The One You Feed - Dr. Jud Brewer on Habits to Heal Anxiety

Episode Date: January 12, 2021

Dr. Jud Brewer is a thought leader in the field of habit change and the science of self-mastery. He is the Director of Research and Innovation at the Mindfulness Center and associate professor in psychiatry at the School of Medicine at Brown University. In this episode, Eric and Dr. Jud talk about his book, Unwinding Anxiety: New Science Shows How to Break the Cycles of Worry and Fear to Heal Your Mind and they explore something called the Habit Loop, using it to understand and heal difficult emotions like anxiety.If you’d like to start out this new year restoring some balance and putting some healthy habits in place, or if you’re tired of waiting for the right circumstances to make progress towards your goals, Eric, as a behavior coach, can help you. To book a free, no-pressure 30-minute call with Eric to see if working with him in The One You Feed Personal Transformation Program is right for you, click here.But wait – there’s more! The episode is not quite over!! We continue the conversation and you can access this exclusive content right in your podcast player feed. Head over to our Patreon page and pledge to donate just $10 a month. It’s that simple and we’ll give you good stuff as a thank you!In This Interview, Dr. Jud Brewer and I discuss Habits for Healing Anxiety and…His book, Unwinding Anxiety: New Science Shows How to Break the Cycles of Worry and Fear to Heal Your MindReward-Based LearningTrigger, Behavior, ResultThe Habit LoopAddiction defined as continued use despite adverse consequencesHabits: Set and ForgetHow if we don’t pay attention to how rewarding the habit is right now, we can’t change the behaviorHow to heal anxiety as well as emotional eating using the Habit LoopThe role of curiosity in healing anxietyLearning to be with difficult emotions and learning to allow them to passHow to remember to be mindful throughout the dayDr. Jud Brewer Links:drjud.comInstagramTwitterGreen Chef: The first USDA Certified Organic Meal Kit Company that makes eating well easy and affordable. Go to www.greenchef.com/wolf90 and use code WOLF90 to get $90 off including free shipping.Peloton: Of course the bike is an incredible workout, but did you know that on the Peloton app, you can also take yoga, strength training, stretching classes, and so much more? If you download the Peloton App today through January 30, 2021 you get 2 free months free! Kettle & Fire: Bone Broth and soups carefully crafted by world-class chefs, made with the best whole ingredients and the bones of humanely raised animals delivered right to your door. Go to www.kettleandfire.com/wolf and use promo code WOLF for 20% off.If you enjoyed this conversation with Dr. Jud Brewer on Habits for Healing Anxiety, you might also enjoy these other episodes:Dr. Jud Brewer on Addiction and the Craving Mind (August, 2018)BJ Fogg on Tiny HabitsJames Clear on Compounding Nature of Habits-Part 1James Clear on Compounding Nature of Habits-Part 2See omnystudio.com/listener for privacy information.

When we try to hold on to something and it's inevitably going to go away, that's painful. When we try to resist something and it's inevitable that it's going to come and be here, that's painful. Both of those are optional. Welcome to The One You Feed. Throughout time, great thinkers have recognized the importance of the thoughts we have. Quotes like garbage in, garbage out, or you are what you think ring true. And yet for many of us, our thoughts don't strengthen or empower us. We tend toward negativity, self-pity, jealousy, or fear. We see what we don't have instead of what we do. We think things that hold us back and dampen our spirit. But it's not just about thinking. Our actions matter.

It takes conscious, consistent, and creative effort to make a life worth living. This podcast is about how other people keep themselves moving in the right direction. How they feed their good wolf. I'm Jason Alexander. And I'm Peter Tilden. And together, our mission on the Really No Really podcast is to get the true answers to life's baffling questions like why the bathroom door doesn't go all the way to the floor, what's in the museum of failure, and does your dog truly love you? We have the answer. Go to reallyknowreally.com and register to win $500, a guest spot on our podcast, or a limited edition signed Jason bobblehead.

The Really Know Really podcast. Follow us on the iHeartRadio app, Apple podcasts, or wherever you get your podcasts. Thanks for joining us. Our guest on this episode is Dr. Jud Brewer, a thought leader in the field of habit change and the science of self-mastery. Jud is the Director of Research and Innovation at the Mindfulness Center and Associate Professor in Behavioral and Social Sciences and Psychiatry at the Schools of Public Health and Medicine at Brown University. His newest book is Unwinding Anxiety, New Science Shows How to Break the Cycles of Worry and Fear to Heal Your Mind. Hello, Dr. Judd. Welcome back. Thanks for having me. It's a pleasure to have you on. We're going to be discussing anxiety, bad habits, habit loops in general. But before we start, let's start like we always do

with a parable. There's a grandfather who's talking with his granddaughter and he says, in life, there are two wolves inside of us that are always at battle. One is a good wolf, which represents things like kindness and bravery and love. And the other is a bad wolf, which represents things like greed and hatred and fear. And the granddaughter stops and she thinks about it for a second and she looks up at her grandfather and she says, well, grandfather, which one wins? And the grandfather says, the one you feed. So I'd like to start off by asking you what that parable means to you in your life and in the work that you do. Well, I think it means a lot. So in my life, I can relate to that personally, you that I do that I'm literally feeding both mentally or

physically, they get reinforced. And how that relates to my work is just about everything because that's how habits are formed. Habits are driven not based on the behavior themselves, the behaviors themselves, but they're actually driven based on how rewarding they are. And you can think of that reward piece being us feeding them, literally. You know, everything from intellectual curiosity being, you know, feeding knowledge, and you can think of food as literally feeding, you know, feeding sustenance. And in that sense, virtually everything we do, I can't think of many exceptions, is really fed this way. So that's what it means to me. And the mechanism that you're talking about really is a very old evolutionary-wise

mechanism called reward-based learning. Yes. It's actually evolutionarily conserved all the way back to the simplest of nervous systems. So the C-slug, which is the simplest known nervous system, it's got 20,000 neurons. We have a few more than that. Some of us. As humans, we learn most behaviors basically in the same way as sea slugs. So some people might think, what? Sea slugs? But in fact, they can teach us something about what we do and we can look at our own experience to see how true it is for us. So basically, think of our ancient ancestors

on the savanna or in the woods foraging, hunting and gathering, if they happened upon a food source, their brain needed to learn to remember where that was. So you can think of just three key elements. One is a trigger. Second is the behavior. And the third is the result or the reward. So imagine foraging, and then you come across a food source like, oh, here's some edible mushrooms. So there's the trigger. You see the mushrooms. The behavior would be that you eat the mushrooms and then the reward from a neuroscientific standpoint is your stomach sends this dopamine signal to your brain that says, remember what

you ate and where you found it. So it's actually there to help us learn to remember things. Oh, here's food. We also learn to avoid danger in very much the same way. You come across the wild animal that's going to chase you down. You run away. There's the behavior. And then the reward is you don't get eaten.

Right. So this is often referred to as the habit loop. So let's take that basic idea and apply it to a bad habit. So walk us through a habit loop of a bad habit. You could do a hundred of them, but yeah, good. Let's pick smoking or eating. Well, let's use eating because I think, you know, smoking is pretty straightforward. You know, you're stressed out, you smoke a cigarette and then, you know, you, you feel a little bit of, of relief. And so you keep that going. In that case, the trigger is I'm stressed out. Yes.

The routine or the habit is I smoke, and the reward is I feel a little bit of relief. Yeah. But if you apply this to eating, for example, we can think of smoking as some behavior that we've learned that we don't need to do to survive. But eating gets trickier because we could be driven by physiologic hunger. In scientific terms, we talk about homeostatic hunger because we need to get back to homeostasis when we're hungry. But we could also think about this in terms of hedonic hunger, which is just a fancy term

for emotional eating. So let's talk about hedonic hunger. Eating in the absence of hunger is driven by boredom, by stress, by loneliness, you know, by a bunch of things. And so you can think of whatever that emotional state is as a trigger. Let's say, you know, these are negative emotional states, but there can also be positive ones. We want to celebrate some great thing that happened. And then the behavior is we go get ice cream, go get cake, eat some

chocolate, whatever our favorite food is, our celebratory food, or we eat our comfort food, if it's to help us not feel as bad as we're feeling. And then the result is, you know, if we're celebrating, we feel great. If it's that we're trying to distract ourselves or feel better from the boredom, from the sadness, loneliness, whatever, that helps us distract ourselves a little bit or feel a little bit better. I had a patient who used to binge eat, and she would describe it as numbing herself out from negative emotions. She would binge to the point where she would just numb out. Does that make sense? would binge to the point where she would just numb out. Does that make sense?

Totally. 100%. I have a question about that because as we look at bad habits or bad habits taken too far, right? We start to refer to that as addiction, right? And in addiction, it seems that something breaks in that that habit loop doesn't get updated. It's like for a long time, it's like, okay, trigger is I feel bad. The thing I do is I take a drug and the reward is I feel better. But after a little while, that starts to become, I feel bad, I take a drug, maybe I feel better for just a brief second, and then I feel terrible. Or I eat, you know, I'm binge eating, I eat, I might feel better for a flicker of a second, and then I feel terrible. Or I eat, you know, I'm binge eating. I eat, I might feel better for a flicker of a second, and then I feel terrible. So it's like that loop doesn't learn. It doesn't learn. You know, this goes back to your parable, where constantly the loop is designed

for deficit, meaning the one you feed, it gets hungry again, and it says, do that again, do that again. I like the simple definition of addiction as continued use despite adverse consequences, right? So, the habit could be anything where, you know, let's say eating, you know, and so, oh, you eat a little bit of chocolate. But then if we keep doing that to the point where we're eating chocolate every time we're stressed out or every time we're sad or every time whatever, and we start to notice that we're gaining a bunch of weight or we're getting cavities or whatever, we can see, oh, there are the adverse consequences that are coming from this.

The habit has kind of bled into addiction just because we're continuing to do it over and over and over because that habit loop has literally been fed. And is it that the consequences in most cases come after the reward? And so even if that reward has become vanishingly slim, it's still there for a flicker, even if then what comes is bad. And that's why the loop can't be updated as easily. Yeah. And I'm glad you bring that up because there's a nuance here. So it's as you are talking about, but also when we form habits, habits are actually set up in a way that I think of as set and forget. So as in we set the habit and then we forget about the details

and that's actually set up so that we don't have to remember or relearn everything every day, right? So we often set up habits. Let's keep going with the eating theme. Birthday cake, for example. You know, we set up the reward of that birthday cake when we were a kid. And every time we went to a birthday party, it gets associated, you know, not only the taste of the cake, but with presents and friends and fun and all this. And rinse and repeat. You know, this happens over and over and over to the point where, you know, say we're in middle age and our brain just says, oh, it sees cake and it says, oh,

I know how rewarding that is. Just eat it. So we're not actually often paying attention to how rewarding that behavior is right in that moment. And if we don't pay attention, our brain does not change, it can't update that reward value. And so it doesn't change the behavior. And that's actually a critical piece for what sustains behaviors, and also is a critical element for changing behavior. And this is where being mindful of what you're doing is so important. Like what you just said, it allows us to update that reward information. Yeah. So specifically there's a part of the brain called the orbitofronon cortex, which is involved in setting reward values and kind of holding them in mind. And it kind of

sets up this reward hierarchy so that when given a choice between two behaviors, it says, oh, pick this one. I already know how rewarding this is. So for example, if we're given a choice between broccoli and cake, our brain says cake, duh. And that's set up not only from the caloric density standpoint, from a survival standpoint, but from all the birthday parties and all of these things. So that reward hierarchy is set up so strongly. This is why parents don't bring out dessert at the same time as vegetables because their kids are, you know, duh, their kids are not going to eat the vegetables. But that reward hierarchy also is the critical element for change. So if we don't pay attention to how rewarding something is right now we're not going to change the behavior we're just going to keep going through the behavior and say oh

i've got this set reward value and i'm just going to assume it's the same and i'm not actually going to pay attention i'll give an example i had a guy who came in to my clinic who wanted to quit smoking and he'd been smoking about 40 years so he had reinforced his smoking habit loop about 300,000 times, literally. Think of a pack of cigarettes, 20 cigarettes in a pack, 365 days a year. Anybody can do that math. So there he had reinforced it. And what I had him do was start paying attention as he was smoking. And he came back and he's like, how did I not notice this before?

You know, these cigarettes taste like crap. Well, it was because he would smoke a cigarette to help his dopamine deficit because he was addicted to the nicotine. And that relief from the dopamine deficit was what he was focusing on as compared to the actual act of smoking. And as he started to pay attention to what the smoking actually tasted like, it helped him update that reward value. And we've just recently done some studies where we can actually map out the change in reward value over time as people simply bring

in mindfulness practices and pay attention when they're smoking cigarettes, or when they're overeating, or when they're eating junk food. Is that based on people's surveyed response to how the activity feels? We try to do it in the moment. So that's the best way to collect accurate data. And so we've developed these app-based mindfulness training programs. And what we've done is we've embedded something that we call the craving tool, which basically has people pay attention as they're doing the behavior. So if they're smoking a cigarette, it has this checklist that walks them through it says, Okay, notice what it smells like, okay, check, take a drag, you know, click on the box, What does it taste like? How does it feel going into

your lungs? What does it smell like coming out of your mouth? And then we ask them, how content do you feel now? You know, and we have them check in with their body, check in with their emotions, check in with themselves to see how rewarding was that behavior right then. Same thing for eating. We have them pay attention as they eat and then ask them how content do you feel? And then we also ask them how much did you eat? So they can line that up. If they overate and they don't feel very content, that actually decreases the reward value in their brain so that the next time they come back, they can remember it. So the other piece that we've put in this tool is basically an imagination exercise where before they do the behavior, so after they've done the mindful eating or mindful smoking, we have them pay attention and say, okay, imagine doing this behavior before you do it and bring to mind what you're going to do and do it, which basically brings forward the previous times that they've done it.

which basically brings forward the previous times that they've done it. And as they've paid attention previously and updated that reward value, then that's what gets stored in their brain. And as they imagine doing it in the future, their future imagination is based on previous behavior. And so that updated reward value from the last time they've done it gets into their brain and it actually helps them become less excited to do it if that reward value is dropped. Now get this. So we can collect all these data as people are in their daily lives doing these things. It only takes 10 to 15 times of somebody using this craving tool

for the reward value to drop basically to zero. 10 to 15 times. So it's not like, you know, if somebody has been smoking for years, it's gonna take years for them to realize that smoking really tastes crappy, and that it's going to be crappy enough that it updates the reward value. It takes 10 to 15 times of people really paying attention, where they become significantly disenchanted with the behavior. That's pretty remarkable. And so the key then is to do the behavior very mindfully, then very much sort of check

in on how rewarding was that. And now while I have that idea in mind, like, boy, that wasn't so great. I imagine myself doing it again from where I'm sitting right now, which then sort of updates that value. That's basically it. And the only slight tweak there is next time they have an urge to do the behavior, we have them go through the imagination exercise because right afterwards, they might not be that excited to do it again. But the next time they want to smoke a cigarette or eat the comfort food or eat the junk food or

whatever, that's the time where we can bring this in so it can kind of bring that recollection up so that they can become disenchanted right in that moment and help them actually change the behavior. Okay. So the imagination exercises before they do it the next time. Yeah. Yeah. And with this mindfulness training, when we've delivered this in person, we've had people get five times the quit rates of gold standard treatment. Right. More recently, I had a study that was led by Ashley Mason at UCSF where she found a 40% reduction in craving-related eating. And so, you know, we can see significant change as people go through this mindfulness training and in particular, pay attention to the results of

their behaviors. What are your ideas on moderation in the case of people who have had an addiction? I work with a lot of patients, for example, who don't want to quit drinking altogether. You know, they've struggled with drinking, but they really struggle even more with imagining a life of abstinence. they really struggle even more with imagining a life of abstinence. And so there's a lot of research around this idea of harm reduction. It's better to help people meet them where they're at rather than try to force them to be somewhere that they might never be able to go. So I very strongly found that that works pretty well in my clinic. And in particular, it lines up with what we're seeing with this reward-based learning piece, which is if people pay careful attention to

what they're doing, this doesn't necessarily mean that, let's use alcohol as an example. It's not that alcohol is this evil thing. Now, the current research shows that no level of drinking is actually healthy. So, you know, physical health benefits aside, you know, so I just need to state that as a physician, you know, the research is relatively clear that no level of drinking is that healthy. But if somebody wants to drink, you know, socially, what my patients do is really pay attention to what it's like if they have one drink. Okay, what's that like? If they have two drinks, what's that like? For a lot of my patients, it's actually around two to three drinks where they start to lose control. So if they want to drink, if they want to do this in moderation, if they enjoy drinking wine or if they enjoy the taste of beer or whatever

it is, they can do that. And if they really pay careful attention, they can get that satisfaction from a single drink. And they can also notice and remind themselves what the consequences are afterwards. You know, if they drink a second or a third drink and they get out of control or they get drunk or they binge or whatever, they can notice the results of that and say, oh, wow, that's not helping. That's not leading me to a happier, healthier life. What's it like compared to simply drinking a single drink? And they can start to notice that the single drink gets them a lot of the benefit that they're looking for, but also doesn't have those adverse consequences that come with binging or getting out of control.

Half the listeners of this show just set down their headphones and are now about to throw off 20 years of sobriety and have a drink. So I'll point that out as well. So folks that have years of sobriety, they can probably notice the benefit of being completely sober. There are huge benefits to that as well. And from a physical health standpoint, that's probably the way to go. So I think it's really important, especially if somebody has had 20 years of sobriety,

it's really important for them to focus on what that feels like now. To live the sober life, I have tons of patients who just feel really good physically, mentally that, you know, they just feel sharper. They're, they're on, you know, everything about their life feels better. If they focus on that as compared to what, you know, what they get with a single drink, often people are like, eh, this isn't really doing it for me. You know, it's easier for them to even maintain the sobriety itself. Right. I often talk about, in my case, the beautiful clarity of zero, you know, for me, I start waiting out of that. And it's a lot of contemplation and debating and what should I do this and a lot of work and zero is just zero. Yes, absolutely. Thank you. I'm Jason Alexander.

And I'm Peter Tilden. And together on the Really No Really podcast, our mission is to get the true answers to life's baffling questions like why they refuse to make the bathroom door go all the way to the floor. We got the answer. Will space junk block your cell signal? The astronaut who almost drowned during a spacewalk gives us the answer. We talk with the scientist who figured out if your dog truly loves you.

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signed Jason bobblehead. It's called Really? No, Really? And you can find it on the iHeartRadio app on Apple Podcasts or wherever you get your podcasts. So let's take this habit loop idea and apply it to anxiety. In what way does this help us with anxiety? anxiety can actually be reinforced in the same way as smoking or overeating or any other habit. T.D. Borkovec started doing some of this research at Penn State back in the 80s and has published quite a bit on this. Basically, if you think of that trigger-behavior-results relationship, so the trigger could be a negative emotion. The behavior in this case is a mental behavior, worrying. So worrying does a lot of things. It can make us feel like we're in control. It can distract us from that negative emotion. It can help us plan for a worst case scenario. You know, there are a bunch of things that worrying actually does. The results of that can actually perpetuate anxiety and worry habit

loop. So if the distraction from the negative emotion feels better than the negative emotion itself, there's a reward in that. If the feeling like somebody is in control or problem solving, even if they're not really solving the problem, that feeling of doing something feels better than doing nothing, there's a reward in that. And all of those will drive themselves as anxiety habit loops. You know, I hadn't learned this in my psychiatry residency training. It was only when I started to look at these mechanisms and to try to understand why were my patients suffering so much that I started to understand this myself. And in fact, I do this now with every new patient

that comes into my clinic. The first thing I'll do is as I'm taking a history, I'll have them map out their habit loops. And I'll give an example of somebody that I've been seeing in my clinic who came in, referred for anxiety. And he sat down and I had him describe what it was like. And he said, well, I go on the highway and I feel like I'm in a speeding bullet, you know, his car. And he said that thought would lead me to avoid driving on the highway to the point where I just don't drive on the highway anymore. So we mapped it out on a piece of paper. Actually, we just mapped it out in 30 seconds. OK, the trigger is these thoughts.

The behavior is not driving on the highway. And then the reward is that he could avoid those negative feeling thoughts. And this was to the point where he had full-blown panic disorder. He would avoid driving on the highway. He barely drove on the local roads. And just him being able to see this, right, just to map this out in 30 seconds was really eye-opening for him where he could start to understand rather than his mind being this black box, he could understand what was actually happening. So once he sees that, is it just the seeing it that starts to unwind it? So let's continue with him because he's an interesting example. So this gentleman, he met all the criteria for panic disorder, met all the criteria for generalized anxiety disorder. And he was also very overweight. He was about 180 pounds overweight. So I sent him home with the instruction to just map out these habit loops. I gave him our Unwinding Anxiety app and said, go map out these habit loops. He came back two weeks later. And the first thing he said to me was, I lost 14 pounds.

And I looked at him quizzically because we hadn't even approached that yet. I was gonna save the eating piece for later. And he said, I started mapping out my habit loops. So anxiety was triggering me to eat. And that actually was making me feel bad about myself because it wasn't fixing my anxiety and it was just causing me to gain weight. And I know that my weight is very unhealthy right now.

So he became completely disenchanted with the overeating through that mechanism of just learning how his mind worked, which goes back to this orbitofrontal cortex piece. If we bring awareness in, the first step is to map out a habit loop. That's what he did. What this does is it can naturally lead to a second step, which is becoming disenchanted with our behavior. And the way we can do that is by paying attention to the cause and effect relationship. What's the result of the behavior that we do? So he was paying attention to the eating, and he realized that the result of that was that he didn't actually feel very good about himself,

and he wasn't losing weight. So he became disenchanted with doing that behavior. He didn't have to force himself to stop doing it. He just stopped being interested in doing that. And over the course of five to six months, he lost over 100 pounds. Notice how that doesn't take willpower, grit, force, or anything. It was literally tapping into that same reward-based learning mechanism that had driven the process in the first place. One of the things that I see in a lot of people that I do one-on-one work with is that we don't see those loops very clearly because we have so much self-judgment that just sort

of kicks in and seems to trigger all this emotional, which doesn't allow us to learn. That part of what you guys see also? Absolutely. Absolutely. Absolutely. So I bet you could map out self-judgment habit loops with folks that you work with. I see this all the time in my clinic, especially with folks who feel like their weight is unhealthy. So thinking of a patient right now who would get up in the morning, look in the mirror. Okay, so there's the trigger. Her behavior was to judge herself for being overweight. And then the result was that she would get into this shame spiral. Yet, because she had

binge eating disorder, she would actually, because that negative emotion was a trigger for her to binge, sometimes she would binge, you know, ironically, because she was judging herself for being overweight. So that self judgment habit loop is there all the time. I think in the West, we're very good at judging ourselves. Yeah, I think it's one of the ultimate mechanisms in the downward spiral of addiction. You know, I feel bad. So I use now I feel worse about myself. So what tool do I have to deal with except to use? And it's just, but yeah, I do think there is that ability. Like we talk a lot about self-compassion being a really powerful tool, not just because it

makes you feel better. That's great. But because it allows you to learn. If you can suspend that judgment and move into a more neutral place, you're actually able to learn. And learning, as you're pointing out here, learning and seeing is really the key to unwinding a lot of these things. Yes, yes.

And I like the framework that Carol Dweck put forward decades ago around growth mindset. You may be familiar with this, but just for anybody that's not, she talks about fixed versus growth mindset. And she had focused in the educational space where if a student feels like they've got a fixed IQ, then they're not going to be able to change. But if somebody imagines that it's not fixed, they're in this growth mindset and they actually do better in school. I think this is actually true for all of us. If we get locked into self-judgment

or shame spirals, we literally are closed down and we are not open to learning. But if we can bring awareness in and get curious, oh, here's this habit loop. Already it opens this up and it literally feels more open. So my lab just finished a study, in fact, looking at these things where we had people rate a bunch of different types of mind states, everything from anxiety to frustration, to connection, to joy, to curiosity. And universally, people reported that anxiety, feeling frustrated, anger, things like that, anxiety, feeling frustrated, anger, things like that all felt more closed down and contracted, whereas things like joy, connection, curiosity felt open. So even there, we can see how frustration,

anger, those are motivated states. Those are not states where we're looking for more information. They say, go do something. Whereas curiosity literally feels more open and opens us up into this growth mindset where we can learn. So I'm really glad you brought that forward. So let's go back to an anxiety habit loop. So I can imagine some people who are listening, saying something like, okay, I know that I worry. And I know that it doesn't do me any good. And that the more I worry, the more sick to my stomach I feel. And the more sick to my stomach I feel, the less able I am to show up at my job and do a good job. So they sort of see that. So what's the next step for somebody to go from there? Yes. So we've talked about the first two steps. We haven't talked about the third step yet. So step one, map out that habit loop.

Step two, you know, check in to see what we're getting from this. And as you're pointing out with worry, it's pretty straightforward for most people. It's not getting us anything, right? So if we can see that, that reward value of worrying starts to drop. Now that opens the door for step three, which I think of as bringing in a BBO, a bigger, better offer. Okay. So our brain, it's always looking for something better. And it says, well, you know, if worry doesn't feel that great, give me something better. Okay.

So here, well, let me ask you, what feels better? Worry or curiosity? Curiosity. Yeah. So here we can use simple mindfulness practices. And I think of the attitudinal quality of mindfulness as that of being curious. So, if we simply get curious, so let's think of this. So, somebody's worrying and they can get curious and start to notice, oh, what thoughts are going through my head as I'm worrying? What does this feel like in my body as I'm worrying? And in particular, we give people an exercise to explore that worry or the anxiety in their body and just ask a simple question. Do I feel it more on my right side or my left side? Or is it more in the front or is it more in the back? And what that does is it engenders this natural, hmm, is it more on my right side or my left side? Because that draws in our natural

curiosity. It doesn't matter what side it's on or whether it's in the front more or in the back, or whether it's in the front more or in the back. But just asking the question naturally brings up our curiosity. Hmm, is it more on the right side or the left side? And right there, we're more curious than we were a moment ago. And that helps us tap into the curiosity right then and there when we're anxious or we're worried. And it also helps us see, oh, these are physical sensations. Maybe I can be with these physical sensations rather than trying to push them away or get rid of them or

avoid them. Oh, what's this feel like? Oh, it's vibration, it's tightness, it's tension. And we can start to explore what does worry actually feel like? And then as we explore it, we start to notice that it's constantly changing. And so, we don't have to be as afraid explore it, we start to notice that it's constantly changing. And so we don't have to be as afraid of it or trying to constantly avoid it as much as we might habitually have done in the past. Does that make sense? Totally, totally. One of my favorite questions that I'll use is something like, how do I know I'm sad? I'll find my brain declaring an emotional state, And then I'll go, how do I know

that I'm that? And it does that immediate, like, I have to start sort of on a detective hunt. Like, well, that's a good question. How do I know? Well, I guess there's these thoughts. And I like that idea. I think you and I may have talked about this last time you were on that. If you start to unpack, these things tend to land on us as this like, boom. But if you can start to unpack like, oh, there's some thoughts here. There's some physical sensations here. There's a desired behavior that's being called for. As I start to unpack those, each of those is easier to handle than one big blob. Absolutely. It's like, you know, a thunderstorm by itself can seem big and bad and scary to a kid. But if the parent is explaining to the child, oh, well, there's lightning, there's thunder,

there's rain, there's wind, suddenly the child understands what it is. And it's not this foreign, big, bad entity. It's something of a natural wonder. Oh, thunderstorm. Yeah, that's a great example. I have been looking for an analogy of that, and that's a really good one. Thunderstorm. Going back to anxiety, you mentioned that the trigger is a negative emotion, which would

send us into worry. The reward then is that we would feel a little bit better, except until we don't, right? Is part of it getting back to that original core emotion that we're trying to run away from? with the original emotion. So that's really the core of mindfulness in general, which is to change our relationship to whatever the emotion is. Often the habitual tendency is to kind of use our willpower or our control and say, this is unpleasant. I want to make it go away. So I'm going to try to do something. I'm going to distract myself. I'm going to force it out of my mind, whatever. The key here is really learning to be in relationship with whatever is. And so if we can be okay with whatever's there, that core emotion, we can be intimate with it. We can allow it to do whatever it's doing in the moment, and then also allow it to pass.

So instead of pushing it away when it comes up, we allow it to come. Instead of holding on to it, if it's a positive emotion, we allow it to pass. And both of those are really key aspects of what mindfulness is all about, is changing that relationship. So we can really focus in on what's it like to resist an emotion? What's it like to hold on to an emotion? You know, both of those are actually painful. When we try to hold on to something and it's inevitably going to go away, that's painful, right? When we try to resist something and it's inevitable that it's going to come and be here, that's painful. Both of those are optional. So curiosity is one strategy. What are other strategies for being with something that doesn't feel good? This idea of be with the emotion, welcome the emotion, allow it to be there.

At least it seems to me it's a pretty common notion, and that just may be that I interview people who talk about it every week, right? But what I find with a lot of people that I talk to, they're like, well, I did that and I still felt terrible. And so I think one of the things is to say, well, okay, yeah, it doesn't just, you know, I think we hope like if I just allow the emotion to be here, it's just another strategy to immediately get it to go away. But what are some strategies for going, all right, I'm allowing this emotion to be here. And yes, I know it'll pass, but it's not passing on a timescale I would particularly like. So how do I settle in here? So there are a couple of things that we can do. The first one is that we can turn toward ourselves to see, is there impatience here? Am I not okay with the present moment? Because you're talking about this time scale. It's not on the time scale that I want, meaning I'm not okay with what's happening. And for a lot

of people, it's really about identifying that impatience and noticing what impatience feels like and bringing a kind, curious awareness to that. Oh, here's impatience. What does impatience feel like? And focusing in there. Related to that is resistance. Because often where there's impatience, there's resistance. And we can focus in there. Oh, what does resistance feel like?

And get curious about that. And explore that. That helps us learn a whole lot about our habitual reactions. Oh, here's an impatience piece or a habit loop. Here's reactivity or here's resistance. Another thing that we can do is to bring kindness in. You mentioned this just briefly, and I want to unpack it a little bit more. We can't force ourselves to accept things, but we can notice the difference between the opposite of kindness would be judging or meanness or whatever. How are we relating to ourselves in these moments?

Are we relating to ourselves in a way that's kind? Or are we relating to ourselves in a way that is judgmental or even harsh? And we can see this in even subtle things. I remember being on a long silent meditation retreat where it was helping me dial into all the subtle ways that I was not being kind to myself. And I even noticed that the way I was brushing my teeth was kind of forced, like as compared to with kindness. So we can see it even in these subtle, seemingly habitual things that we do, like brushing our teeth. And we can notice the difference between that and simply being kind as we do these behaviors that are supposed to benefit ourselves. Do you find that having a formal

meditation practice makes people better able to practice these skills that you give them in your clinic or you give them via your app? Is there a correlation of, okay, I spend time formally sitting down and trying to practice. Does that strengthen these mindfulness muscles, do you find? And is that an important part of being able to get over anxiety or smoking or eating is to actually get... I'm Jason Alexander. And I'm Peter Tilden. And together on the Really Know Really podcast,

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And register to win $500, a guest spot on our podcast or a limited edition signed Jason bobblehead. It's called really no, really. And you can find it on the I heart radio app on Apple podcasts or wherever you get your podcasts. My ability to practice these mindfulness based type things. Do I get better at it over time? Well, certainly I think we get better at anything that we do over time. So it's the one you feed. So if we feed the habit of practicing mindfulness, it's going to strengthen. Now, when we were doing some of our early clinical studies, we were looking at both formal mindfulness practices like meditation, and we were also looking at informal

in-the-moment practices. So, for example, if somebody was paying attention as they were smoking a cigarette in our smoking studies, that counted as an informal mindfulness practice because they were paying attention. We found that both correlated with clinical outcomes, but in fact, we found that the informal practices were stronger in their mediation effects yeah or their moderation effects to be precise so we actually started changing up our training to the point where we start with the informal stuff we say you know don't commit to sitting 30 minutes a day don't don't worry that. Let's start with helping you understand how your mind works. Let's start with helping you work through these three steps where you map out

your habit loops, where you look at the cause and effect relationship, and where you start to bring, even in a moment, you bring in kindness rather than self-judgment. The more people do that, the more they can start to see how mindfulness works. And then they can start to apply that in ways where the formal practices support the informal daily practices. So we start layering in the formal practices after we start with the informal stuff. And I think it gives people a much better framework with which to understand and benefit from the formal meditation practices. So you're having people bring mindfulness to a situation. So I'm going to smoke.

I bring mindfulness to the experience of smoking. And that's where my mindfulness is. Is it important that it expand beyond those moments? Or is it just enough to just be mindful just in those moments? I know that's a question there's not a simple answer to. Yes, it is complex, like you're saying. Yet, I think that the more we just even focus in on those simple things, the more it helps us start to just naturally see how our minds work. And our minds are really good at generalizing things where they'll say,

oh, maybe it's also over here. Maybe it's also over here. And I see this all the time, both in my clinical work and in our research studies, where people make these insights and make these leaps where it had nothing to do with what we were talking about in the training, but they're seeing the parallels and they're seeing that these habit loops are playing out somewhere else. For example, we did this study with anxious physicians. We gave them our Unwinding Anxiety app and we were just focusing on helping them with anxiety. Yet we found that there was a strong correlation between anxiety and burnout.

And we also found without even mentioning the word burnout in any of the training that we got a 50% reduction in certain aspects of burnout simply by people helping to unwind their anxiety, but also learning to apply this to certain aspects of burnout, like callousness toward their patients. Interesting. One of the things I find with people is that it's a challenge to remember to be mindful during the day. Our day starts and we go off. Do you have any practices that you recommend that help people remember to be mindful, to actually do some of this practice? Because I think, I agree with you. I think having a seated meditation practice has a lot of benefit, but it almost seems that the ability to actually bring some of those concepts

to mind as we go through our lives is of more benefit. And yet that's challenging. Absolutely challenging. I think that's one of the biggest challenges that people face. You can think of this as how do you start a new habit? So I think one of the key pieces here is a little paradoxical, which is to focus on after you've done the behavior. So after somebody has been mindful for a moment, or they've done a five minute meditation, or they've done a 10 minute meditation or whatever, to really focus on what the result is, where they can see, oh, I learned something about myself, or even if they just mapped

out a habit loop, right? So it takes them Or even if they just mapped out a habit loop, right? So it takes them 10 seconds, they've mapped out a habit loop. If they focus afterwards and say, oh, what does it feel like to know my mind a little bit more? There's some juice to that reward. It feels better. And because it is rewarding, that will help to drive that behavior in the future. So previous moments of mindfulness will lead to future moments of mindfulness, I would suggest, especially if we notice the results of that, oh, you know, I was aware, or, oh, I was kind to myself as compared to being mean to myself. Oh, that feels pretty good to be kind to myself. That's going to update that reward value.

And it's going to be more rewarding for the brain. So the brain's going to say, oh yeah, I want to do that again. Excellent. We are at the end of time. I've got one more question. I don't know if there is an answer to it, but I constantly wonder about it. And it is this, every single time in my life that I have exercised, every single time afterwards, I have gone, that was a great idea. I'm glad I did that. And yet you would think with that kind of track record, I would sprint to my treadmill or to my exercise bike. And yet I still find it takes effort. Now, again, I've been doing it long enough, consistently enough. It's not like I have to put a huge amount of effort, but I'm just stunned that it seems like it should be easier.

What's going on here? Yeah. So let me ask you when you say, oh, that was a great idea. Is that kind of up in your head or are you feeling down into your body and really paying attention to what your body feels like? I think I'm paying attention to my body. You say, oh, that was a great idea. What's it feel like? My body feels like it has energy. It feels like it's alive. It feels like it's loose. So the next time you think about exercising, do you recall that piece? What it actually felt like the last time you did? When I want to get myself to exercise, I do. Okay. And what happens? Well, I go exercise.

I'm wondering if there's a habit in there. It was like, oh, this felt like effort. But what you just described, I didn't hear effort in it. Sometimes I think my brain does this mental calculation and it's like, all right, I'm going to go exercise. And that takes, you know, imagine a big stack of quarters in one hand, that much energy. And then I look at my current level of energy and it's like one quarter and I go, I don't have that. And so, you know, the strategy I use of course, is to just go, we'll just get started. And I go, oh, that's one quarter of effort versus one quarter of energy. I can do that. You know, maybe that that's, what's going on. I was a heroin addict and I

would have robbed you at gunpoint for that, but I don't quite feel like I'm ready to do that for my 30 minutes on the treadmill. Right, right. Well, you're bringing up something really interesting, which is when there's an energy mismatch, if we just feel into that in that moment, it can feel like, oh, this is not matched, right? And so you're saying the stack of quarters, it's not a stack of quarters to get started. Yet, intellectually, it's hard to kind of remember, oh, when I get started, you know, that's like somebody handing me a stack of quarters, you know? That's right. That's right. Yeah. Yeah. So remembering into that piece, as compared to just feeling the energy level right now, if you go back and

remember, what does it feel like when I'm exercising? I'd be curious to see, and we're not trying to kind of force the point here, but it'd be curious to see if that actually brings that stack of quarters up more quickly by remembering, you know, specifically, oh, what's my energy level feel like when I'm exercising, not at the moment when I'm not exercising, because when you're not exercising, it's different, right? That's right. That's right. Yeah, it's not a it's not a fair comparison to say, well, exercising is one stack of quarters. No, it's this stack of quarters when I'm actually doing it, but just recalling it not intellectually, but just recalling it. I'd be curious to see if that actually helps that movement into it more quickly.

Yeah, it does. You know, I always remember that basic idea that I think is so powerful, which is that we get motivated and we do something. And a lot of times we start doing something and then the motivation comes rushing in. I just, you know, I remind myself, like, it just feels like something that is that good for me to do is exercise. Like it would just be always easy to do. And it sometimes just doesn't feel, I mean, again, it doesn't feel terribly hard, but I have to convince myself it's a good idea. Whereas, you know, there's a, there's some chocolate chip cookies on the table that I don't need any convincing on. I wonder if it's the immediacy of the reward versus the expected output. So that could certainly be some of it. And I'm not saying this is the case for you,

but just in case any of your listeners would benefit from this. One thing that I see often is that people are kind of stuck up in their heads and they're saying, oh, it's a good idea to exercise. But our thinking brain does not hold a candle to our feeling body. Our feeling body is really what drives behavior, which is why I was asking you about recalling what it feels like to exercise, because that could be that refreshment of the stack of quarters simply by recalling what it feels like to exercise as compared to not currently exercising and thinking, oh, I should exercise again. Yeah, I agree. I think, and I do this with

coaching clients a lot, which you were talking about before, which is you've got to take a moment and feel the goodness that came from the behavior you just took. Like we've got to stop and go, look how good this feels so that we can update it. And yeah, I often with exercise, I will just feel into my body and be like, don't like it. So I know if I exercise what it'll be like, and there I am. Yeah. And let's just take 30 seconds to apply this to other things. So one thing that I'm seeing a lot of is like self-righteousness or divisiveness in communities and families and society. And so, it can feel immediately good to think, oh, I'm right, you know, and I'm going to push my point forward. And it's hard to, in that moment, remember what it feels like to actually

be connected. So, let's say that we're having an argument with our significant other or partner. There can be this tendency to say, I'm going to dig in and I'm going to push my point. I'm right. I'm going to fight or I'm not going to talk to them until they get my point. If we just feel into how it feels to be connected with the other person. And we compare the two. There's this ancient saying, you know, anger with its honeyed tip and poisoned root. So that honey tip can just be so delicious right now, but we don't realize that we're actually causing harm to ourselves, to our relationships, to others. And if we can just take a moment to feel into what it feels like to be kind, to be connected, that can sometimes be a great way to humble ourselves, to step back and say, oh, this actually feels better to be connected,

you know, to try to understand where the person's coming from, rather than trying to ram my point down their throat, which generally doesn't go so well. Does not tend to work, no. No. And yet, talk about another feedback loop that we as a human species don't seem to have quite figured out.

Yes, unfortunately. But we can. This is where awareness comes in. Yeah, well, thank you so much. It's a pleasure to see you again. I find your work fascinating. These topics are near and dear to my heart. So thank you for taking some time with us.

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