 sticky note because that's what I happened to have in my office at the time. I wrote down trigger behavior result. And I said, okay, let me get this straight. Is your trigger, this fear of having a panic attack driving on the highway, fear of getting in an accident or something like that? Yes. The behaviors to avoid driving on the highway.

Yes. The result, you don't get a panic attack. Yes. And then I drew arrows from one to the next to the next to the next to the next. And when I drew that arrow from results, you know, of not having a panic attack back to the trigger, his eyes got really wide. And he said, oh, I had no idea that my brain works this way. So if we can't map it out, it's going to be really hard to work with it, whatever the habit is. So that's a really good place to start. And the bottom line is awareness. One thing I'll highlight that I've

seen over the years is the trigger is the least important part of the equation. So I'm going to say that again in case folks missed it. The trigger is the least important part. And the reason I say that is because often people think the trigger is the most important part. If they can avoid the triggers, they won't have whatever it is. The problem is the trigger is not the problem, right? It's called reward-based learning because how rewarding a behavior is is what's going to drive it in the future. So we could have all the triggers in the world, but if it's not, if the behavior is not rewarding, it doesn't matter. And so there's triggers lose their power.

And so that's the first step, mapping out the habit loop before we go on. Does that make sense? Totally. And I'm glad you said that about the trigger is the least important part because I've seen people spend so much time trying to say, well, was the trigger the thought or was the trigger the feeling or was the trigger when somebody said such and such? And all we need to know is there's been a trigger and here's the behavior that's following it. And here's the reward or result. Yeah. Thank you. Yeah. Great. So once somebody can map this out, and actually we created a free habit mapper. I think the URL is just map myhabit.com. Anybody can download it, free PDF. They can just start mapping out their habits. So I found that really helpful for my

clinic patients, but anybody can download that and use it. Like, it's just really helpful in general. And it comes down to one thing, awareness, right? Got to be aware of your, of your habit loops and that you're stuck in a habit loop. So we can zoom in there on the behavior, right? First step, just recognize what's the behavior? Am I worrying? Am I procrastinating? Am I going on social media? am I stress eating and, you know, all the things. The second step or shifting into second gear, we think of it that way, is really tapping into the power of our brain. Okay.

And I'm going to highlight something that it is not because this is often where people get stuck. They think, oh, the power of my brain, just got to use my willpower. No. Not the right answer. Not that they are wrong because the internet perpetually. this, I'm going to say, myth of willpower. So they probably learned it somewhere because that is the dominant paradigm. The problem is that from a neuroscience standpoint, neuroscientists don't talk about willpower

at all, okay, at all. It's not in the equations of behavior change. So what are the equations of behavior change? Well, it's basically that a reward value gets set up. We've talked about set and forget. And then we keep doing it if it's habitual and we're not paying attention. and the only way to change it is to pay attention to bring awareness in. So there's this variable, this error term, that can go one of generally one of two ways.

So if we pay attention and something's more rewarding than expected, right? So we've set up a reward value for something. Let's say chocolate cake. So for me, you know, I've got a certain reward value for chocolate cake. Okay, this type of chocolate cake is really good. Like somebody gave us this great chickpea chocolate cake recipe, where it's like gluten-free chickpeas, five ingredients, it's awesome. So that's like my gold standard for chocolate cake.

If a new bakery opens up in my neighborhood, I go there and I try their chocolate cake, and it's like it beats the pants off the chickpea chocolate cake. And I would throw that down, anybody that can beat this, go for it and tell me, I will try that chocolate cake. I get what's called a positive prediction error. It's better than expected. So my brain gets this dopamine spreads and it says, hey, remember this bakery. They nailed it.

on the other hand, if I eat the chocolate cake and I'm like, meh, chickpea chocolate cake's better, I get a negative prediction error saying, don't bother going back to this bakery, not so good. I still learn something. Dopamine spreads. So both of those help me learn. Notice how they both require one ingredient. Awareness. I have to pay attention as I'm eating the cake.

So we can leverage this, right? Notice how none of that has to do with willpower. We can leverage this and leverage the power of our brain and how it learns. by paying attention when, let's say, we're worrying. So when we worry and we ask ourselves simple question, like, what am I getting from this, which can help drop us into our direct experience? Oh, what does this feel like in my body when I worry?

Typical answer, oh, I feel more anxious. That's exactly what my patient reported. You know, like I sent him home after our first visit, had him start paying attention, you know. Actually, he came back two weeks later. This is true story. first thing he said to me was, hey, Doc, I lost 14 pounds. So he had, he was 400 pounds when he came to see me the first time. He'd already lost 14 pounds in two weeks because he was

paying attention mapping out these hamletloves and realized that he was eating fast food. That was his addiction as a way to numb himself from his anxiety. And he realized that he, it wasn't actually rewarding. It was giving him health anxiety because he had, he was, he had a lot of health sequela. Let's just leave it at that. You know, his, his, his weight was affecting his health. So he realized that that was not rewarding. The behavior was not rewarding. And this is where we see really significant results. So we did a study, a randomized controlled trial of our unwinding anxiety app and people with generalized anxiety disorder, right? The Olympians of worrying. Ready for this? We got a 67% reduction in anxiety. And that number needed to treat, we talked

about with medications, 5.2. The number needed to treat in that study was 1.6. Right. So, you know, again, smaller number is better because it's like, you know, more people are going to benefit. So here we're seeing when you target worrying. And so we're bringing with this unwinding anxiety app is really training people to map out these habit loops and start asking this question, what am I getting from this and bring some mindfulness practices in to really dive into their direct experience? And they see worry doesn't get. them anything so they start to become disenchanted. Now I want to give some props because we didn't come up with this stuff. This is straight out of the Buddha's playbook, right? Tons of Soutas that talk

about exploring gratification to its end, right? It wasn't until I explore gratification to its end that knowledge and vision arose, something like that. And the idea there is when you pay attention and you see that worrying isn't getting you anything, you become disenchanted with it. No will power needed. And that disenchantment is critical for behavior change because we're going to keep slipping back into our old habits if our brain says, well, it was rewarding before. We have to really see, is it rewarding now? Boom. When it's not much easier to step out of it. I have my patients who smoke cigarettes pay attention as they smoke. They realize, oh, cigarettes actually tastes like crap. So that's the second step or second gear. Before we go, let me ask you a question

about second year. So part of what I wonder sometimes is at what point to pay attention to the reward because if I'm, you know, overdoing it, I'm preparing and busy and so on, but there's some part of me that's calmed down because I think, okay, I'm better prepared now. There's a reward there. But if I wait a bit and realize all I need is for one more event to come on my screen that I have to prepare for and I realize, you know, it just lasted two minutes, that sense of accomplishment. Then that bigger picture of seeing the lack of real reward is actually very compelling. So at what distance do we check in on reward? Because it becomes clearer, the big picture becomes clear of how it's falling short over time. That's a really good question. So here, I would actually,

I would fall back to the Buddha's playbook again. And so I'm curious, you might have even taught on this. So there's a Suta where the Buddhist talking to his son, Rahula, and his son's asking about unwholesome behaviors. And he says, you know, the Buddhist says, well, if you can notice how unwholesome they are, unhelpful they are before you do them, great. But if you can't do that, don't worry about it.

Pay attention while you do it, right? If you can't do that, no problem. Pay attention afterwards. Because the idea there is you can learn them. matter what. And so I think of this as, you know, most of the time when we're first starting, we notice afterwards, we're like, man, I spent hours worrying about that. If we can drop back into what it felt like to worry and what it was like to worry for hours, if we can draw that experience back into our felt sensation, you know, back into our body, then we can still learn

from it. It's still, it's still ripe for picking, you know, picking some wisdom. Because we can learn, oh, worrying doesn't actually help me. That then helps us say, well, I can look at it afterwards. I can reflect on it afterwards. Now let me pay attention while I'm worrying, right? And then we can pay attention while we're worrying. And then eventually we can get to it before. And we're like, do I really want to worry about this? What did that get me last time? And so we can use recollection from the last time we're worried to help drive wisdom in the present moment so that we're less likely to worry now. Now, I'd be curious what your thoughts are. You know, if you look at the the word sati, you know, that is translated as mindfulness, it really, you know, from what I understand,

I'm not a poly scholar, but what I understand is it really refers to like remembering or to remember. And so if you think of that being applied, well, what does remembering have to do with, well, maybe if we remember what our behavior was like before, it can help us not repeat that behavior, just like the Buddha was talking to his son about, oh, this is unwholesome. In the past, it was unwholesome. It didn't help. Oh, then we become disenchanted. We're less likely to repeat it by recalling that in the present moment. Now, that might be too liberal of an interpretation, but it seems to be very pragmatic in my book. It actually doesn't seem too liberal. It seems really accurate. And the only thing I'd add is that remembering is a strength that we cultivate, that we're

remembering to remember. And it's easier, the further away we are from a situation, the easier it is to ask, you know, what did I get from this and actually pay attention? Because what we're talking about when we're actually caught in it, when we're really caught in the behaviors, is a kind of limbic hijack where we don't have much access to our prefrontal cortex, which means even curiosity's dimmer. You know, even the capacity for any contact with the body is dimmer. And so what I would say in terms of training ourselves to remember is that to be patient because it'll, the skill and strength of that inquiry will get stronger over time and it's fine for it to be patient. after the fact. It's fine to be whenever we have enough capacity for presence that we can actually

examine. And it's important in that examining, the more we can feel the felt sense in the body, the more compelling it'll be as a teacher for the next time. And it's very hard to contact the felt sense when we're caught in this spiraling of worry behavior. I just want to second that. That is so resonates so much with my with my experience and what we've seen in our in our research i think of it this way because often you know we so in the west in particular we so preference our thinking brain that if you look at the neuroscience and and surely you said it so beautifully the feeling body is so much stronger than the thinking brain right because that feeling is what drives behavior. That feeling is what drives disenchantment. If we could think our way out of, you know,

out of bad habits, boy, my clinic would be so much easier. You know, I just tell my patients to stop smoking, stop overeating, stop worrying, and then they'd stop. You know, they'd flip that, that proverbial switch. It's really about feeling into our direct experience. So I love how you describe that. Yeah, which is why hand in hand with any training of observing the habit loops and asking that question is training on how to move from thoughts into the body. Because for myself, the only real freedom where, you know, I had a new learning and was able to inhabit a larger space of awareness was through being able to directly contact the sensations in my body. And we do get cut off when we're caught in those behaviors. I mean, that's just part of the deal. Yeah, yeah, for sure.

Friends, thank you so much for joining us for Part 1 of Unwinding Anxiety. We look forward to continuing this in part 2 and really deepening our exploration of how we can break cycles of worrying and inhabit a much more open and curious and kind presence. So I hope you'll be with us next week. Thank you.