Well with Arielle Lorre - 110: Dr. Jud Brewer on The Science of Anxiety, Cravings + How to Change Negative Behavior

Episode Date: May 12, 2021

In this episode I’m talking to Dr. Jud Brewer, Director of Research and Innovation at the Brown Mindfulness Center and associate professor in psychiatry at the School of Medicine at Brown University, executive medical director at Sharecare, as well as a research affiliate at MIT.  Dr. Jud has spent over 20 years at Yale, MIT and Brown University researching how our brains form negative behavior patterns, bad habits and addictions, and the specific techniques needed to create lasting change. He is the author of The Craving Mind and Unwinding Anxiety, and developer of mindfulness apps Unwinding Anxiety, Breathe and Eat Right Now. We discuss addictions; what happens to our brains when we have a craving; how to change a behavior; how to manage anxiety; how to stop letting cravings drive our lives and so much more.    www.helloned.com/BLONDE for 15% off your first one-time order, or 20% off your first subscription order plus free shipping www.gomacro.com with code BLONDEFILES for 30% off plus free shipping on all orders over $50 www.headspace.com/BLONDE for a free one-month trial www.ritual.com/BLONDE for 10% off during your first 3 months   Produced by Dear MediaSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

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The following podcast is a dear media production. Hey, welcome to the Blond Files podcast. I'm your host, Ariel Lori, and I'm here to talk all things wellness. From how to achieve optimal health and well-being to the best beauty tips and everything in between, no topic is off limits. I know there is so much information out there, so I'm here to help you navigate it all and live your best life. Thanks for listening.

Let's get into it. Hi, everybody. Welcome to the show. This is a big episode for me because this guest is one of my ultimates and he did not disappoint. I am talking to Dr. Judd Brewer. He's the director of research and innovation at the Brown Mindfulness Center and associate professor in psychiatry at the School of Medicine at Brown University as well as a research affiliate at MIT. Dr. Judd has spent over 20 years at Yale, MIT, and Brown University researching how our brain. form negative behavior patterns, bad habits and addictions, and the specific techniques needed

to create lasting change. He is also the author of The Craving Mind and Unwinding Anxiety, and the developer of Mindfulness Apps Unwinding Anxiety, Breathe and Eat Right Now, which I have recommended a bunch of times on this podcast. We discuss addictions. What happens to our brains when we are having a craving, how to change a behavior, how to manage anxiety, how to stop blooding cravings drive our lives and so much more. Such a fascinating conversation. So enjoy. So welcome to the show. I'm so excited to talk to you as a former addict and alcoholic and cigarette smoker and binge eater and current meditator and sometimes anxious person and more recently phone addict, I feel like there's a lot of ground to cover here. I feel like I'm afflicted with pretty much

everything that you study. So to start out, though, I would just love to find out how you came to do what you do and why you do what you do. Yeah, you know, it's a, it was a long and winding road and not at all what I expected. So, you know, I started meditating my first day of medical school, actually, just as a way to help me with my own stress and didn't think, much of it in terms of studying it. I was studying molecular biology and I was looking at like what genes are affected and how, you know, how the immune system gets suppressed when we're stressed out, for example. I was doing that all in mouse, you know, in mouse models. But when I got more into meditation, I started seeing some really interesting things just first starting by

understanding my own mind a little bit more, but also seeing how there was a lot of overlap between what I was learning there and what my patients were talking about in psychiatry. So when I was doing my psychiatry residency, I got really interested in actually seeing if we get studied this stuff. You know, there really wasn't much, much studied. Not many published papers. people weren't doing many studies, especially around addiction. So I actually did my first study with people with alcohol and cocaine use disorder in residency training. I wanted to see if mindfulness could help. And it could.

The study went pretty well. And then we said, well, how about some of the hardest addictions to quit? So I think a lot of people don't know that smoking is actually one of the, if not the, hardest addiction to quit. because, you know, you can reinforce, if you smoke a pack of cigarettes a day, you can reinforce that habit 20 times a day, whereas, you know, it's hard to eat 20 pieces of cake a day or to, you know, well, I'm sure some people have struggled with that. But, you know, long story short, you know, it was really interesting to see that mindfulness could actually work for, you know, major addictions.

We got five times a quit rates of gold standard treatment with our, you know, with this mindfulness training that I developed. And so, you know, we then looked at the neural mechanisms and could start to understand that. And so it really just came together from my own personal interest in understanding my own mind and then seeing this need with addictions. And then seeing that really expand to, you know, it's not just about the classic addictions. It's about helping all of us understand how our minds work and seeing how we can use this for for overeating, we can use this for anxiety even. How have you seen addictions change over the time that you've been studying this or have you?

I've seen a little bit of a change in the sense that often, you know, addictions are thought of, you know, what do you see in the movies? You see, you know, what is it, Nicholas Cage in leaving Las Vegas, you know, with alcohol. And you see train spotting. Was it Ethan? What's his, I shouldn't say, what's his name? The famous actor that I can't remember. member's name for the heroin, you know, but nobody. So here I've been seeing it broaden a little bit where this, I learned this definition of addiction back in residency, which is continued just despite adverse consequences. And that really struck me because I was thinking, huh, you know, this isn't just about cocaine or alcohol or cigarettes. This is about all of us where, you know,

And then I started going through my own. I was like, wow, I never realized I was addicted to exercise at one point, you know, and I addicted to thinking and all of these things. And so I think that has changed a little bit in terms of people being more open to a broader definition, especially now that we have very addictive things like our smartphones. You know, they are certainly smarter than we are many times. Yeah, we kind of have like the crack pipe in our pocket now. Yes.

And it can be very rewarding and very tough to break. And I want to get to that or like kind of pseudo rewarding. We think it's rewarding, but it's really not. I mean, I think that I've heard you call it like the slot machine in your pocket. And it is really fascinating how they've designed it to be exactly like that. You know, you never really know what you're going to get. And I think that's what makes it so addictive. But when it comes to classic addiction, say drugs or alcohol, do you think that it's kind of a biopsychosocial thing?

I know that you mentioned that you studied. genetics, what do you think makes some people more predisposed to it than others? Well, certainly genes play a role, but that's kind of that, genes play a role of everything. So it doesn't really mean anything, and we can't really change our genes. You know, some of us win the genetic lottery and some don't. Certainly, there's more work now showing that they're epigenetic factors where, you know, our genes are a little more fluid in terms of how they're expressed, but the, you know, the genes that we have are the genes that we have.

that we have. So here I focus more on the, you know, the environment. And so certainly what we do to our bodies makes, you know, will affect things. And also how we, you know, how we live. So our upbringing, you know, we can actually learn behaviors from our parents or the people that raise us or the environments around us. And even, you know, as we go through life, we can be influenced heavily by, you know, the company that we keep, for example, the friends that we hang out with the social circles and even be influenced by our work environments if we spend a lot of time there. So I focus a lot there because that's something that we can work with, you know, and that goes back to the fundamental aspects of, you know, understanding how our minds work.

So you mentioned the definition of addiction, right, which is continued use despite adverse consequences. And you kind of touched on how there are so many things. It doesn't have to be drugs or alcohol. And I think everybody listening can probably think of something that they do where they continue to do it despite adverse consequences, the phone being a really good example. And I also know that a lot of my audience struggles with like binge eating and emotional eating and especially over the past year, right? I mean, we've had to kind of find new coping mechanisms. and I know a lot of people have been reevaluating their relationship with drinking and all of that. So what exactly is happening in our brain when we are getting a craving, when we're getting an urge to reach for one of these things?

This goes back to our basic survival mechanisms, actually. So, you know, if you think of our ancient ancestors where they didn't have refrigerators, they didn't have, you know, coca leaves were not refined to cocaine, you know, all of these things, they basically had to focus on two things, which was to eat and not be eaten, right? And our brains are set up to help us remember where food is and also to remember where a danger is so we can avoid it. And in fact, it doesn't take many things for us to learn. You know, this is called reinforcement learning because this behavior gets reinforced. So it really only takes three elements to trigger a behavior and a result. So if you think of somebody out in the,

Savannah, you know, foraging for food. When they see food, there's the trigger. That's the first element. They eat the food. There's the behavior. That's the second element. And then their stomach sends this dopamine signal to their brain that says, remember what you eat and where you found it. So it's really set up to help us remember where food is. And same thing for danger. They see danger. They run away and they remember. Don't go back there. So dopamine fires in those moments to help us learn. Yet interestingly, that firing starts to shift. When we go back to the food source, our brain says, oh, dude, I already know that. And so it doesn't fire after a very short period of time, it doesn't fire again when we go back

to the food source. Yet it starts firing in a different pattern, which is really interesting. It starts firing in anticipation of that, you know, the substance or the food or whatever. And so we have a thought, oh, I should go get some, you know, some pizza or some chocolate. And our brain says, yeah, that's a good idea. go get some. And so we get this urge to go get the food. And those urges are that dopamine firing saying, you know, get off your butt and go do it. Let's talk vitamins. There are so many now that it can be really confusing when it comes to what to take, why and when. And I get asked about supplements

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which is usually my biggest problem with supplements. And it's one of the reasons why I don't really load up on like 20 different pills a day. So with ritual, I take them and I'm fine. I feel good. And they have everything that I need. You deserve to know what's in your multivitamin. So that's why Ritual is offering my listeners 10% off during your first three months. All you have to do is visit ritual.com slash blonde to start your ritual today. That's R-I-T-U-A-L dot com slash B-L-O-M-D-E to start your ritual today. You guys probably already know about my love for go macro macro bars. I literally eat one every day and have for the past year since I found them when I was doing

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Join Go Macro and supporting Farm Sanctuary by going to go macro.com. That's It's G-O-M-A-C-R-O-com and using promo code blonde files, B-L-O-N-D-E-F-I-L-E-F-I-E-S for 30% off plus free shipping on all orders over $50. Well, hello, I'm Giddy Maloney, and you probably know me from a little show called Banner Bumber Rules. I've been labeled all kinds of things. A bitch, a bully, and a mean girl. But there is so much more to a person than what you see. on TV. Tune in every Friday as I talk to some of my friends and castmates, celebrities, comedians,

medical professionals, and maybe some political figures. And by the time we're done, you're going to love me. I'm just thinking back to when I was using. I've been sober for over seven years. But I remember even just with alcohol, sometimes the anticipation of it was more rewarding than actually getting it eventually. And I remember learning something. I'm completely going to butcher this. But I remember learning that people's actual biology changes in anticipation of using drugs. I think I read something that there were like more overdoses and people using drugs outside of their home. I don't know if this is ringing a bell at all because of the changes that were happening

in their body. I wonder, vaguely, just ringing a bell from me as well, it may be related to where people will, when they're in a certain environment, their body knows how much, how to deal with the substance that they're taking. And so let's say that the same amount of substance is taken in a different environment, their body is not, the environment actually plays a role in how their body responds to the drug, even though it's the same amount of drug. If that's what you're referring to, I think. Yeah, yeah, I think so. So you mentioned meditation and mindfulness. And I have recommended your app a lot on this podcast, especially around eating the Eat right now app.

Can you explain to people how to bring mindfulness into this and how having awareness around behaviors can change the behavior? I'd be happy to. So here there's this, you know, something that had kind of frustrated me for a while was this whole approach around addiction where people would tell other people with addictions, oh, you just need to use your willpower. you know, you're just too weak and you're not strong enough and that yours are some moral failing and all of this. And I'm thinking, dude, it's not that. You know, they might have a

condition, but it's a condition that we all share. It's the human condition, right? And in that sense, our brains learn things based on how rewarding they are. Willpower is much more of a myth than muscle. And so there's been this emphasis on willpower that's not actually where the money is. If we want to change a behavior, we have to actually go to how we form the behavior in the first place. And even if, so let's just say willpower is the weakest part of the brain. It goes offline when we get stressed. It goes offline when we, you know, there's this saying that I learned in residency halt. I don't know if you've heard it hungry, angry, lonely, tired, right?

that's when folks are vulnerable to slipping back to any bad habit. So here it's not about willpower. And I mentioned that because that's been the approach, everything from dieting to binge eating to alcohol to any addiction. So like, just stop it. And boy, if I could just, you know, patient comes in and says, you know, I have a struggle with alcohol and I could just say, just stop it, you know, and we'd have one visit and they'd be done.

You know, just stop smoking, just stop overeating, just stop worrying. It'd be great if it worked, but that's not how it would be out of work. I would happily be out of work, right? I'd happily find another job. You could just surf every day. I would happily just surf every day, yes. So here, it's really about understanding how our minds work. And this is where mindfulness comes in.

So I won't go into all the math and all of this. I included all of this in the unwinding anxiety. book, but the idea here is that the only way to change a behavior is to change its reward value. And this doesn't come from positive affirmation, nothing against positive affirmation, but it doesn't come from positive affirmation or willpower or just telling ourselves, you know, that that's bad for us. Again, you know, all my patients know that smoking is bad for them, but it doesn't help, you know, might help them a tiny bit, but it's not what helps get them over the edge.

it's really about how rewarding the behavior is. And those behaviors can sometimes be set up years, decades before. So on average, I'll just keep using smoking as an example. My patients and even folks in our research studies, they start smoking in their teenage years. And I think on average, 13 years of age in one of our studies. And then I get folks that have been smoking for 40 years, you know, and they've laid down that reward value of how cool smoking is because they, you know, they wanted to rebel. they wanted to be cool at school or whatever.

And that reward value just gets carried along as a habit. And our brains don't check to see, oh, is that still rewarding? Do I still want to be doing this? But this is where mindfulness comes in. So if we can bring awareness in, in the moment that we're doing a behavior, that's how we can change it. There are two steps here. One is we have to see how unrewarding the current behavior is.

And then we have to give our brain a bigger, better offer. In fact, I just finished a study in my lab where we did this with the E Right Now app, where we have, we built in this craving tool so that people could pay attention as they ate and then really it would help them line up. Okay, was that really rewarding through asking them questions about how content they were? Ready for this? 10 to 15 times of somebody paying attention as they overreach and that reward value drops below zero. below zero, meaning they shift their behavior. So it doesn't take a lot, but it does take direct awareness and lining up that cause and effect relationship because that's how this process works.

You know, that's how habits are set up. So that's where mindfulness comes in is not only it helps to see how unrewarding the old behavior is, right? I've never had a patient come in and say, you know, thanks, Doc. You know, I never realized how great cigarettes taste, you know. It doesn't work that way. But they do see how unrewarding it is. And then awareness itself can be what I call the BBO, the bigger, better offer.

Well, you tell me, pop quiz, hot shot, are you ready? What feels better, a craving or curiosity? Curiosity. Yeah, it's a no-brainer, right? We did a study to prove that, but I think anybody listening can confirm this from their own experience. So when we have a craving for something, we can actually get curious about what that craving feels like. That's mindfulness. And in that moment, we're going from that closed down, contractive, driven, restless quality of craving to more of an open like, oh, instead of, oh, I got to get that.

Oh, what does this feel like in my body? So mindfulness not only helps us see how unrewarding the old behavior is, it also becomes the more rewarding behavior. that we can start to bring in not only in those moments, but throughout our lives. I'm thinking about my own experience. And I think the hardest part for me, both with drugs and alcohol and with other things, you know, other habits, whether it's checking the phone or going for the cookies at night, is that place where I know that the behavior is not particularly rewarding, but I can't get myself to the place where I'm willing to do something about it.

I mean, I always say that I'm a rock bottom person. I had to get to the point with drinking and doing drugs where I was having seizures nonstop. I was in and out of the hospital. I was on the brink of death before I was willing to say, okay, you know what? I will give it up and I will try a few different things. And even with checking my phone or, you know, like I said, the cookies are over exercising, which you mentioned earlier, I have to get to the place where I'm so beaten into submission that I'm then willing to do something about it.

So if anybody is listening and can relate to that, do you have any tips for them? I would have to say for some people, and I've seen this in my clinic as well, for some people, they have to hit rock bottom, unfortunately. And that's not everybody. So I think that's, I would say, a minority of the folks. Here, even when we're still doing it, we can learn from it. That's the beauty of this process. because if we're still doing something, right?

It's not about saying, okay, I need to hit rock bottom before I stop. We can just ask ourselves in that moment, oh, is this really that rewarding? I even have folks do this on a moment-to-moment basis, like when they're eating. Because we all have this pleasure plateau where if we're hungry, we eat, let's say, I don't know, pizza, chocolate, whatever. So we start eating pizza. And with each bite, we can ask ourselves, is this bite better than same amount? are worse than the last one. And we can just get curious. As we're eating, we're still going to do it,

right? It's like, go ahead and eat the pizza. That's why I tell you know, patients come into my office. I say, go ahead and smoke and they look at me like I'm crazy. But I know that's the only way they can change. And I say, just go ahead and smoke, but pay attention as you do. Go ahead and eat the pizza, but pay attention as you do. And that's, you know, so we're already doing the behavior. So in that sense, we can just bring a little bit of curiosity in and be like, huh, is that guy a nut job? Or was he on to something? Huh, let me see. There's something like that in recovery where they say,

like, if you don't believe that you're an alcoholic, go out and try some controlled drinking. And I think once people have that idea in their head, then they may or may not realize, oh, that's not something that I'm capable of doing. Yeah, they've collected their own evidence. Right. Do you think that mindfulness is kind of the future

for maybe people who have drinking or drug problems to be able to drink in moderation? Or do you think that abstinence is always the key or the way to go? You know, it really depends on the person. So I've seen both. And I, for the life of me, I can't predict which of my patients. I'm like, for you, it's abstinence for you. Often it's somebody just has to try it.

I'm thinking of one of my patients now who really had to go to the abstinence route for a long time. and then worked with some of the underlying issues. So it was anxiety for her. And now she's done a pretty good job of, it's one to two drinks, only in social situations. And I'm thinking of another one who every morning, she does,

she plays the tape forward, you know, where she's like, what was it like when I drank last? And what's it like to feel to be sober? And that's the only way she's going to roll. So it really, it really depends on the person.

Yeah. I mean, again, just drawing from my own experience, because that's all I really have here. Like I, even though I've had a lot of time sober and I have addressed a lot of the underlying things, I feel like if I were to have a glass of wine, I would end up in Tijuana. Like, that's just how I, that's just how I roll. But it is really, it is really interesting. And I have seen people. And I feel like sometimes with drugs, too, like you'll hear about somebody who is addicted to heroin, for example, and really went to like, got to really low places, but then they were able to recover from that and still drink.

So I wonder if it's dependent on the substance. Is it just because that's more physically addictive? So it just kind of takes hold of you in that sense. Yeah, it's a great question. I would have to say, again, genes probably play a role here. So for some people, based on their genetic makeup, you know, it could be that they can drink, but they can't use opioids, you know, because their opioid system has these polymorphisms that are different than this and that. So it's hard to say for certain, but I would say one thing that I've seen that is pretty consistent is that, and you tell me if this is the case for you, that, you know, people often spend a lot of time, like, what can I do in moderation, but they actually ignore the beauty and the truth.

joy and the physicality and all the benefits that come from not using and not drinking. And so, you know, there's all this emphasis on, you know, oh, can I, maybe it's back to this willpower thing. Oh, can I do it as compared to, dude, what's it like, you know, for you, even for me now, when I notice like that I've had like one or two drinks the night before versus not drinking, I feel so much better in the morning. And so it's actually, you know, for me, I'm like, do I really want to have a drink tonight? And my body's like, well, it felt pretty good the other day when you got up when you, you know, when you didn't.

And so for me, I'm actually leaning more and more in that direction of like just taking care of my body because it feels so much better. So I would say, you know, anybody that's having that debate in your head, go and collect a bunch of data where you've, you know, taken really good care of your body. You've eaten clean. You know, you haven't used alcohol or drugs. you haven't smoked cigarettes and you've made sure you got enough sleep. Just see what that feels like because I can tell you that is the biggest bestest offer that I have run into yet. Yeah, I mean, you hear people in recovery talk about like if one day, and I think there

might be some literature on this, if one day there were a pill that you could take that wouldn't enable you to drink or use in moderation, would you do it? And for me, I wouldn't. You know, I really have come to a place where I'm really, I'm grateful for my experience and I feel like it's given me an advantage and tools to deal with life on life's terms and deal with the underlying stuff. But I know that that's not everyone's experience. But it is true. I think a lot of people are kind of sober curious now. And they want to find ways to either stop drinking or be able to drink with moderation. But they're still very

hesitant to go the whole way. And it is really, it can be really rewarding. and beautiful. It can be. And I like the way you describe your experience. I think you're being humble. But I would put that in the category of wisdom. You've actually developed a bunch of wisdom. And we can only get wisdom from our own experience.

This isn't to say that everybody should go out and use a bunch of drugs just to see what that was like. That's not wisdom. That's probably stupidity. But here it's like, okay, you have these experiences and you learn from them and you're wiser, you know, and there's no substitute for wisdom here. So we all can develop our own wisdom by explaining, oh, what's it like? You know, if you're sober curious, get curious and try it out and see what it's like.

And just see what the joy of life feels like the body does naturally. You know, it's pretty amazing. We are talking a lot about being mindful and aware. And something that helps so much with this is, of course, meditation. You know it has changed my life. It is my number one wellness tip. and it affects every single area of my life in a positive way. It is a surefire way to be sustainably less reactive, calmer, more at peace, more present, more grateful, happier.

And there are many different modalities, but Headspace is a fantastic resource and just a great place to begin and maintain your meditation journey. So it's an easy to use app that delivers your daily dose of mindfulness and the form of guided meditation. I love using Headspace if I'm feeling overwhelmed, if I need to do kind of a quick refresh meditation, if I can't sleep. They have a three-minute S-OS meditation that is my go-to if I am getting panicky, and I just love their approach. Headspace is advancing the field of mindfulness and meditation through clinically validated research, and it can seriously help to reduce stress, improve sleep, boost focus, and improve

your overall sense of well-being. I always say if we could get all of that from a pill, we would take it. This just takes a little bit of willingness and discipline on our part and the benefits are massive. You deserve to feel happier and Headspace is meditation made simple. Go to headspace.com slash blonde. That's H-E-A-D-S-P-A-C-E dot com slash B-L-O-N-D-E for a free one-month trial with access to Headspace's full library of meditations for every situation. This is the best deal offered right now. So again, head to headspace.com slash blonde. Something that has really helped me with my anxiety that I kind of keep in my toolbox, so to speak,

is Ned CBD. Now, you guys know I am sober, and this is something that I really researched and explored before taking. And Ned is really the only brand that I'm super comfortable with because of their ethos, and the quality of their product. So you know that I do therapy and meditation and journaling and I work out and eat well and all of the things, but sometimes I can't shake this feeling of tension and anxiety no matter what I do.

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Again, that's H-E-L-L-L-O-N-E-D.com slash B-L-O-N-D for 15% off your first one-time order or 20% off your first subscription order plus free shipping. So we're kind of hopefully coming out on the other side of a really unprecedented year and a lot of probably collective trauma and fear and uncertainty and anxiety, have you and how have you seen that affect people that you work with? And do you have any advice on how to deal with some of the stuff that has come up in the past year? I've seen a huge spike in anxiety in particular over the last year. And it's funny because I was just finishing writing my unwitting anxiety book last

spring just serendipitously. I just happened to be writing this book. And I had to add one to two chapters at the beginning because there was so much information coming out about the anxiety, you know, as a secondary epidemic that was on the heels of this pandemic. And it was, it just fits. I mean, from a scientific perspective, it's fascinating because it just kind of proves exactly why we get anxious, which is our brains don't like uncertainty. Guess what? A whole lot of uncertainty starting back in March of 2020 or earlier for some people. And that uncertainty didn't stop, right? We still have, you know, oh, variance. Oh, schools. Oh, economy. Oh, this, oh, that. You know, we still have these spikes of uncertainty that are happening

over a year later. So, you know, this is, so I've seen anxiety spike, and I see exactly why it's happening, which is that our brains don't like uncertainty. You can think of it as like fear helps us survive. Uncertainty helps us go get, gather information. You know, it's kind of like our stomach rumbles when we're hungry, our brain rumbles when we don't have information when something's uncertain. Yet when there is no answer, that uncertainty, you know, that fear plus uncertainty equals anxiety,

it can spin out into all the what-if scenarios if we don't know how to work with our minds. So we move into from our comfort zone when we, you know, things are certain, into our panic zone. We've seen a lot of panic over the last year, you know, toilet paper, all these random things that people are just panicking about. Yet there, if we know how our minds work, we can actually move into our growth zones and lean in to the uncertainty because that's what our brains are designed to do. It's like, go get information. Don't freak out, get information. When we freak out, it's harder to get information. It's harder to think and plan.

So how can people do that? What if somebody's listening to this? And they're like, I am not mindful. I don't meditate. I don't know how to do this. I don't know how my mind works. What's a good starting place besides buying your book? Yeah.

Which everybody go buy the book. It's amazing. Thank you. Well, so I'll give everybody the three-step process that I outlined in the book and is also the same process that we use in our unwending anxiety app, which, by the way, I'll just mention there are tons of apps out there. My lab studies to see if this stuff actually works. And we got, we did two clinical studies, one with anxious physicians. We got a 57% reduction in anxiety. One with generalized anxiety disorder.

We got a 67% reduction in anxiety. So I would have to say, you know, if an app could do a mic drop, that app, you know, let's just say it does all right. So. And just sorry to interrupt you, but compare that to, isn't it called the number to treat? Yeah, there's this number needed to treat, which is a quick and dirty way of calculating how good a treatment is. So with medications, and I prescribe medications, the number needed to treat is 5.2. So I have to treat five patients before one person shows a significant reduction in symptoms.

So I'm basically playing the medication lottery. And what do I do with the other 80%? You know, with this study with generalized anxiety disorder, a number needed to treat was 1.6. Yeah. Big mic drop. Yeah. So the three-step process is basically, well, people don't have to remember more than one word, which is awareness. Okay.

So you don't have to meditate. You don't have to remember anything else. Just remember the word awareness. And here's the context for that. First, we have to map out our habit loops. So what's the trigger? What's the behavior? What's the results?

And we actually have a free habit map or anybody can download it from mapmyhabit.com. So download the PDF, start mapping out your habits first step, really straightforward. Second step is a little less straightforward, but you and I've already talked about it. It's about hacking this reward value piece of our brain. So I have people ask a simple question, what am I getting from this? So we talked about, you know, having people pay attention as they overeat and seeing what they're getting with any habit, whether it's worrying or procrastinating or overeating or overeating. or whatever, when we're doing it or right after we're doing it,

we can ask ourselves, what did I get from this? So that our brains can update that information and we can see just how rewarding it is right now in the present moment. Okay. So we need awareness to map out habit loops. We need awareness to update this reward value. Third step, also based on awareness. And we talked about this as well.

Curiosity is that bigger, better offer. So you can think of awareness already is there. So when we have a craving to do something, we can get curious. And now we've already tapped into that bigger, better offer. So that's what I would say for anyone. Notice how I didn't say, sit down and meditate for 45 minutes or light some candles or whatever. No, awareness, awareness. Yeah, I think that's where I lose people.

I started doing TM a few years ago. And so I'm kind of an evangelist about it because it just helped so much with my anxiety and my awareness. But I think people's eyes kind of glaze over because they're like twice a day, silent, 20 minute, no, can't do it. Now, certainly, and I've been meditating for about 25 years now. So, you know, meditation can certainly help provide that baseline foundation like you're talking about. Yet in the moment when somebody is struggling with anxiety or a craving, that's when they can bring awareness in using this three-step process. So they can use this anywhere. And the two go together really nicely.

Some of our research studies have shown that. Is anxiety ever a good thing? I think that we're talking about anxiety. Like it's the big, bad thing, and we have to get rid of it no matter what. But when can it can it and when can it be useful? I have not yet found any data suggesting that anxiety is useful. The best that I found is that it is this, you know, it's our thing. thinking and planning brain going off the rails. So it's part of a normal process that our brain is

trying to help us get information. Yet when we can't get that information, we start to freak out. So not only does anxiety feel bad, it's associated with all sorts of bad health outcomes, but it makes it hard for us to think. And there have been plenty of studies showing that the more anxious we are, the worse we perform. So there's this myth. around performance anxiety. I write a bit about it in the book because this is a big thing. People say, but I need to be anxious to perform well.

No, you don't. There's no evidence of supporting that. Yet our brains are really good at making associations, false associations, where they say, you know, A, I'm anxious, B, I perform well, and then they attribute what's called causality, where they say, oh, because I was anxious, I must have performed well, not true.

It's just an association, and our brains love to ascribe causal. causality to that. And there was this, you can get into all this stuff about these York's Dodson curse and all this stuff. That was Japanese dancing mice back in 1908, in case anybody's curious, where they found that if they shock them, you know, they basically, you know, a moderate amount of shock got them to perform best on a, on some task that they had the Japanese dancing mice do. For humans, nothing, no amount of anxiety has been shown to improve performance. So how has your anxiety improved over the years since you started studying this and since you were a med student?

Well, let's just say, so I certainly had anxiety that was even leading to physical symptoms going into medical school. I won't go into all the details, but let's just say my GI tract wasn't the happiest. And I would get panic attacks in residency, so that wasn't fun. yet I found that the, so I haven't had a panic attack in a long time, I've certainly started to panic at times. And, you know, and I'm thinking of, you know, like when I get caught inside a set when surfing and I feel like, you know, I'm just getting hammered and, you know, my brain starts going. Right. Yeah. It starts saying, you know, you could, you could actually drown here.

And so being able to, so my mindfulness practice has really helped me be able to notice that. that, okay, here's a thought, right? Freaking out in this moment's probably not going to help you survive, right? And be able to work with the panic in those moments. I certainly still feel feelings of anxiety come up. And when they come up, I can relate to them differently than I used to. I used to get caught up in it. I can now get curious about it.

Oh, here are these physical sensations. So I don't feed the process. I don't get caught up in it nearly as much as I used to. It sounds a little bit stoic, like non-judgmental. It's not good or bad. It just is. Yes. I think they're often stoics get this bad rap where it's like the non-feeling. That's not what stoicism is about at all. I think they're huge overlaps with the little than I know about stoicism and what I'm talking about here. I think of it is they try to see the world really clearly. And there's a huge overlap with, you know, Apasana, it literally means to see clearly.

So whether it's Buddhism or stoicism, they've got a commonality there where they're realizing, oh, if I see the world clearly and don't get caught up, I'm not as reactive. I live a better life. Shocker. They were on to something back then. Yes. All right. I want to get to listener questions.

So let me pull them up here. Okay. We kind of covered this, but maybe to just kind of condense it. are small ways someone can start being more mindful today? One of my favorite practices right now is called five-finger breathing. I talk a little bit about it in the book, but I also did a short YouTube video. I did a coronavirus pandemic series back last year to help people with a bunch of different anxiety-related things.

And it's a great practice because all we need is basically two hands. And as we breathe in, we can start tracing up, let's say, the outside of our pinky. And as we breathe out, we trace down the inside of our pinky. And you get the idea, you know, as we trace a finger, you know, in five breaths, we've traced from our pinky to our thumb. In 10 breaths, we've traced back. And I like that practice because it, our brains can only hold so much information in this working memory, in our working memories at one time.

And we're forcing our, it's called the, dorsalato prefrontal cortex, we're forcing that part of the brain to pay attention to four things. So physical sensations on two hands are breathing and our vision, watching our hand. And what that does is it crowds out any worry thoughts. And then if we've taken, say, 10 breaths, we tended to have our physiology calm down at the same time. So now when those worry thoughts come back in, there's a mismatch between how we feel and what we're thinking and our feeling body drives behavior much more than our thinking mind. So it's much easier to see a thought like, oh, there's that worry thought. I don't feel anxious right now. Okay, let's go with

that. And so it's a great way to help people ground in, you know, any situation. We kind of covered this, but a lot of people asked how to break the phone and the social media addiction. So maybe we can just walk through the process, start to finish. If say I'm feeling like I want to be. pick up the phone and go on Instagram? Yeah, it's a great question. So the first thing I would start with is, you know, step one and have somebody start mapping out the habit loop. So what triggers somebody to go pick up their phone?

Let's use, we can use Instagram as an example. So what triggers that urge to go check Instagram, you know? Is it a thought? Is it feeling bored? Is it feeling, you know, anxious, whatever? So map that out, you know, what's the trigger? The behavior would be going on Instagram or social media. And then the results, which, you know,

they can start to check that out. So, you know, what am I getting from this? So not only are they mapping that out in the first step, in the second step, they're starting to ask, you know, what am I getting from this? And that's, you know, that's really where the money is. It's like, okay, is this distracting me from something? Is it helping me procrastinate? So what am I actually getting from this? You know, am I spending endless, you know, am I spending a lot of time scrolling? So, for example, in one of my classes at Brown, I have students pick a habit to work with, and a lot of them pick social media as a habit. And they just start tracking, you know, how much time they're spending on social media versus, like, actually talking to their roommates or talking to their friends and spending time with them. And they start to see, oh, it's really not that great to spend five hours on social media as compared to spending five hours in my college experience.

So here, you know, they start to see, oh, spending all this time on social media is not, doesn't really feel that great. It makes, you know, often there's the whole social comparison thing. So we feel bad. There's the fear of missing out, you know, the FOMO where they're like, oh, everybody else is having a great life and I'm not. So on average, you know, it's not a great, you know, it's not a very rewarding thing. Sure, cute pictures of puppies or whatever. Occasionally, you know, there's nothing wrong with that. not like we're going to suddenly hate it. But we can start to see, you know, where's that sweet spot

between, you know, having a break from work or whatever and something that where I'm spending way too much time. And I'm driving the addiction. Every time we get caught up in it, it makes it makes that habit loop stronger. So that's kind of the second and third step is that, okay, what do I get while I'm spending a lot of time on this? And then just comparing it to what it's like when they don't spend as much time on it or just, you know, start to put it down sooner. oh, it gives me more time in my life. Oh, maybe I'm less anxious or less, you know, less jealous or feeling less self-judgmental because I'm not spending all this time, you know, being fed information that's telling me how

I'm not good enough. So that's the three steps with social media. I have a few questions pertaining to that. The first is how long does it take to create a new neuronal pathway, you know, to not reach for the phone or the cookie, but to do something. something else? Well, there are a lot of myths out there, thanks to the internet. I think the most perpetuated one that I've seen is 21 days. That's based on... Gimicky. Yeah, it is totally gimmicky. And this is based on a plastic surgeon writing a book in the, I think, in the 1960s,

who talked about how it took his patients about 21 days to get used to their new nose job. So very specific thing. And it was some dude writing a book. You know, it wasn't even a science. end of a study. Right. So here I would say it's variable. So it really depends person to person. But what I can say on average, at least in one study that we did, you know, 10 to 15 times of people paying attention as they overate actually started to shift that habit from

overeating to not overeating. So here I would say the more someone pays attention and really, you know, gets into that second step of what am I getting from this, the more disenchanted they'll get, the more quickly. and then they can actually shift that into, you know, that BBO, whether it's stopping an old habit or even just, you know, you can use the second step with good habits. You know, it's like, oh, what's it feel like when I exercise or like we were talking about? What's it feel like when I don't drink if somebody's so precarious? You can get into that habit pretty quickly, the more you see how rewarding it is.

So I could be wrong, but I think that they found that there's less teenage drug use and drinking, I believe in the last, I don't remember how long, but I think there was maybe a correlation or I don't know if it was an actual correlation between social media and cell phone use and drugs and alcohol or lack thereof of using. I don't know if you saw that. I have not seen it, but, you know,

if you think of it as teenagers are going to get addicted to something in some proportion, maybe they're spending all their time addicted to social media. Yeah, I think the indication was that they're just not socializing as much because they're on social media and socializing that way. So numbers were down. I could be wrong. But in terms of outcomes between, say, drinking or drugs or smoking or binge eating, stress eating, phone addiction, how do they compare, if you can compare them at all?

Yeah, I've not seen a direct comparison there in terms of the rates or the use of the outcomes of those. Yeah, it's pretty variable. So it depends on the study. It depends on the treatment. And here, you know, I would say in general, treatments haven't been very great at helping people with any type of addiction. You know, the willpower-based approaches

have not been shining stars for us as a planet. So I think as we start to see shifts into, you know, neuroscience, more neuroscience-based approaches, you know, around, say, reward value, I think we're going to see those numbers. change. And I think we'll also see, you know, we're seeing this digital therapeutic revolution where people are learning to use technology in a healthy way. You know, we've talked about addiction to technology, but it can actually be used in a healthy way. You know, that's why

we develop app-based mindfulness training programs because it can be mindfulness training in your pocket as compared to the slot machine in your pocket. So I think as those techniques and technologies are brought to bear more, I think that's actually going to be really useful. Yeah, it's a brilliant treatment because it's kind of the same mechanism, but different drug, if that makes sense. What is the greatest misconception about anxiety? The greatest misconception? Well, I'll have to say my greatest misconception or the thing that I didn't know

was that it could actually be driven like a habit. I never learned that in medical school or residency. And I'd say it's the greatest because when we actually, approach it from that perspective, we can get huge benefit, huge results. And so for me, it's, you know, not knowing that anxiety could be driven like any other habit. Somebody asked, why do we repeat bad behavior, bad behavior? I'm doing that in quotes. When we know we shouldn't, and we've kind of covered this, but I've been thinking about this a little bit too, like back to the eating example. So say that I, every night, go down and have some chocolate

or a cookie. And there aren't negative consequences. Sometimes maybe the sugar will keep me up a little bit or maybe I won't feel so great the next morning. But it also brings me so much joy. Is that a problem or does it just depend on the person? Well, this goes back to the continued juice despite adverse consequences piece. So I'll just give, let's use cookie and chocolate that example is because I can give my own experience with this. When I eat, I remember somebody bringing fresh baked chocolate chip cookies over to my house. And I, so I eat the first one. It's great. And I immediately want a second one. I eat the second one, you know, and I immediately want a third one. And I'm noticing how it's probably the sugar content there in terms of the refined

sugar. It just drives me to want to eat the next one. It used to be addicted to gummy worms. I would have to eat the whole bag, you know. Whereas when I eat dark chocolate, especially, you know, like 70% or higher, I really, you know, like 85% is really, I really enjoy that. I can eat a couple of squares and I'm totally satisfied and I don't have a craving for more. So there's something driven, you know, that drives us, probably that sugar thing saying, hey, calories, survival, go get some more calories. So there it's really about, you know, where are the adverse consequences?

So it's not like a cookie's a bad thing. It's just about how do we want to live our lives? I don't want to be driven by constantly thinking about chocolate chip cookies. You know, they taste good enough, but I have to say chocolate, for me, tastes just as good and I don't have that restless quality. I feel very satisfied. So I think it really comes down to, you know, focusing on like where, where's that pleasure plateau going off the cliff of, you know, overindulgence?

I called my friend the other night because I was eating a cookie and I said to her, the same thing that happened to me when I was drinking is happening to me now. I'm having a reward malfunction here because I was not even hungry, but I thought I would just have one because, you know, whatever. And I mean, instantly, and these didn't even have refined sugar. I was like, but, you know, I just, I needed more and more and more and it's like one is too many, a thousand is never enough kind of thing. But it's funny, I just had another doctor on my show this week. And he said the same thing, about 85% or more chocolate. And all of my listeners said, I'm going to buy 85% right now. So maybe there would be a shortage. Well, it's funny. I think any chocolate that's above 70% is considered health food because they can't get enough sugar in there for it to fall out of the health food category.

And it's got all these positive benefits. Amazing. Yeah, if you can't find 85%, you can still. do the 70, you know, 70% or above. I have to say there's, I love Trader. Trader Joe's has the 72% that's actually got a really nice mouth feel to and tastes really good too. And their 85% is killer. Nice. Okay. I'm going to go get that. Well, I like to ask everybody, what is one thing that we should maybe stop doing today and one thing we could start doing today? That's a great question. So one thing I would say to stop doing is,

stop letting your cravings drive your life, not through willpower, but through awareness. And the one thing I would suggest people start doing is just doing like one or two kind things, like to yourself or to other people without looking for anything in return, and just pay attention there to see what it feels like. Because I'd love to see, you know,

instead of fear spreading through social media, let's spread kindness. It is definitely the bigger, better offer, and it's something that our planet needs right now. Yeah, and sustainable returns, too. Yes, yeah, zero calorie, you know, pay it forward, all that stuff. It's true. Love it. Thank you so much for coming on. It was so much fun talking to you. Oh, it's my pleasure. I hope you enjoyed that episode. if you liked it, and if you like the show in general, please take a second to rate, review, and subscribe.

It goes a long way, and it's actually the best way to support the show. Also, if you want to see more about each episode, you can head over to The Blonde Files podcast on Instagram. I'm always posting about each episode there or over on my personal page at Ariel Laurie.