Ten Percent Happier with Dan Harris - 258: Why Your Bad Habits (and Addictions) May Be Getting Worse - and How Mindfulness Can Help | Dr. Jud Brewer

Episode Date: June 22, 2020

Do you find yourself overeating during this stressful time? Maybe drinking or smoking more than you would like? What about shopping or gambling? And how's your relationship to your phone these days? Our guest this episode, Dr. Judson Brewer, is an addiction psychiatrist - with a special interest in how mindfulness can help. He says we all sit somewhere on the spectrum of addiction. And when you add stress into the system- in this time of pandemic, recession and racial strife- many of us move the wrong way along the spectrum, toward hardcore addiction. And of course, for people who already have full blown addictions, the current conditions can be an utter disaster. But again, Jud has good news. He's used mindfulness and meditation to treat people with addictions to cigarettes, food, and opioids. He is the Director of Research and Innovation at the Mindfulness Center at the School of Medicine at Brown University. He has written a book, called The Craving Mind, and founded three apps to help people with eating, smoking cessation, and anxiety. Before we dive in, I want to mention that we recorded this episode a few weeks ago - right before the recent protests. As you will hear, though, this conversation is still fully relevant. With that said, here we go with Jud Brewer. Where to find Jud Brewer online: Website: https://drjud.com/ Twitter: https://twitter.com/judbrewer Facebook: https://www.facebook.com/judson.brewer.9 YouTube: https://www.youtube.com/channel/UCi6bQu-Df7Wh2x3gFT5a8aw Other Resources Mentioned: Borkovec's model of GAD - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3073849/#:~:text=Borkovec's%20model%20of%20GAD%20 Mindfulness-Based Relapse Prevention for Addictive Behaviors: A Clinician's Guide - https://www.amazon.com/Mindfulness-Based-Relapse-Prevention-Addictive-Behaviors/dp/1606239872 New Research Shows Results for Smartphone Intervention for Obesity - https://osher.ucsf.edu/news/new-research-shows-results-smartphone-intervention-obesity Eat Right Now - https://goeatrightnow.com/ Craving to Quit - https://www.cravingtoquit.com/ Unwinding Anxiety - https://www.unwindinganxiety.com/ Additional Resources: Ten Percent Happier Live: https://tenpercent.com/live Coronavirus Sanity Guide: https://www.tenpercent.com/coronavirussanityguide Free App access for Frontline Workers: https://tenpercent.com/care Full Shownotes: https://www.tenpercent.com/podcast-episode/jud-brewer-258 See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Before we jump into today's show, many of us want to live healthier lives, but keep bumping our heads up against the same obstacles over and over again. But what if there was a different way to relate to this gap between what you want to do and what you actually do? What if you could find intrinsic motivation for habit change that will make you happier instead of sending you into a shame spiral? Learn how to form healthy habits without kicking your own ass unnecessarily by taking our healthy habits course over on the 10% happier app. It's taught by the Stanford psychologist Kelly McGonical and the Great Meditation Teacher Alexis

Santos to access the course. Just download the 10% happier app wherever you get your apps or by visiting 10% calm. All one word spelled out. Okay on with the show. to Baby, this is Kiki Palmer on Amazon Music or wherever you get your podcasts. From ABC, this is the 10% Happier Podcast. I'm Dan Harris. Do you find yourself overeating at all during this stressful time, maybe drinking or smoking more than you would like? What about shopping, gambling, and how's your relationship to your phone? I find myself checking compulsively. Our guest this week, Dr. Judson Brewer,

is an addiction psychiatrist with a special interest in how mindfulness can help. He says, we all sit somewhere on the spectrum of addiction. And when you add stress into the system in this time of pandemic recession and racial strife, many of us move the wrong way along the spectrum toward hardcore addiction. And of course, for people who already have full-blown addictions, the current conditions can be an utter disaster. But again, Judd has good news here. He has used mindfulness and meditation to treat people with addictions, to cigarettes, food, opioids, and more. He's the director of research and innovation at the mindfulness center at the School of Medicine at Brown University. He's written a book called The Craving Mind and Founded

Three Apps to Help People with Eating, Smoking Sessation, and Anxiety. Before we dive in, I do want to mention that we recorded this episode a few weeks ago right before the recent protests, but as you will hear, this conversation is still fully relevant. So, here we go with Jud Brewer. Nice to see you. Thanks for doing this. My pleasure. So, I'd like to start just to get a sense of your philosophy as it pertains to addiction.

I have this memory of when you were writing your book, The Craving Mind. You briefly played with the title, we're all addicted. And so I'd like to get you to, because I really like that title, and I thought it says something profound about human nature. So can you just talk about what you meant by that? Yeah, I've forgotten about that. Thank you for reminding me. It's really based on what I've been learning more and more, both from my own personal perspective,

what I've been learning in my psychiatric training as well as working with my patients and also even the science, the research that I've been doing, which is the dediction seems to be at the far end of the spectrum of habit formation. You know, there's this survival mechanism that helps a set of habits that help us not have to remember everything from learning how to walk to talk to make our food, you know, that stuff. So that's actually really helpful, yet on that, if you take that to an extreme, you know, my favorite definition of addiction is continued use despite adverse consequences.

And so continued use could be a habit and helpful adverse consequences. Well, that, you know, that says where it's slipped into the addiction realm. So I think that title comes from this piece where our brains are really set up in this way and everybody shares this. Right. So it's interesting. I'm thinking about like framing this episode for people. I think most of us, I may be wrong about this people. I think most of us, maybe wrong about this, but I think most of us don't think of ourselves as addicts,

per se, although there are many walking around and I've had periods of addiction and many people in my family suffer and so there are tens of millions of addicts. And, but there are probably more people who don't consider themselves to be addicted. But what you're saying is actually, you need to think about addiction on a spectrum.

Yes, yes, it really is a spectrum. So what given the foregoing, what kind of impact do you think the exogenous stress of this pandemic is putting on all of us, no matter where we stand on this spectrum? Yeah, well, the number, I think it's the number one, if not the top, one of the top three predictors of relapse is stress. And I would include in that anxiety. And I certainly see this clinically, you know, my patients are most likely to relapse when they've had a major stressor. They've lost a job or they've gone through a relationship breakup or even had a fight with a partner. I had a patient like that recently who relapsed after doing really, really well. So if you think of it as, you know, on a population level, we all probably

have a certain amount of anxiety. And once you go over some threshold, that anxiety can lead to somebody using a substance or relapsing or starting to learn to drink more when they hadn't been drinking that much before. So there's this buffer. And that buffer has actually been diminished because I think the societal level of anxiety has increased. It's like that tide has risen. So it takes less of a wave to go over the whatever it is, the wall that protects the town from the flood.

Right. So if stress is the number one predictor of either relapse or, as you just indicated, the sort of formation of a new bad habit or a new addiction, we've just added a massive universal stressor, and therefore we're gonna see people at every point in the spectrum moving toward the more extreme end of the spectrum. Yes, yes, whether it's people who've been suffering with addictions, their addictions getting worse, or people who haven't suffered with addictions, starting to form habits or addictions, everything from things that seemingly

are benign, like you've probably heard of the quarantine 15, you know, when people gain weight because they're stress-eating, to people not even knowing that they're, you know, they look back two weeks later and they've been drinking several drinks every day, you know, and hadn't done that before. But it's just their new habit, you know, because they don't know how else to deal with the stress. This seems like it could have. And we even started talking about people who went into this pandemic with profound active addictions. But just for those who were in the middle or the far end of this spectrum are away from addiction as we most often think of it, this seems like a profound issue that is not being talked about enough perhaps, the mental health impact. I mean, there are many mental health impacts of this

pandemic, but the fact that we're going to see people having even more complex relationships to food, drinking more, smoking more, gambling more online, being addicted to video games or TV, sorry, my employer, ABC News and Disney, I love TV, it's good for you. But you don't have what I'm saying. This seems like a big, big deal. Yeah, it is. And I think there are a number of things that play in here. One is, it's hard to think of ourselves

as developing problems so there can be denial. Another, there are so many things that play in here. But some of these other aspects include where it's just, you know, we can't imagine that we would suddenly start, you know, having something where we'd never had that before. And let me articulate that a little better. I'm thinking of one of my patients who works at his family's liquor store in in Rhode Island and he said that liquor stores are considered an essential business. So they stay open.

And his family's business has never been busier. He is working has been working his tail off because so many people are coming in as a way to to work with this. And I think a piece here is, we hear about the physical elements so much. And there's a lot of uncertainty around the physical elements. We're learning more, but we still don't know a whole lot. We're getting a better sense for it. So that's something where people say,

give me something that I can work with. Give me something that's reassuring. And they learn a little bit about a new symptom cluster or this or that that gives comfort. But with the mental health aspect, as you're talking about, nobody's talking about this and I think some of this is nobody knows what to do. I'm a psychiatrist, I prescribe medications. The gold standard treatment for anxiety is not particularly great. There's this number, it's called a number needed to treat where antidepressants are the

gold standard for anxiety. You have to treat just over five people for one person to benefit from that. If you're playing the mental health lottery, that's not, you know, that's not great odds. So I don't know if people just don't want to talk about it because they don't know what to talk about besides saying, yeah, this is really going to suck. What are you hearing from your patients? They're all saying that they're struggling. I shouldn't say all of them.

I would say 80% of them are saying that they're struggling more than they have previously. There's a subset of them and ironically, maybe not ironically. I'm thinking of a couple of them that have actually fared pretty well almost to the point where they're feeling guilty that they're doing so well, but they've actually incorporated some really solid mindfulness practices, kind of pre-pandemic BC before coronavirus. And it's like this litmus test for their practice and it's really showing them how resilient they can be. So I think it really depends on the individual

and what, you know, what resilience factors they've developed. Would you say that having a robust mindfulness practice is what separates those of your patients who are doing well from those who are not? In a nutshell, yes, I'm not sure if there's anything else that separates them because a lot of them have actually struggled with drinking more or struggling more with their anxiety and the ones that have been resilient to it have been, yeah, they've been practicing mindfulness. So I would say that's probably the big differentiator. And in your patient group, as I understand it, you treat a lot of people with anxiety and

addiction, both to opioids, alcohol and smoking. So was that, was that an accurate description of your patient pool? I see patients with all sorts of addictions. So I have a buprenorphine clinic. So I treat a lot of folks with opioid use disorder, treat folks with stimulant use disorder. So I treat a whole range. I would say almost 99% if not all of them have comorbid anxiety, but yeah, that if that is a better sense. I could only imagine for those of your patients who are not doing well, which I would imagine is the majority now, and not because of your treatment, because of the current situation, you're the amazing doctor, that was not what I meant. But for those for those who were not doing well in this situation because they went in with real issues they were contending with and are now living through what we're all living through. The pain must be

intense. Yeah, I think the psychological pain is really intense and a lot of them are dealing with the same issues that everybody else is dealing with. You know, they've got kids that are trying to do school work from home while they're trying to hold down their jobs. So, you know, some of my patients have been laid off. Some of them are really struggling with just being able to time manage where they're trying

to hold down a job. And, you know, I've got one patient who's got three kids who are all trying to do school work at home while this patient's trying to work. It's really challenging. And then that increases her anxiety, which then just sets things off. What do you advise people in these situations?

They're dealing with the things that all of us are dealing with, maybe the loss of a job or having a job and then having a bunch of children or having a job and having no children, so having no stress in either of those areas, but worrying about the overall being locked down and lonely or whatever it is, and then on top of all of that, an addiction. Yeah, so I don't have a blanket prescription for them. I, you know, I approached them each individually based on, you know, what they're struggling with.

But here, I look to see where their strengths are and what they've been able to rely on. Often, I would say for the vast majority of them, we've had conversations around mindfulness, if not have had them start mindfulness practices themselves. And so here I have them, I ask them, well, what's been helpful for you in terms of a mindfulness practice, even if it's just a short breath awareness exercise or just bringing your awareness into your feet. I think of our feet as an anxiety free zone. And so that's a great place to anchor our awareness, especially in times of a pandemic when it tends

to affect a respiratory system. And so, you know, the breathing might not be that calm inducing. So simple practices, I think, are really helpful. Our research shows this. And I think my patients can really access these more than, you know, go and sit for 45 minutes or something like that where that's just not, you know, they can't do that with three kids and a job and, you know, espouse and all this. So, you know, simple breathing practices. I mean, some of the ones that you describe, just very, very simple breath awareness practices, very, very simple, you know, feel your feet or they warm or they cold, is that one warmer than the other, ways to just bring in some curious awareness to anchoring parts of our body that don't tend to be associated with anxiety. That's a really good place to start.

And then when somebody can kind of anchor their awareness in the present moment, calm their physiology, that's a time to help them kind of get to know their mind a little bit more because everybody wants to know that their mind works. You know, even if it's not like teaching them something, you know, with the word mindfulness in it, simply helping them map out habit loops around anxiety is really helpful for a lot of them.

It kind of illuminates this black box of their mind that was yanking them around. I think you've used that term before, you know, our mind yanks us around. And it helps us kind of turn that light on so that we can see how we're actually yanking ourselves around and we can stop doing it. I want to talk more about how meditation helps, but let me just add, I suspect that another thing that helps your patients and could help other people struggling in this way is simply about how meditation helps. But let me just add, I suspect that another thing that helps your patients and could help other people

struggling in this way is simply to have somebody really smart to talk to about it, to have a good therapist. Absolutely. Yes, I'm biased on it. There are many things. But yes, having somebody that can even just give some basic answers and help reassure people that they're not alone.

For a couple of weeks at the beginning of the pandemic, I was just holding open office hours online for anybody that wanted to join. Just so I could answer basic questions as a psychiatrist because that wasn't something that people had access to, you know, and, uh, and whatnot. And so I think having access to somebody that can answer some questions is, is really reassuring in itself. Do you think I mean, I'm just thinking about the people listening to this, given the nature of our healthcare system and given the magnitude of the addiction issues in this country, which I suspect will only get worse now, sadly. Are there enough

therapists out there to treat people? Well, I haven't done the research to know how many therapists there are based on how many people need treatments, but what I do know is access to mental healthcare has been woefully lacking even BC, you know, before coronavirus. So I think it's safe to say that there probably aren't enough out there to help everybody. I think one thing that's helping is the kind of we've been all been pushed into telemedicine. I see all of my patients now virtually. And I think that increases the accessibility for folks that haven't previously been near, you know, healthcare facilities where they might be geographically remote or just not have transportation or things like that. So hopefully that's going to actually increase access for people, you know, who are underserved in general. But I would say in

general, we do not have enough mental health treatment specialists out there, especially with the coming wave. I don't want to freak people out more, but it's real. I think we're only going to see more mental health issues come from this as we go. So we know from the treatment of addictions that being in a group and working these things through like AA can be really healing. But we're now under these social distancing orders, many of us. And for some people of addictions, either they can't see the people with whom they're sort of co-healing in AA, or they're just totally isolated. So what can people do and how dangerous is that dynamic?

Yeah. So you're touching on something really important, which is support and connection is really healing, really rewarding, right? It feels good to be supported. It feels good to be connected with others that we really feel can relate to us. So I've seen with a number of my patients where their life has been upended where they can't go to their AA or 12-step meetings. They go daily or sometimes multiple times a day.

What they found is that they're moving online. So a lot of these groups are forming Zoom meetings or some other type of web-based platform where they can connect, they can see each other, they can support each other that way. I think there's, there's nothing like being in the same room as somebody, but the next best thing is being able to see each other, hear each other, and support each other that way. So fortunately, technology is helped here, where even more people can access these web-based platforms because you don't have to be in a certain geographic area to be able to attend a meeting.

So that's what I'm seeing primarily is people using this as a measure. I haven't heard anybody say, they like it better or more, but I have heard them say, you know, this is part of the new normal right now and it's better than not having it. The other thing I've seen, and I think people should do this that they're, you know, really think about this carefully to make sure it's safe. They'll also, they'll meet in smaller meetings. So in Rhode Island,

for example, some of my patients are meeting in groups of four to five as compared to larger AA groups at individuals' homes where they can kind of screen and make sure the circles are small and taking the proper social distancing precautions as they do that. So, for example, with people with social anxiety, where they, their door is one of the biggest barriers as in walking out the door is really

challenging for them. This is where a phone call or a screen-based intervention can help reduce that barrier to entry. So here they might feel more emboldened. Okay, I can do a phone call. I can do a video chat with somebody where, you know, before the only option was walking out the door, going on public transportation or getting in a car and going to a therapist's office. So hopefully this can help folks in that respect. The other thing I would say is I'm seeing that people are really starting to see finally

that how stigmatized mental health is. And everybody can relate to anxiety right now. I don't know anybody that said, man, I'm so much more chill. So here, I hope that people can empathize with folks who've really struggled with anxiety and other mental health issues, much more because they're actually feeling it themselves. So my hope is that this will help at a population level where everybody can start to relate to the folks who've really struggled with this and have felt, oh, nobody can understand where I'm coming from. Well, I think many, many more people, if not everybody, can understand this more now. What do you think of sort of technological solutions like talk space

and other companies that allow you to connect to a therapist online, sometimes via text? Yeah, we've even played with this ourselves, but I think the tech, so I'm not gonna speak to the technology piece because that's, I'm not an expert there, but just giving people access. You know, there are many ways to do that and there are many, so more probably better than others.

But I think the ability now to connect with a therapist is tremendously helpful. I was surprised by how much I actually like telemedicine and virtual medicine, you know, I've only ever seen patients in person and then I'm now half to see patients through telemedicine and even through phone. I haven't done much text-based treatment, but that's, you can connect with people really well. You don't get all the cues through seeing somebody, but I think it's certainly better than nothing.

And especially as more and more people become comfortable with texting, sometimes they're more comfortable texting somebody than actually talking to them. You know, here again, it goes to, you know, where are they comfortable? Where are their strong suits? So I know, you know, I actually learned from you all with the 10% happier app. I think you were probably some of the first, if not the first, to actually be doing text-based, what would you call it, coaching through, for meditation, is that fair to say? Yeah. And that type of thing, you know, so that's text-based coaching for meditation, but I think the same

thing applies to treatments. You've probably found that really effective. I was really impressed with what you all are doing, and I've heard nothing but great things from people who have used it. So I would imagine that that could actually apply to getting a hold of a therapist or working with a therapist, especially compared to not having that. And absolutely, I think it's going to be much better than not having anything. And probably people are finding that it is better than they imagined when they're forced to use it. As you are. So let's go back to meditation because I think this is worth a lot of discussion here. How is it that meditation can help with addiction? From a basic perspective, I think meditation really helps people understand how their minds work.

I mentioned that earlier, I have to say one thing I didn't learn in medical school, one thing I didn't learn in residency. One thing I didn't even learn from my colleagues was that anxiety can actually be set up as a habit. I think you and I have talked about this a little bit before. But this idea that anxiety can be perpetuated as a habit was a black box for me until I was illuminated toward that and seeing how that worked, just understanding the mind and that respect was really helpful for helping me, helping my patients.

Well, wait, wait, wait, so stop me to stop you for a second. I apologize. I hate interrupting people, but anxiety as a habit, that's, people are going to want to know what you mean by that. So can you just, since you brought it up, let's unpack that. Sure. Happy to. So to form a habit, you need three core elements, a trigger, a behavior, and a reward. And so I, a simple way to think of this is, this is what helps us survive.

You know, you see food, you eat the food, and then your stomach sends this dopamine signal into your brain that tells you to remember what you ate and where you found it. Same is true for avoiding danger. See the saber-2 tiger run away. That's the behavior and then survival is the reward. So in the same way, a negative emotion, such as fear or anxiety, can trigger a mental behavior. So these physical behaviors like eating or running away are survival

mechanisms. Our brain uses the same mechanism, but it kind of turns it internal. So we worry as a mental behavior, which I hadn't really thought about as a behavior until I learned this. There's a guy, a BorkiVec who'd studied this back in the 80s and his literature had been kind of buried. I've never really learned much about it. So that mental behavior of worry makes us feel like we're in control or distracts us from that negative feeling, emotion, such as anxiety or fear, okay?

So in that sense, worry can be perpetuated in the same way that smoking a cigarette can. Does that make sense? Yeah, so let me see if I can restate it. Yeah. Q routine reward. So the Q might be, I see something on the news about the pandemic. The routine is start planning for how I'm going to get through this with six pack abs and my side hustle becoming a venture backed business. And reward is that anxiety loop of planning,

planning, planning, planning gives me a feeling of, I got this, I'm in control. Yeah. Yeah, and you can see the fallacy in that because worrying doesn't actually help us think our plan. And it's tremendously taxing energetically. Maybe it helps us sweat off some extra pounds, but that's not the way I'd recommend losing weights. Okay, so what does that have to do with meditation?

Understanding the mechanism of how this works, then we can look to see what is a targeted solution. And meditation is the only targeted, I shouldn't say only, one of the only targeted solutions that I know of that actually gets right at that core mechanism. So I think of meditation as this small circle inside a larger circle of mindfulness. So meditation can train us to be mindful, but meditation isn't the only way that we learn to be mindful, right? We can be mindful when we're eating Oreo cookies, for example. I'm getting triggered. Right, and we can notice. So let's use Oreo

cookies as an example. So one could meditate, so let's say you have an urge to eat Oreos, a hypothetically speaking, you could sit down and meditate and watch that urge come up, you could notice it as sensations, you could notice it as thoughts, and you can watch them go by, right? And so you learn, oh, this urge to eat Oreos is just a thought, it's combined with emotions and physical sensations it comes and goes, oh, I don't have to act on this every time I have an urge to eat an Oreo, right? So there's a place where meditation can actually help us

see the habit loop for what it is. So the trigger may be a stress, the behavior is that urge to eat Oreos and that urge to eat Oreos then leads us to eat Oreos and then we get that brief relief for the distraction or the dopamine hit from the sugar or whatever. So we can meditate on that and we can map out the loop through meditation. We can also be with those urges as they come and go and watch them, you know, watch them fade away. We've done clinical studies with smoking where formal meditation practice is correlated with the likelihood

that somebody's going to quit. We've done studies with eating, etc. So that's meditation. Even within that larger circle, we can even bring that meditation into a mindful moment, right? So if you have an urge to eat Oreos, in that moment, you can actually pay attention as you eat that Oreo. And notice, oh, what's this taste like?

What's this feel like? And what's the result of this? So how rewarding is eating this Oreo or as you've described to me previously, a sleeve of Oreos, right? That was just hypothetical, right? That doesn't actually happen in reality. I was asking you for a friend. Yeah, for a friend.

Okay, so to help your friend out, you could tell your friend, hey, pay attention as you eat that sleeve of Oreo, what's the result? You know, do you wake up in the middle of the night and with your stomach so sick that you actually throw up? You know, I'm just saying hypothetically speaking. So, that may or may not have happened to be well. So here we can bring awareness in and just track up that process even the moment where we see, oh, when I eat a bunch of Oreos, this is the result and we see that it's not that rewarding.

We've actually built what we call a craving tool right into our Eat Right Now app and we can study how that reward value changes and we can geek out on this if you want, but there's this whole mathematical model developed in the 70s where you can actually model out how rewarding a behavior is. And that drops close to zero after somebody just bringing awareness as they do this mindful eating exercise 10 to 12 times. So it doesn't even take a lot of practice for somebody to do this. So that hopefully that gives you a sense for how meditation can actually work with this. When we see how these habits are formed, we can specifically see how mindfulness jumps in there and targets those mechanisms, both through formal mindfulness practice, through meditation,

and also through informal mindfulness practice. So, in that moment, paying attention. Okay, so there's a bunch of things to say just to build on that and then I'll build to a question. First, you mentioned one of your apps, which is called Eat Right Now, which is an app designed to help people who are struggling with their eating. You also have an app for people struggling with smoking cessation called Craving to Quit. And you have an app for people with anxiety disorders, which is called... Unwinding Anxiety. Unwinding Anxiety. So just want to get that out there. quit. And you have an app for people with anxiety disorders, which is called unwinding anxiety.

Unwinding anxiety. So just want to get that out there. I will have said that I hope in the introduction, but it's worth just doubling down on that for folks looking for extra help. And I recommend all three of those unreservedly. So just to walk through this cycle again, it is, you know, we may be sitting there watching TV, anxiety hits, and we get this urge to, by TV, I'm saying we're watching the news or, or I don't know, we're surfing the web and we're, somebody we're reading tweets that are upsetting us for some reason, and the desire to eat a sleeve of Oreos or to chug a brew can arise. And you can use that as an in the moment meditation

to stop and just examine, what does this urge feel like in my body right now? What does it feel like? Let's just stop and look at it. It's my chest buzzing. It's this kind of desire to get out of my seat. Under that is a lot of fear or anxiety or anger. And you can just be with it, avoiding our habitual reactions to strong emotions, either fight it or feed it or deny it.

And in that moment of turning it into a meditation, you can see that the urge will arise and pass away on its own. And so that is one way to, that is the way you teach your patients, or one of the ways you teach your patients to deal with anxiety. Have I articulated that correctly? Yeah, beautifully, beautifully.

And it's not just anxiety, it's for an urge to smoke, it's for an urge to eat the audio, all of it. That's the beauty of mindfulness. It can help us with any habit that's formed in any urge to make something unpleasant go away, like a craving or anxiety. So you talked about informal meditation. What I just described was an informal free range in the moment meditation, something happens, and instead of just acting on the urge, blindly, you turn it into a meditation. I'm of the view, but I wonder whether

you agree here that having a formal, a consistent formal, daily-ish formal meditation practice can up the odds that you will be able to muster the mindfulness in the moments when you most need it. Do you support that view? A nice alliteration. Yes, and I would say these compliment each other. So if you think we were talking about the anxiety tied, right, is when it's low, you need a big swell for it to go over the seawall and hit the town. Our collective anxiety has risen the tide. The polar ice caps of calm have melted. That level has gone up. What formal meditation

can help us do is keep those levels low. It's like that pump that keeps the analogy is dying here. Basically, it helps that sea level drop a bit so that we're less likely, it takes a bigger, something bigger to drive that wave over the wall. So that's where the formal meditation practice can be helpful. And then the informal practices,

as that wave is starting to come up and go up, can it help us write in that moment? So I think the two complement each other really well. And our research suggests that both are helpful. You took me exactly where I wanted to go, which is, I want to hear more about the research because I suspect there may be skeptics listening either they've struggled with addiction personally or they know somebody who's struggled with addiction, you can see how ugly it is and how hard it is. How can this sitting watching your breath thing actually help?

Yeah, it's a great question. I did my first research study on this in the mid 2000s where we were looking, I wanted to know if this stuff could actually help with hardcore addictions. And I did my first study when I was a resident physician, you know, I was at Yale and in our substance abuse treatment unit, looked to see if mindfulness training could be as good as gold standard treatment and helping people not relapse. Here I was

working with people with alcohol use disorder and cocaine use disorder, long story short, you know, it was as good as gold standard treatment. And so I looked to see if there was a signal there and there was a signal. Then we started looking to see, okay, what are the active elements? We had studied a modified version of mindfulness-based relapse prevention. It combines mindfulness training with evidence-based relapse prevention developed by Alan Marlat. We stripped out the relapse prevention components and just taught people mindfulness. Here we did a study with smoking because smoking is actually the hardest addiction to quit. We can talk about what that is later. It doesn't get memorialized in movies, you know, like leaving Las Vegas isn't about quitting smoking, you know, train spotting isn't

about quitting, weren't struggling with smoking. And in fact, I, unfortunately, I'm seeing smoking glorified more and more in television and movies, which is unfortunate. So I don't know if some regulation changed or whatnot. But I'm sure that doesn't help. You know, the Marbor Man help glorify it. You know, whether it's people smoking on, you know, the Mar-Brow man helped glorify it, you know, whether it's people smoking on, you know, homeland or other types of television shows, you know, it glorifies it. But anyway, so with, you know, we studied smoking cessation and found that we could get five times a quit rates of gold standard treatment. And with those studies, we could actually look mechanistically

to see the mindfulness was decoupling that urge to smoke with the action of smoking. We then looked to see how we could broaden this to look at other behaviors. You know, we talked about addiction being on a spectrum. You don't have to smoke to survive, but you do have to eat. And so, could mindfulness help people with overeating or stress eating? You know, we did a study with the right now app where we got a 40% reduction in craving-related eating. That was a study led by Ashley Mason at UCSF. And more recently, we just finished two studies with the unwinding anxiety app where we found a 57% reduction in clinically validated anxiety scores in anxious physicians. And then another, we got a 63% reduction in anxiety and people that generally is anxiety

disorder. So looking across the spectrum, that continuum of continued use despite adverse consequences, whether it's smoking or eating or even that mental behavior. Mindfulness seems to be able to help people notice these habit loops and then be able to write out those urges to act. More 10% happier after this. Celebrity feuds are high stakes. You never know if you're just going to end up on Page Six or Du Moir or in court. I'm Matt Bellesai.

And I'm Sydney Battle, and we're the host of Wonder E's new podcast, Dis and Tell, where each episode we unpack a different iconic celebrity feud from the build up, why it happened, and the repercussions. What does our obsession with these feuds say about us? The first season is packed with some pretty messy pop culture drama, but none is drawn out in personal as Britney and Jamie Lynn Spears. When Britney's fans form the free Britney movement dedicated to fraying her from the infamous conservatorship, Jamie Lynn's lack of public support, it angered some fans, a lot of them. It's a story of two young women who had their choices taken away from them by their controlling

parents, but took their anger out on each other. And it's about a movement to save a superstar, which set its sights upon anyone who failed to fight for Brittany. Follow Dissentel wherever you get your podcasts. You can listen ad-free on Amazon Music or The Wondery app. By the way, listeners, you may notice that there's a slightly different audio quality right now as compared to before. Earlier in this interview, and that's because in the middle of the interview, my computer died. And instead of recording, the power cord would not run all the way into my wife's closet.

So I'm now sitting outside my wife's closet on the floor next to my cat Toby as I ask these questions. So that context provided, let me get to the question. If I'm, you know, finding myself in the midst of this pandemic, drinking more than I want to or having revivified myified my old, you know, college smoking habit or, you know, putting on the COVID-15 or whatever, the move is what, boot up in meditation practice and

then apply it to whenever the urges are arising? I would say yes and I would start that booting up with just a basic mapping of the habit loop. So one could do that mapping, whether they're doing sitting formal, sitting meditation, where they can notice that urge to check their phone, notice what the behavior is,

notice what the result is, or they can even do it in the moments, whether they're reaching for the refrigerator handle or whatnot. And I would say that mapping piece can then help us start to learn to explore what cravings and urges actually feel like. And importantly, as part of the practice,

we can also look to see, what's the result of the behavior? Because our brains don't change behavior based on just, you know, you can't think your way out of a habit, can't think your way out of an addiction. Otherwise, I would just tell my patients, okay, stop smoking, you know, and they'd go home and they'd quit. Wouldn't it be great if it were that easy? So we can't think our way into a, into a better behavior, but we can hack this same learning process in our brain.

So here, it's all based on reward value. So we can help people see how rewarding it is to smoke a cigarette or to have that third drink versus just one drink or to eat six Oreos versus one Oreo. The reward value tangibly changes, and if we pay attention, our bodies will actually tell us, hey, that was enough for that was too much. So if we really focus on the results,

that's what Mindfulness helps us do. See that cause and effect relationship. OI-8, one versus six Oreos. And really notice how different that experience is. That helps that reward value drop. So it opens up the door for that bigger, better offer, right? And the beauty of mindfulness is the mindfulness itself is that bigger, better offer. Okay. Pop quiz hot shot in your own experience. What feels better? Craving or being curious about that craving itself? What feels better a craving or being curious about that craving itself?

Definitely curiosity that just to put some meat on the bone there if I'm sitting watching, you know, end of the day. I'm unwinding. I'm tired. You know, maybe a little restless, but I'm just unwinding. I've had a I've had an innovating day as many of us do these days and I'm watching a little Disney plus at the end of the day, shout out to Disney. And I get the urge to, you know, like a zombie walked in a kitchen and open up a bag of pretzels. What feels better?

Doing that just automatically, or actually having the wherewithal to say, what's going on here? Press pause on the show. What does this feel like to have this urge that popping into the mindful awareness for me in my experience feels better than just doing the thing? Yeah.

And I know you talk about mindfulness as a superpower. There's something that you talk about as being a superpower? I've heard you say the superpower of not being owned by every urge and emotion that flits through your consciousness. Yeah. So I would put curiosity in there as that, as that cape for the superpower. Because the curiosity is what helps us not get owned, right? It's not some magic or some fairy dust or some, you know, magic wave of the one,

Bibi Bibi Boo, and you're not, you know, you're not addicted. It's really about bringing that curiosity in and seeing that it is that bigger, better offer. It feels good to be curious. But I have to say, you know, I've been meditating for a little while and there are times when I still do the thing. You last night I was really tired. I had where I've been working.

It was a Sunday. I had been up to early doing good morning America. It was, um, and, and end of the day. My wife and I had some cookies and I just overdid it. I don't actually, I've gotten much better at not overdoing it. I've got the period where I wasn't eating sugar at all and then I decided to eat some sugar and I've been able to moderate reasonably successfully. But I just, you know, I got it with like a feeding frenzy, began, the waters were chummed

and I just ate a bunch more, not like a ridiculous amount, but more than I wanted to and didn't feel that good about it. So I guess what I'm saying is, it's not, I have not found that meditation or mindfulness is some sort of panacea in the face of all of my urges. Yeah, and if we look at the mechanisms of how it works, that's not how our brains work. You know, our brain, you can't flip your, flip a switch in the brain.

This is all based on our brains trying to survive and learning through that. So here I would say if you think back to what you did, was it just last night? You said? What's it feel like? Can you bring up the feeling of what your stomach felt like or your emotions were after you ate a bunch of cookies? Yeah, it wasn't great. I felt sort of belly distended, self-laceration, heavy in the head.

We're actually kind of like jacked up feeling from all the sugar late in the day. Yeah, so it didn't feel good. So if you just sit with those, what you just described, that that you know, so not a thinking but just really in your embodied experience Does that make you more excited to do that behavior again or less excited? Less Less. Yes, so I I say that but that's kind of like this is what mindfulness is about if I kindly rub it in your face You know you can learn even now from what you did yesterday where you can, you can just reflect back on your behavior. And even in the Bainton Buddhist psychology, you know, the Buddhist, the Buddha apparently was talking to his

son, Rahula, and he said, reflect on your behavior before you do it. If you can't reflect on it before reflect during, if you can't reflect on it during reflect during, if you can't reflect on it during reflect after, because if you reflect on something afterwards, you can learn from it. That's what mindfulness helps us see, is that cause and effect relationship. Oh, I ate a bunch of cookies. Oh, what you just described.

Oh, I've become disenchanted, especially if I can bring that memory forward the next time I've emerged to over-indulge. Right? It's not about force or willpower or grit. It's simply about learning. Oh, that didn't work so well last time. And if you do it again, you can bow to us

and teach her again and say, oh, what can I learn from you as compared to beating yourself up for having done it, right? And you kind of kick in a second habit loop of self-flagulation or self-judgment. I've often described your approach as kind of co-opting the pleasure centers of the brain, even in not feeding the pleasure,

what we think of as feeding the pleasure centers of the brain by snorting about your cocaine or taking a ton of pills or whatever it is, that actually there is this, as you said, BBO, bigger, better offer, that if we're tuned in via mindfulness, we can co-op the pleasure centers and the brain in ways that bring us not through grit to the healthier behaviors. Yeah, grit takes work, you know. Yeah, grit takes work, you know, I get sweaty. But here we can just simply let the process unfold. No effort necessary, just simply a kindness,

awareness and curiosity, right? Oh, what did I do yesterday? Oh, what can I learn from that? But there is some work here because, as I often say in the show, the, and this is something you know, obviously, the one of the original translations of the ancient Indian word of Sati mindfulness, we translated that Sati into mindfulness,

but what are the original meanings of that word is recollection. And so we do have to remember to do this thing, and that is not nothing. Yeah, and so I think, and I'm not a Buddhist scholar, so the Buddhist scholars can throw rotten Buddhist tomatoes at me or whatever, for saying this. But here I would say one way to explore remembering a recollection is, okay Dan,

recall what you did last night, right? And when you recall what you did last night, how much effort does that take? Not much, but it's also remembering to do that sort of making this a practice of, because you, one, I can recall what I did last night as just a cudgel to beat myself with, or I could recall it as a way to say, hey, to really summon the felt sense of awfulness, not again to beat myself up with it, but to help me remember next time I'm tempted to do it, not to do it again. But this is a practice that really needs to be learned. And that is, I think it's better than grit. Obviously, I think it's better than grit,

but it's not no work at all. So let's unpack this a little bit more. You ready? Yes. Okay, so yes, we could try to force ourselves to develop this as a practice, right? And I'm not saying you're saying force it, but I hear what you're saying in terms of it can take effort.

And a lot of teachers talk about it taking effort. So here, I would say, is there another way to explore this? Can we, when I think about my patients who really are ready for change, when they've really struggled with an addiction, it's when they've hit rock bottom. So when they really notice how much they're suffering, they don't have to force themselves to be motivated to seek out change.

They're naturally seeking it out because that suffering motivates them to change. So here I would suggest, and let's explore this. I'm not saying this is, you know, this is it, but what do you think of this? If we can recall, so recollect how, you know, our own suffering from the last time we did a behavior, does that kind of engender a motivation to want to practice more as compared to thinking,

oh, I should practice more, or however else we might think of it? No question, in my experience, no question about it that it creates positive feedback loops in the mind to see over and over again that it feels better to be curious and mindful about what's going on internally, and to see over and over that it leads you to doing the things that feel better for your body. So I wonder if tapping into our own suffering is a way to kind of unleash

is a way to kind of unleash motivational energy that helps us be inspired to practice as compared to feeling like we need to crack the whip and practice. I throw that out as a question that anybody can explore themselves. Yes, no, I actually agree with what you're pointing at here. I just think of my own life and as somebody who's a committed

meditator, probably doing more than most people will do even once they're committed, just because it's a huge part of my life. It's my career now in many ways. And yet I, especially now with a pandemic, I'm checking the phone. My phone addiction is worse than it used to be.

My relationship to food has gotten trickier. My relationship to sort of numbing out probably more than I want to with entertainment, et cetera, et cetera. Various of my bubbling addictions, again, not hardcore addictions, but the sort of run of the mill addictions have been exacerbated and so can we can any of us really get to I know you're I think you're gonna say perfection isn't what's on offer here but when you're dealing with a hard core addiction actually any imperfection is could be a profound relapse. It could be yes and. You know. could be. Yes. And, you know, if we relapse, there we are. Right. And so we can kind of hold on, you know, like, can't relapse, can't relapse, can't relapse. And that actually uses our energy in a way that's using it up as compared to opening to the possibility.

And then remembering, you know, oh, what was it like last time I relapsed and having that open up the energy in a way that is motivating? But I don't know if I'm getting your question or your question. I think so. I think what I'm hearing from you is, what I was going at is,

I think what I'm hearing from you is, we're not gonna be perfect. We're still going to going at is, I think what I'm hearing from you is we're not going to be perfect. We're still going to, at times, eat or drink or smoke or self-medicate more than we want to. And we can use those quote unquote failures as learnings that can superpower our navigation of our own urges going forward. But I then then I started to think, well, for some people with hardcore addictions, any falling off the wagon could actually have much more profound implications than my eating more chocolate chip cookies

last night than I wanted to. It could and it doesn't change the circumstances for them. But I would say for anybody who has profound addiction or a cell phone addiction, I think the more we build up our resilience factors, the less likely we are to relapse whether it's a hardcore addiction or a quote-unquote, not hardcore addiction. So you brought the example of news. Maybe we could explore that as a tangible example that anybody can work with, especially with something like a pandemic where we don't have a lot of information.

I think it's helpful for people to understand that our brains, information is like food for our brains, it helps us survive and it helps us plan for the future. So our minds are naturally going to seek out information. This isn't something that we, you know, we could try to force ourselves not to do it, but I think it's helpful just to acknowledge, oh, I'm looking for information. That's what my brain's doing to try to help me survive. So just letting ourselves, giving ourselves some grace around that.

But then looking at the news cycle, it's fascinating because you know, if you check the news and there's like a big news story, that tells our brain, hey, news is here, go check the news. So we check the news again, no big story, no big story, no big story. And then sometime later in the future, you could be later that day or the next day, whatever, big news hits again. Does that sound familiar? Hint casinos, right? You pull the lever, you pull the lever, and then suddenly hit the jackpot. So I think especially when there's something brand new out there, and there are big stories that are hitting, it's really important for us to see how we're especially vulnerable to becoming more addicted to checking our news feeds.

I'll give you a concrete example. There was a resident physician that I was training back in 2016, and she was just learning mindfulness. I was actually training to work with people of the Dictions. She was starting to learn the practice, and she told me the story about, this was in January of 2016, so right after the 2016 election, she had two young kids and she woke up one evening. Her kids were sitting at the dining room table, eating dinner,

she was standing back from the table, checking her news feed and she woke up to the fact that she was so addicted to checking the news. There's so much uncertainty in January of 2016 that she hadn't realized that she was that disconnected from her family. And so that's suffering where she's like, oh my God, what am I doing? Was like a big wake up call for her where she was saying, oh, this little thing that didn't seem like a big thing had progressed to the point where she was seeing this little thing that didn't seem like a big thing

had progressed to the point where she wasn't, you know, she wasn't having dinner with her kids. And that was a, that really, really helped her learn. Oh, this is what mindfulness does. This is how I can work with it and was able to really unwind that behavior. And I use that as an example because I'm guessing that many, many, many of us are

much more addicted to the news now because our brains say, Hey, this is pandemic thing. This is very, we have a very uncertain future right now. Our brains hate uncertainty. So we can learn to work with something like that. So if we have a quote unquote, more hardcore addiction, just knowing that can help us develop the resilience to work with not only with our news addiction, but some of these other things as well. Do you ever struggle with any of these things? Are you perfect? I struggle with with all these things.

That's why I wrote my book. I realized I had chapters upon chapters of my own experience to write about. And I have to say the poll for the news, I noticed that that is much stronger now than it was BC, you know, before coronavirus. And do you have times when you, you know, go further than you want with either the news or having something to drink or eat or whatever. And do you ever find that applying your own advice is even hard for you? Then the news in particular, I noticed that I am pulled to my news feed more than I've ever been.

And yes, absolutely. I find that there are times where I'm like, what am I doing? The news feeds are set up like slot machines. You scroll, you know. And then there's that little balance. They set them up perfectly to make it see, you know, to pull in all these tricks of the casinos. So yeah, my news feed absolutely has been something that I've noticed that I've over

indulged in. And here, so I tried also take my own advice where it's like, oh, what am I getting from this? Instead of trying to hide it or beat myself up over it, I bringing some kindness and some self-compassion in and say, oh, what can I learn from this? And each time I can remember what it's like to over indulge in the news, where it actually makes me feel kind of restless

and dissatisfied, especially because there's not a whole lot of new news out there right now. That helps me be able to step back. So certainly not perfect, but kind of doing my own training in that respect. Right, and so you may have an occasion where you go too far with the news, but then you learn, you use the negative or the difficult physical and psychological sensations in a way that the next time you have the urge to do the same thing, you bring the last experience to mind

and maybe it goes differently for you. Yeah. The both the last experience and the current experience. It's like, oh, I've been scrolling for five minutes. Okay, and when I can just wake up to that, it's much easier to let go because I can immediately drop into my direct experience and be like, oh, you know, and then I put it away. It doesn't take effort to do that.

When I just drop right into what it feels like right in that moment. Last question for me is when I think about particular hardcore diction but it can really apply to any of the addictions along the spectrum, you know you describe it in a in this kind of mechanistic way and that's my word probably, not yours of, you know, Q routine reward, but I think the assumption that many of us myself included have is that often it's deep psychological stuff that's driving a lot of this, that we, you know,

maybe had abuse in our background or what, you name it, and that that too needs to be tended. Yeah, so I'm a card carrying psychotherapist and I might be about to say something heretical. So card carrying psychotherapist get your rotten tomatoes ready. Here I would say, I love this, there's a quote, and I haven't been able to find who actually said it. It's a tree to be did often, I think, to Lily Tomlin, but I'm not sure that that's accurate. That forgiveness is giving up hope of a better past. Have you heard that one?

No. Forgiveness is giving up hope of a better past. So what I've seen is a lot of my patients really struggle with the why. Why is this happening? Why am I doing this again? And they think if they can go back and figure out what it was in their past, that they'll magically be better or something like that. You know, oh, well, I saw that it was because of this or that. This isn't to

minimize trauma or abuse that people have had, you know, a ton of my patients come in with trauma histories. That's what led them to addictions in the first place. So this isn't to minimize that, but it's to say, okay, so what if you learn what happened in your past, what does that actually help you now? Can we actually focus on what is happening right now? So instead of why is this happening, let's focus on what is happening right now,

because they can do something about what's happening right now. If they're getting caught up in a habit that they've triggered by an emotional memory, okay, well, you can't fix the past. You may be able to give yourself a little bit of grace and forgive yourself for, you know, or forgive, you know, do a little bit of forgiveness around, you know, let's let go of a hope of a better past.

Let's focus on what's happening right now. What's it feel like to get caught up in that urge to do something? What's it feel like to get caught up in worry? What's it feel like to get caught up in self-judgment, blaming yourself maybe for something, for your role and something that happened in the past? That all of that is workable in the moment,

but we can't change the past. So here, we can, you know, I think of it as, let's, it's not about forgetting about the past or, or, you know, minimizing it, but it's about, for, you know, giving up hope of a better past. That's where a lot of folks get stuck. Okay. Can we focus on what's happening right now rather than why has this happened or why is this happening again? That's workable. Is it possible that there are a couple of things that need to happen that we need to, yes, everything that ever happens happens right now? And so all of our past, the issues from our past are manifesting now. And so we need to learn coping mechanisms that we can apply in the moment. And it might

it also be useful to talk through the issues from the past so that we can stop having them kind of rear their heads in unpredictable half. I don't know if I'm going to be able to talk about this correctly, but that sometimes we're reliving just like half of the memory from some traumatic event, but not living it all the way through in a way that would allow us to metabolize and put in context, and that that can really be a big part of talk therapy, that these two tracks could be pursued. Yes, I think they can be complimentary, and so it really depends on how we're doing the psychotherapy. So if it's, you know, if we're being encouraged to talk about our past and then it's just

retraumatizing us, that's obviously not helpful. And I'm not sure any therapist is meaningful, you know, is purposefully doing something like that. But if, you know, I think good therapists are there to help people, you know, if they want to understand what happened in the past, help that not contribute and get laid down as a more of an emotionally charged memory in the present. So memory can reconciledation from a neuroscientific standpoint is where, you know the memories can actually gain emotional charge. We bring up a memory and then there's that emotional element that's with it. And then right now we're like, oh yeah, that was really terrible.

And that piece adds extra emotional charge to it so it can actually make it worse. As that gets reconsolidated, then we bring it up later and it happens over and over and over. So here, I think it really dependent on how we're working with these things. You know, if we're thinking about a story or bringing it up in therapy and talking through it, are we able to kind of bring in an awareness?

So again, mindfulness can be really helpful here so that we can notice these things as thoughts. So we can notice these things as body sensations and notice these things as memories. Oh, here's a memory. I'm safe now, right? Is this trying to tell me I'm not safe? And then I get laid and it gets laid down as, oh, not safe, don't go there. Or if somebody's working with a good therapist, they can help them hold that stuff

in a way that doesn't actually perpetuate it or potentially make it worse. So here I would say, both of these can be, they can be very complimentary. This has been incredibly interesting and really helpful. I mean, you help people for living one-on-one, but now you're helping a lot of people, one-to-many. So I really appreciate it, Judd. Thank you. It's always fun to kick out with

you, Dad. Big thanks to Judd, and if you want to check out his apps, they are called Eat Right Now, Craving to Quit and Unwinding Exity. Also, he has a course on the 10% happier app about mindful eating, so go check that out as well. And before we go, I want to thank everybody who works so hard to produce this show, Samuel Johns, runs Point on the Show. Our sound designers are Matt Boyn and Ania Sheshek of Ultraviolet Audio Maria Wirtel is our production coordinator. We get an enormous amount of guidance oversight and more from our TPH colleagues, Jen Poient, Nate Toby Ben Rubin, and of course, big thanks to our guys from ABC, Ryan Kessler and Josh Kohan. We'll see y'all on Wednesday with another episode. co-hand. We'll see y'all on Wednesday with another episode.

Hey, hey prime members. You can listen to 10% happier early and add free on Amazon Music. Download the Amazon Music app today, or you can listen early and add free with 1-3-plus in Apple podcasts. Before you go, do us a solid and tell us all about yourself by completing a short survey at Wondery.com slash survey.