Can awareness and curiosity be the secret sauce to fighting our epidemic of worry and anxiety? The MOST fun you’ll have learning about mental health, I guarantee ūüėā

Dr. Jud Brewer is an addiction psychiatrist and neuroscientist. He is an associate professor at Brown University and executive medical director at Sharecare. His new book Unwinding Anxiety: New Science Shows How to Break the Cycles of Worry and Fear to Heal Your Mind is now a New York Times best seller.
 
 
 

Click here for easier navigation through this show’s key topics

0:00 Intro

2:09 A doctor’s personal approach to breaking the spiral of anxiety

12:07 Approaching anxiety/worry as an addiction or habit

17:36 Behavior versus reward in relation to ‚Äúwillpower‚ÄĚ

23:55 Mindfulness, the importance of awareness and its connection to the reward-value of worrying

34:49 The cognitive distortion of ‚Äúshould‚ÄĚ statements

37:26 Understanding the importance of the ‚ÄúBigger Better Offer‚ÄĚ

45:05 Neuroscience of anxiety and show summary

 

Full Transcript Below

Dr. Z: What’s up everyone, Dr. Z. Today I have Dr. Jud Brewer, author of a new book, “Unwinding Anxiety,” new science shows how to break the cycles of worry and fear to heal your mind. Okay, look, normally, like Jud’s been on the show twice and normally I have to like remember an introduction that really puts into words what this guy’s about. Luckily, we’ve got one right here. Let me read this, shall we? Judson Brewer, MD PhD, is an internationally renowned addiction psychiatrist and neuroscientist. He’s the Director of Research and Innovation at Brown University’s Mindfulness Center, as well as an assistant professor in both the School of Public Health and Medical School at Brown. His 2016 Ted talk, “A simple way to break a bad habit,” has been viewed more than 16 million. Okay, now, gunner, Jud, why? Why do I hate you so much? I mean, look, MD PhD, but what really got me was the 16 million views on the Ted because now you’re in my space. I don’t have 16 million views on my Ted talk. I mean, what was different about that thing? And how do I get some of that juice?

Dr. Brewer: Yeah, I think you’ve got the juice, my bro, it’s just about getting caught up in it. That’s the problem. Maybe we could talk about that a little bit. Let’s do that because because this idea of curiosity and this deep interest in stuff is what actually drives a lot of your work. For people who still don’t know, like you’ve done some of the seminal research with fMRI on looking at how the brain and the mind works, mindfulness, approaches to managing anxiety, which is, first of all, it’s killing us right now. It’s killing us. And I’ll tell you, like, just because you’re my free therapist right now, by the way, do you like my shirt?

Dr. Brewer: That is awesome.

Dr. Z: So a fan made this for me, one of our supporters, anytime I say something crazy, I’m just going to show the shirt and we’ll let the audience decide, right?

Dr. Brewer: That’s right, enough said.

Dr. Z: So, this very morning, okay, like many in the pandemic, there’s these low levels of anxiety and sometimes high levels of anxiety. So this morning I woke up at 4:30 AM, heart pounding, I don’t remember if I had a dream or what but you could feel that visceral sort of body sense of anxiety and what was strange, Jud, is I don’t know what the trigger was, I don’t know what it was about and I couldn’t pinpoint why it was happening, but I had to get up because I couldn’t sleep because what it did was it triggered a thought storm of all the different things that could have caused anxiety. I got up, I went and had coffee, I meditated, I washed my mind, it cooled down, et cetera, but I would have liked to have gotten another hour or two of sleep and what are your thoughts on this?

Dr. Brewer: Yeah, well, about a gazillion things here. So one, you’re describing just about every one of my patients that’s come into my clinic over the last year.

Dr. Z: Really?

Dr. Brewer: Yeah, so they say, I wake up, no kidding, they wake up and they’re like, I just anxious, I don’t know why, I can’t figure it out. And they spend all day. So you went, you broke the cycle, you went and meditated, right? They go and they start spinning out of control, worrying about why they’re anxious and trying to figure it out, which, surprise, makes them more anxious, okay, so that’s one piece of it. The other piece is I’ve watched myself. So when I first started practicing as a psychiatrist, I was struggling with my own anxiety with helping them with their anxiety. So, and actually in residency, I used to get panic attacks. I write about that in the book, but here this, you know, it’s interesting with medications there’s this term number needed to treat, right? You can actually calculate this with any treatment. So basically it means how many people you need to treat with X before they show a significant reduction in symptoms. So medications, for best medications for anxiety that number needed to treat is 5.2. Meaning I have to treat five patients before one shows a significant reduction. So two things there, one, I’m playing the medication lottery because I don’t know who’s going to benefit, but worse, number two, what am I going to do with the other 80% of them that don’t benefit from, don’t show a significant reduction in symptoms with medication? So I was starting to get anxious and on top of this, with the pandemic, with all this uncertainty, ’cause our brains hate uncertainty and we can geek out about that if you want, everybody’s anxiety has skyrocketed. So it’s gone, I’ve seen numbers like 250% increase in psychological distress, 290% increase in, I think it’s diagnosis of anxiety disorders just in the last year.

Dr. Z: And that’s just me. That’s just one, that’s an N of one.

Dr. Brewer: You’re accounting for that whole 290%.

Dr. Z: Everything that’s gonna happen all show, I’m just going to show my shirt. Dude, by the way that mug is off the chain, look at that. Wow, focus on cats. Stay curious, pounce on opportunities, okay, so this gets into the curiosity. Okay, but, ah, man, Jud, this is why I hate talking to you. I hate it actually, because every time I talk to you I have about a trillion thoughts about that I want to follow up in these threads that you bring up and you open this sort of gate into the possibilities of actually managing our mind and understanding our mind and relieving suffering. So let’s unwind one of those, this increase in anxiety since the pandemic and you mentioned this uncertainty, this idea that we’re really, this is very uncomfortable for us and let’s talk, let’s just bring it right to the right now because you’re about mindfulness. It’s the present moment. The present moment, people are crapping their pants about Johnson & Johnson and AstraZeneca and the one in, you know, a lightning strike chance of getting a blood clot from one of these drugs. People don’t understand. They’re uncertain. Some of them have gotten the Johnson & Johnson shot already before it got paused and they’re just messaging me with, if there was a panic emoji that was this big, they’re using 12 of them. Tell me what to do. How do we manage this?

Dr. Brewer: Yeah, well this goes back to how our brains work. And now I’m wondering what is the likelihood of lightning strike? It’s probably actually more frequent than these side effects, to be honest.

Dr. Z: ¬†I actually, I looked it up because I did a show yesterday on this, it’s about per year for an average person about one in 500,000 and the Johnson & Johnson risks, so far, there are six per 6.8 million, so you’re talking about less than one in a million.

Dr. Brewer: Okay, so lightning more dangerous.

Dr. Z: ¬†It’s twice, lightning strikes are twice as dangerous, Jud, as the Johnson & Johnson vaccine.

Dr. Brewer: Okay, so what are we talking about here? Well, the key is not the actual risk because if that were the case, then they would cancel lightning, right? You know, it’s like, okay, you know, that’s right.

Dr. Z: ¬†That’s what, lightning’s wearing that shirt right now. You’ve triggered lightning. That’s amazing. How do you even do that?

Dr. Brewer: So, it’s not about the actual risk, right? Because if you look at the risk, you know, well, we don’t need to go there, but our brains just don’t like uncertainty. And so if you just look at this and people say, “Oh no, you knew AZ, you know, had these effects, Johnson & Johnson had these effects,” people freak out because they don’t know what’s happening. We saw this at the beginning of the pandemic. We didn’t know how dangerous this was. Okay, tell me the truth, how long did you leave your packages outside your front door before you felt they were safe to pick up? Three days, a week?

Dr. Z:  This is a deep source of shame for me, Jud. In the early days, because I did believe the fomite hypothesis, I was leaving those packages out for like two days and just leaving them in the sun to UV bake.

Dr. Brewer: Yeah, yeah, I did the, I was three days.

Dr. Z: ¬†Again, you’re such a gunner, dude.

Dr. Brewer: Yeah, I know. I beat you, I beat you again. So the point there was, we didn’t know, right? I’m a scientist, I’m an immunologist, right, that’s what my PhD is in is immunology.

Dr. Z: ¬†I didn’t know that, wow.

Dr. Brewer: Yeah, so it’s not that I don’t, I suddenly lost all my sense of what immunology was, it was just that this was a new virus and nobody knew, you know, maybe this is the magic virus that’s suddenly going to be able to survive in environments where it’s never, viruses don’t survive. We just didn’t know, right, and so everybody was like, “Well, I’d rather leave the packages out then be the first person to die from touching my UPS package, you know, I don’t want to be that guy.” So, it’s about this uncertainty. So if you go back to these, you know, pausing on the vaccines, it’s uncertainty and people don’t like uncertainty, which goes back to our ancient survival mechanisms. You know, so you can, and this might be helpful just unpack this briefly. We’ve got these survival brains that help us survive through fear, right? So we’ve learned things through fear and say, “Oh, you know, that’s dangerous, don’t do it again.” But that’s our old survival brain. On top of it is layered our neocortex, literally the new brain that helps us survive in a different way and what it does. So through fear, and that old survival basically helps us find food and avoid danger, right? So when the new brain layered on top of it, it helps us survive in a different way by projecting into the future past experience, okay. So we don’t have past experience with the pandemic. At least none of us that are alive. And we don’t have past experience with these new vaccines. Now vaccines have been developed before, so it’s not like we don’t have any experience with vaccines at all, but it’s like, oh, new vaccine. So therefore people are freaked out because just anything that goes, that looks potentially funny, we’re going to freak out about it. And there’s been a lot of hype made about, Oh, these are new vaccines, right? Whereas things like the RNA technology’s been developed for decade, over a decade, right? That start, that’s not new, it’s just that we’re using these and everybody’s highlighting how new these are. So this neocortex, it projects into the future and when it doesn’t have accurate information, it goes into worry mode, it starts freaking out. So you can think of it as this way. So our stomach rumbles when we’re hungry signaling we got to go get food. Our brain rumbles, the neocortex rumbles when it doesn’t have information, yet the problem is it runs off a cliff when it can’t find that information. That’s when we spin out into worry and panic.

Dr. Z: ¬†That actually seems to make a lot of sense to me. It actually feels not only intuitively right to my old brain, but intellectually right to my new brain, which is now trying to figure. And this is a great, man, the fact that you use the new mRNA vaccines and example is perfect because here’s a technology, like you said, it’s been a long time, but people don’t know it, so they think, “Oh, this new, is it gene therapy? I’ve heard that, that’s new. That hasn’t really been used.” And then the questions that I get on yesterday’s live show where I talked about vaccine fears and understanding risk and this risk of lightning strikes, et cetera, the questions I get is, “Well how do we know what the long-term effects are?” In other words, I have no experience with this. It’s outside of my human experience, so I can’t project into the future with any certainty, therefore I’m projecting anxiety into the now. And what I tell people is no, we actually do have quite a bit of experience with vaccines. We’ve not ever seen long-term side effects that you’re worried about. There’s no reason to expect this is any different, but it’s normal to worry about it. And I tell them like it’s just normal to be scared. If you’re not like afraid, you’re not a human, right.

Dr. Brewer: Yeah, yeah, that’s how our brains work, full-stop.

Dr. Z: ¬†Yeah, so you don’t have a brain, you probably .

Dr. Brewer: You have bigger problems.

Dr. Z: ¬†There’s other problems, yes, exactly. Anencephaly is a problem. So, that being said now, you still have a clinical practice, right?

Dr. Brewer: Yes, yes.

Dr. Z:  And so what are you seeing in this practice and how are the techniques you use in the book? How do you actually deploy them? Like kind of walk us through some actionable stuff on this and then we can dig into curiosity and things like that.

Dr. Brewer: Yeah, I’d be happy to. So, you know, I actually take a neuroscience approach in my psychiatric practice, which, you know, I mean, it’s because I didn’t actually learn something fundamental in my psychiatric training. And I don’t think it was because I, well, maybe I slept through some of it, but I don’t think this was standard practice in what we had learned in psychiatry. So it’s interesting historically, you know, we’d been, so I was mainly trained in psychopharmacology, you know, learn these medications, learn the side effects, all this stuff, and when these medications were first, so the newest class of medications, like the SSRIs were being developed back in the ’80s, right, so we don’t have anything really newer than that. Back in the ’80s, do you remember The Stone’s song, “Mother’s Little Helper”?

Dr. Z:  Yes.

Dr. Brewer: She goes running, can you sing a few bars?

Dr. Z: ¬†No, ’cause I’ll get canceled, ’cause look. ‘Cause I’ll do it in an Indian accent.

Dr. Brewer: So she goes running to the shelter of mother’s little helper and it helps her on her way, it helps her through a busy day. Those are benzos, right, they were being prescribed like candy back in the ’80s, okay?

Dr. Z:  Yeah.

Dr. Brewer: In the ’80s, so they’re like, oh, benzos, maybe we shouldn’t be prescribing these so much we figured out recently, right, so I have a bunch of patients who come to me, who’ve been on benzos forever and they’re like, “I don’t want to stop that.” So in the ’80s they were developing these SSRIs and all the eyes were on medications, yet in the ’80s, there was also a lot of work being done where like Thomas Borkovec and others were suggesting that anxiety could actually be driven habitually like any other habit. And so I actually learned about this because we were doing, maybe you and I’ve talked about this before but we’d studied this Eat Right Now app where we, mindfulness training for eating. And somebody in that program said, you know, what’s driving my stress eating is anxiety. Can you make a program for anxiety? And I was thinking, I prescribed medications for anxiety, but as we saw, you know, number needed to treat not so good. So it put a bug in my ear to go back and look and I found this literature and I was like, holy shit, I know how to work with habits And I never thought of anxiety as a habit. Let’s do that. So that’s where we actually developed an app-based mindfulness training program and as a researcher, I want to see if that actually works. Long story short, we did a study with anxious physician, 57% reduction in anxiety. We did a study with generalized anxiety disorder patients. We got a 67% reduction and there we could calculate number needed to treat. Ready for this? 1.6. So if an app could do a mic drop, that app would be doing a mic drop right now.

Dr. Z: ¬†But it won’t do it in an Indian accent, mm-hmm. So that’s actually remarkable. And we talked a little bit about this in our show we did almost a year ago that this idea that anxiety is a habit. You can treat it like an addiction in a sense. There’s this idea, we went deep on that. I think operant conditioning and all kinds of stuff we talked about then, this idea of behavioral modifications as opposed to just throwing benzodiazepines the Valiums and the Ativans and so on, the Xanax. And the fact that your app has a number needed to treat that’s almost like close to one. Like almost everybody you treat as opposed to medications, which what was the number needed to treat again?

Dr. Brewer: 5.2.

Dr. Z:  5.2, you got to treat five people to get one success. The other four get the side effects of the drugs, no benefit, and still suffer from the underlying condition.

Dr. Brewer: Yeah, so they might get a little bit of benefit, but this is, you know, we’re looking about, looking at like how can we get to the point where somebody is showing a remission basically.

Dr. Z:  Remission.

Dr. Brewer: Really being helped.

Dr. Z:  Got it, got it, got it.

Dr. Brewer: So, you know, I don’t want to discourage folks from using medications. I still prescribe medications, but I, you know, I bring in other things as well. But the key piece here was that we were actually starting to see a naturalistic progression as people were using mindfulness training. And that’s actually why I wrote this book was that there seems to be a three-step process that anybody can use to actually work with their anxiety. And it all, the nice thing about this is you don’t have to remember anything except one thing, which is awareness, but we can certainly go into the details. But if people, you know, if they zone out right now just remember the word awareness.

Dr. Z: ¬†So be aware of awareness, aware of being aware. This is the ancient, spiritual teaching, Jud. Like what, this has no place in psychiatry. What’s wrong with you? You need to be penalized by the American Psychiatric Association or whatever the group is that represents your kind. Also my mother’s kind, ’cause she’s a psychiatrist. So let’s get into this because these three parts to the anxiety habit loop. Let me see if I remember from your book, it’s a trigger, is the first one.

Dr. Brewer: Mm-hmm, yeah.

Dr. Z:  And then a, it was a trigger and then a thought. I forget the second one. And then the third one is a result or something.

Dr. Brewer: Yeah, two our of three, that’s not bad. You would like old school.

Dr. Z: ¬†What’s my number need needed to look like an idiot? One.

Dr. Brewer: You’ve just proven it. No, so the second piece is the behavior. And it’s funny that you tripped up on that one because that’s actually, it’s that cause and effect relationship between the behavior and the reward that keeps driving the behavior. But interestingly, you remembered the reward because that’s actually the most critical piece, right? The behavior isn’t as important. So one thing I’ll highlight here before we get into that three-step piece is that in the Western mind we focus a whole lot on behavior. Have you ever seen, do you remember who Bob Newhart, the comedian?

Dr. Z:  Yeah, the Newhart Show.

Dr. Brewer: Did you ever see his skit, “Just stop it?”

Dr. Z:  No.

Dr. Brewer: Okay, so you’ll have to go look that up after the show. There’s this five minute skit that is hilarious where woman walks into the therapist office, he’s the therapist. And she basically says, you know, I have this fear of being buried alive in a box. And he basically says, you know, I’m gonna charge you five bucks for the first five minutes but you won’t need the rest. And she’s like deal. And then he basically says, “Just stop it.” And they go through the whole skit and she was like, you know, but I’m bulimic, he’s like, “Just stop it.” And the idea there is, that’s the approach that we’ve been taking to everything, you know, with weight loss, right. It’s like, just make sure you eat salad instead of cake. And so it’d be great if my patients could just come into my clinic and I be like, just stop smoking, just stop over eating, just stop worrying, right?

Dr. Z:  Willpower, willpower, willpower.

Dr. Brewer: Yeah, it’s all about that that doesn’t actually work. That’s not how our brains work.

Dr. Z:  Exactly, exactly.

Dr. Brewer: I just want to highlight that in case anybody is frustrated by their willpower failure. I’ll just point out that that is a great marketing tool for any program that says, you know, we’ve got the right formula like weight loss, calories out versus calories in, you just failed the formula, you should sign up for another year, right? Great business plan, not so good for the folks that are actually trying to change behavior.

Dr. Z:  Hm.

Dr. Brewer: It’s not how behavior works. That’s not how our brains work. Our brains work based on how rewarding a behavior is. So that piece that you got, you know, trigger, behavior, reward, that reward is the key element. That’s what drives future behavior, not the behavior itself.

Dr. Z: ¬†So tell me about this then in terms of, I mean, again, to me this is so central to clearing up this misunderstanding that somehow we can just power our way through these problems. Like this morning, when I woke up with this anxiety, the more I, like you said, the more I was concerned about the anxiety and its source, which I couldn’t identify, the more anxiety I had and it became a loop and I knew that I had to get up to break the loop and sitting in bed and ruminating. I can’t meditate in bed. It’s one of those weird things. Like, it doesn’t work yet for me. So I had to get up and do it and that worked. Tell me about this loop with regards to anxiety, like what is a reward for suffering anxiety? Like, I don’t understand. Help me understand because this is a central piece of your book.

Dr. Brewer: Yeah, yeah, so one piece here, there are a couple of elements that can be rewarding about worry. So one is it either it distracts us from the worst feeling, feeling of anxiety. So there’s negative reinforcing. It makes something bad go away, or at least less it, right? So if we’re worrying, we’re not sucked into the fear or the anxiety itself. The problem is that worry feeds back and drives more anxiety. So the other piece here is that worry can make us feel like we’re in control or at least like we’re doing something. So think of the parent who has a teenager who just got their driver’s license and the kid goes out partying with friends, you know, on a Friday night and the parent stays up worrying until they hear the garage door open or the front door open and then they can actually relax and go to sleep. I can promise you, or maybe you can disprove this, but I’m going to guess that they’re worrying didn’t keep their kids safe. Yet, they’re like, “Well, I can’t do anything, but at least I can worry.” So they feel like they’re doing something rather than doing nothing. So there’s that reward that comes with just doing something rather than feeling completely helpless.

Dr. Z: ¬†Okay, now I totally get it because it’s, and by the way that statement, if the worrying doesn’t prevent them from getting injured is a non-falsifiable statement in my mind, I mean, I think we can do randomized clinical trials of worrying versus placebo for kid returning home pre-curfew.

Dr. Brewer: Let’s do it.

Dr. Z: ¬†Let’s do it. This is the kind of research that Peter Venkman would have asked for funding for in Ghostbusters. And then the dean of the school comes in and goes “Dr. Venkman, you sir are a poor scientist.” But back to this idea that worrying is a kind of a mechanism of control which is very rewarding for our mammalian mind. Bringing it back to the Johnson & Johnson vaccine. So a female in her 20s emails me, “I just got the Johnson & Johnson vaccine. I’m panicked. I’m very worried about it, et cetera.” Now, you and I both know that what’s done, she got the shot. Her risk is like less, half of a lightning strike, but no amount of concern or worry is going to change whether she gets the side effect or not. All she can do is be vigilant for any symptoms that would go with blood clot. But there’s this loop of reward with the sense of control. Do you think that’s what’s going on there? Is that how you would describe it? Or how would you dig into that?

Dr. Brewer: Yeah, so the worrying says, well, so our brain, you know, again this goes back to our planning brain, that neocortex, which is trying to help us survive. So it is trying to say, okay, let me try to predict the future, which it can’t do, or let me come up with the solution, which it can’t do, but it doesn’t stop it from doing it.

Dr. Z:  Mm. Can I get really weird and philosophical for a second?

Dr. Brewer: No.

Dr. Z: ¬†You have no choice, you’re on my show. He’s like, Jud’s like “no.” What are you gonna do? There it is again. So the distinction between anxiety as a sensation in the body, as a pattern of energy, as something you feel, and the worry, which is the cognitive thought overlay over this feeling is really interesting to me. I think that people who discuss, who are very far down whatever spiritual path they’re on, where they’re very attuned to present moment, they can experience anxiety as an energy feeling and dive right into it now, like really experience it without the habitual thought pattern that arises that then they identify with that then triggers more anxiety. And what they almost exclusively describe is that it’s a feeling and then it evolves and it dissipates in its own time without me flogging it. Same with anger, same with guilt, same with shame. What’s your take on that?

Dr. Brewer: Yes, I’m glad you bring this forward because this is the piece that actually feeds back and drives anxiety and is also workable, can be worked with. So the feeling of anxiety like you’re talking about is, can be felt as energy can be felt as vibration, tightness, tension, whatever. And when that triggers the mental behavior of worrying. So the feeling of worry can trigger the mental behavior of worrying, that worrying is what feeds back and drives more anxiety. And the worrying is something that we can work with. We can’t work with the feeling, we can’t change or fix or prevent the feelings of anxiety, right. You woke up and you just felt those feelings of anxiety. When you started worrying, if I’m remembering this correctly, that actually just spun back and made you more anxious. Yet, when you went and meditated, you were able to step out of that loop. And that’s actually that second and third step of this whole three-step process. So just as an overview, you know, step one is just mapping out these habit loops. If we can’t see that we’re, you know, there’s a trigger that we’re worried or procrastinating or stress eating or whatever, whatever our worry habit loop is, if we can’t see that, we can’t work with it, right? So it sounds like you’re able to see that, “Oh, I’m worrying.” The second step and you made it, you might, so this is where spiritually advanced folks can skip second step. I’m just kidding. Nobody should skip it, but it sounds like you skipped it.

Dr. Z: ¬†I was going to say, I’m getting a little triggered here because I don’t want, it sounds wrong. You can’t skip anything.

Dr. Brewer: You’re going to get struck by lightning.

Dr. Z: ¬†One in 500,000, bro. There’s about eight million people in the greater Bay Area, okay, I could easily be one of those, I mean, easily.

Dr. Brewer: This could be your last show.

Dr. Z: ¬†And what’s the NNS, Jud, number needed to strike? I’m sorry. The spiritually advanced second step, second step.

Dr. Brewer: So the second step is really a critical piece around really tapping into the reward value of reward-based learning. So we form behaviors based on how rewarding they are and the same is true for changing behavior. We have to actually tap into how rewarding a behavior is right now as compared to how rewarding it was when we set it up. So I’ll use a separate example and then we’ll come back to how this works with where just to kind of line this up. So with, for example, my lab studies, smoking and overeating. And what we have people do. So people learn to smoke when they’re on average age of around 13, at least in my studies, okay. So they sat down this reward value of smoking, so they’re actually ingesting a toxin and they have to get used to it, get over it, right? Isn’t that crazy?

Dr. Z:  Yeah.

Dr. Brewer: But the reward of being cool or rebelling, or, you know, going against their parents or whatever is higher than that initial nausea that they feel when their body is saying, dude, you’re smoking, you know, you’re bringing a toxin to your body. What are you doing? Same is true even with eating, right? So we learned to develop this composite reward value of eating cake, for example, every time we go to a birthday party, have a celebration or whatever, and that starts in childhood typically. And so we develop this reward value, whether it’s smoking or eating or whatever, that we then carry through life and it becomes a habit where our brain says, “Oh, I see this thing. I know how rewarding it is. I don’t need to relearn this.” It’s actually an efficiency mechanism so we don’t have to relearn everything every day. So with eating, as an example, what we have people do is bring awareness to overeating right in this moment as compared to when that reward value is set up when they were five. ‘Cause we could all eat cake breakfast, lunch and dinner when we were five, right,

Dr. Z:  Heck, yeah. Fruit Loops mixed with Frosted Flakes mixed with just the marshmallows from Lucky Charms, that was breakfast of champions for this guy right here.

Dr. Brewer: Just the marshmallows, I love it. They were so fake that they just dissolved into the sugar that they were, yeah.

Dr. Z: ¬†They were made of some quantum material like, and I’m using quantum in the way like Deepak Chopra uses it completely non-scientifically. It’s a quantum material that just, you know. Me Lucky Charms, that’s not quantum. That’s fake Irish.

Dr. Brewer: I love it, I love it. So this reward value is something that we all have set up. We have this rewire reward hierarchy set up in our brains so that as soon as we see something where our brain says, okay, that’s where we’re doing. So what we have people do is pay attention as they’re doing the behavior right now so they update that reward value in their brain. And so for example, it doesn’t take very long for this to happen. We did a study with our Eat Right Now app where it took only 10 to 15 times of people paying attention as they overate for that reward value to drop below zero. Which makes sense. Our brain is really plastic. We can’t, you know, we can’t spend 20 times getting chased by the saber tooth tiger before we decide that it’s dangerous. Our brains have to figure stuff out pretty quickly and the same is true for reward value. So with eating, with smoking, we can have people really pay attention when they do it so they can see what they get from it. You can do the same thing with worrying. We can ask the simple question of ourselves, “What am I getting from this when I’m worrying? Is it keeping my family member safe? Is it solving the problem? Is it keeping me from getting side effects from a vaccine?” No.

Dr. Z:  Hm.

Dr. Brewer: And when we see that, our brains get, they update the reward value and they say, “Oh, thank you. That’s not as rewarding. I’m gonna open up that space for something that’s more rewarding.”

Dr. Z: ¬†Okay, this is really amazing, Jud, because I think what, let me repackage some of this so that I understand it correctly. So we learned this sort of reward-value patterning maybe in the past for something. Maybe it’s worry, maybe it’s concern, maybe it’s overeating, maybe it’s smoking. We established this reward behavior, et cetera, and there’s usually triggers that trigger it, et cetera. And then now though, that reward may not be the same. In fact, it’s likely that it’s not. And so what’s happening though, is our brain is so good at set it and forget it. Once it’s learned that, it’s conditioned, it’s the conditioned mind and then it’s just autopilot. And so much of our worry behavior overeating addiction is autopilot based on a reward that no longer exists. What you’re saying is, okay, let’s control alt delete or reboot the conditioning that we have by the following. You get the trigger, you feel the behavior and you go, “Wait, let me pay attention. What’s the reward?” Oh, this smoke tastes like shit. Or eating a whole tub of this thing makes me feel bad and I don’t, I’m not comfortable with my health and so this reward isn’t really there. And then you probably have to keep doing that to recondition and get it reset, or is it quicker than that and did I get that wrong?

Dr. Brewer: You got it right, and depending on how much we pay attention, right, it goes back to this keyword awareness. Depending on how much we pay attention, that will determine how quickly that changes. So, as I mentioned in the study that we just, my lab just did, 10 to 15 times of people paying attention as they overate. So people have been overeating for years, with 10 to 15 times, that resets that reward value. It can happen pretty quickly.

Dr. Z: ¬†That’s really remarkable. One thing I was thinking about when you were talking about this idea of worry begetting the anxiety energy, begetting worry, begetting the anxiety energy, to some degree I like, I think of it in my own mind as any resistance to what’s happening right now. You talk about awareness, being really present with something’s that happening, just really diving into it. You can watch your mind and go, oh, it’s interesting. The problem here is not necessarily what’s arising, it’s the resistance to what’s arising in the form of whether it’s worry thought loop, whether it’s maybe you have an intrusive thought that’s coming up, some shameful thought. And you’re like, man, I really, if you really look at your mind, “I really don’t like this thought, this thought is really obnoxious, it’s causing me, and I shouldn’t be having this thought. I should not, this is not welcome here.” And it’s almost like leaning. I have a friend who talks about this who’s a doctor. He’s like, it’s like leaning against the trigger, the feeling, with resistance, and they both keep pushing and sustaining. And if you just killed the resistance it would end the loop. Is any of that something that you see in what you’re discussing here or is this a different concept?

Dr. Brewer: No, that’s absolutely the case. So there’s this, you might’ve heard this phrase, “what we resist persists.”

Dr. Z: ¬†I haven’t heard that, that’s great.

Dr. Brewer: Yeah, so what we resist persists, and you just described that. As we push back on something, it’s going to persist, which ironically, when we do things like, just stop it, and try to tell ourselves to stop something, what are we doing? We’re resisting it.

Dr. Z: ¬†We’re resisting it, yeah. You see, that’s where willpower, I have a real problem with it. Sometimes I think people believe they have willpower when something has happened that isn’t what they think has happened. They think they’re resisting something, they’re pushing against something and it’s going away, whereas in fact, some other kind of surrender or acquiescence has happened, some other some process and they’re attributing it to willpower.

Dr. Brewer: Yeah, willpower likes to take credit for a lot of things that it deserves no credit for. Yeah. You’re also highlighting something, the shoulds. You know, I think of it as, I heard this joke a while ago, you know, we should all over ourselves because, because that too provides this resistance. So if you think about this from a basic mechanistic perspective, is something’s unpleasant, we want it to go away as quickly as possible, and one of the habits we get into is shoulding. “Oh, I should change this, I shouldn’t do this. You know, I should use more willpower.” And that also provides resistance in the form of self-judgment.

Dr. Z: ¬†So you become a should head, is what I’m hearing.

Dr. Brewer: Yes.

Dr. Z: ¬†So, there it is. Am I canceled yet? For the people listening on audio, they’re wondering what the hell, why are these odd pauses happening? And I have to tell them I’m showing them my “Am I canceled yet” shirt. So, Jud, this is interesting because this idea of shoulds is central I think to a lot of suffering in that, especially in anxiety. And I’m actually about to release a clip publicly that I did just for my supporters where I told a story about when I went to Napa recently on a mini vacation with my family and everything was great. And then I got a flat tire on my bike riding with my kids in the vineyards, and we were five miles away. And I was like, “Oh, I should be able to fix this flat. No problem.” And I couldn’t ’cause I’m an idiot, and had the wrong inner tube, all of these things. It spun out into such a disastrous self-blame anxiety attack where I was just out there going my whole vacation’s ruined. All the cognitive distortions like, oh, this is, I’m overgeneralizing. “Ah man, if I can’t ride this bike, we brought all these bikes, my kids are going to be miserable. They’re going to hate me. They think I’m a bad dad,” all this, of course, unconscious. And in this horrible habit loop where I spent two hours of my vacation trying to fix a stupid tire back at the hotel until I finally got in the steam shower. Yeah, I’m bougie as heck, dude. And I’m sitting in the steam shower watching these feelings arise and going, oh, okay, shame, anger, and stop resisting. And it was weird. I actually started crying in the steam shower. It was that much of a release of just this tension that I felt. And then I felt light like the reward of feeling just perseverating on the shame and the anger was gone and the reward of being present with those feelings and accepting them and going, you know, this is who we are. This is of course, shame is here to keep us on track and you’re welcome, but now you can go, okay. I’m not going to resist you. So it was weird, I mean, a very strange thing. And now I’ve said too much and now I’m embarrassed and I’m going to get uncanceled.

Dr. Brewer: Well, the piece that you’re talking about here is actually, so I think you are spiritually advanced. You must be because you’re talking about the third step of this process, the third piece that I talked about in this book, which is I talk about, I call them BBOs, bigger, better offers, right? So our brain, because it sets up this reward hierarchy, if we help it see very clearly that things like worrying and procrastinating and overeating and whatever are not rewarding, our brain says, “Okay, I get it, give me something better.” And so that opens the door for something better. And remember, the only thing you have to remember is awareness. You’re describing how awareness itself is that bigger, better offer because it helps us see very clearly how painful it is to hold onto these things and how great it feels to let go.

Dr. Z: ¬†I love it. The bigger better offer is the spoiler in the book, right? I mean, this is it. This is like here’s what’s actually better than all what you thought was reward unconsciously by your conditioned behavior. And I’ll tell you, Jud, like when I was present all that, and the steam shower helped in that it created this very hot and focused area where this is all I could do was to try to breathe because it’s so hot. And it allowed me to just be present with this and actually, it didn’t even matter what the origin of it was. Feeling the release, going out, seeing the kids, being present with them, being present for the rest of this little mini vacation, it was one of the best trips I’ve ever been on because I was suddenly so present. Talk about a BBO, man. That sounds weirdly dirty. Like, yo, she got BBO, dog, but that’s not. It’s a bigger, better offer. I love it.

Dr. Brewer: It is totally G-rated and what, what you’re describing, you had the hero’s journey. “Oh, we had this trouble where the tire exploded and the kids were going to die and then I had to be in a steam shower, but then it resolved.”

Dr. Z: ¬†The arc, it’s the arc, you know. It’s every Hollywood blockbuster and it had a happy ending. What should have happened, it should have ended up with me strung out on cocaine ’cause that would have been more accurate to what happens in the real world, but yeah, speaking of reward. So, actually, because we only have 10 minutes left because I know you have a hard out, I want to ask you this. So you deal with addiction a lot, I just mentioned cocaine. I’ve never tried cocaine, but I understand it’s a very dopaminergic kind of thing where it really hacks that brain’s reward system. What is a BBO for cocaine? What’s a bigger, better offer for that behavior loop?

Dr. Brewer: Yeah, well, it’s not just cocaine. We can actually broaden this to any substance and actually behavior that falls into the same dopaminergic pathway. Which is, so cocaine, alcohol, nicotine, you know, any drug of abuse has been shown to activate the dopaminergic pathway, and there’s this feeling of restlessness that says, “Go do this thing, go get this thing” because every time we use it, it says, “Okay that was good, go do it again.” Remember, survival, when we’re hungry, our stomach says, “Oh, go get food.” That’s dopamine firing saying, “You need to go get that thing.” So if we’re addicted to cocaine or let’s say cigarettes, when we get that nicotine deficit, it’s like our stomach being hungry, our brain’s hungry for nicotine, you know, ’cause those receptors are antsy and they say, “Oh, fire that, you know, go get that cigarette so you can feel better.” So any drug, and this is now been shown with things like Instagram. There was a study at UCLA where they just manipulated the number of likes that adolescents got on their Instagram feeds. Fired up that that dopamine pathway, the nucleus accumbens was activated, but also fired up the self-referential pathway where basically linking up you know, ooh, getting a bunch of likes, that excited, contracted quality of experience just from getting a bunch of likes that were artificially manipulated on their Instagram feeds, it wasn’t even that one particular picture was particularly good. So the reason I’m bringing all this out forward is that we can actually see experientially ourselves what the BBO is. So it’s not just, “Oh, you know, I’m anxious, I should start using cocaine.” No, that will actually make you more anxious. Cocaine is not the BBO. Any drug of abuse is not the BBO. And even stress eating. You know, what have we heard, the quarantine 15, what, you know, gaining 15 pounds, which got updated to the quarantine 30 ’cause people didn’t realize how long this was going to last. So just stress eating isn’t going to solve the anxiety, it’s only going to add another problem on top of it where now we’ve got a problem with our weight because we’ve gained a bunch of weight and now we’re also in the habit of stress eating. So it’s not just about distracting ourselves or doing some substitute behavior, it’s really about finding something that taps into a different quality of experience that is more rewarding. So my lab did a study. Now this is going to sound ridiculous. It’s like why’d you have to do a study for this, but this is, we have to do studies to prove things that seem obvious. So we did a study with a bunch of mental states. This was with one hundreds of people. And we said, “Okay, what is more rewarding?” We give them a bunch of them. And of course, anxiety ranks pretty low. Just, you know, frustration ranks pretty low, and anger ranks pretty low. And then things the rank much higher are things like kindness and curiosity. So of course that’s a no, duh, you know feels better to be curious than it does to feel anxious. But the other thing we asked at the same time was what feels closed versus open. The hypothesis was the things that feel closed, so if you think of anxiety, we feel tight. You know, we tightened down into that ball of anxiety when we get caught up in something, you know. when we’re worried about something or whatnot. Curiosity feels open. So you can actually inject some curiosity into that feeling of anxiety because you can’t feel closed and open at the same time. They’re binary opposites. So here it’s not cocaine makes us feel more agitated, contracted, you know, restless. Curiosity makes us feel open and expanded. And that’s really the heart of mindfulness practice is helping us tap into that natural capacity to be curious. And that in itself is the BBO.

Dr. Z: ¬†Wow. You know what, and I think people are going to resist that and say, “Curiosity, ah.” And I think what you would might say is, “Well, you should try it because that’s exactly what it is.” And in fact, I think people who score high on openness on psychological tests and stuff tend to overtly display a lot more curiosity, at least in my own experience. They’re always like, what is reality? What’s the nature of this? What is this? How does this work? You and I being able to talk remotely, et cetera. And that is, you’re right, even my body language opens up when I start talking that way, whereas when I think of anxiety and I think about shame, and I think, you kind of protect your core and you contract and you feel this kind of closure of possibility. And so I love the way you described that and that’s a big piece of your book. I think curiosity as big BBO. A BBBO.

Dr. Brewer: BBBO, biggest, bestest offer.

Dr. Z:  Bigger offer, exactly. Biggerer.

Dr. Brewer: So if somebody needs some neuroscience to back this up, you know, what we’ve actually found is that there’s a network of brain regions called the default mode network, which gets activated when we get caught up in anxiety. It gets activated when we get caught up in a craving for cocaine. It gets activated when we are ruminating, when we’re depressed. That brain region gets deactivated when somebody is mindful and when somebody is curious. And if somebody’s like, “Well, whatever that mindfulness is,” Okay, if you need a drug example, when we first published, this was 10 years ago now. We published our first study on experienced meditators showing this. About three months later, a group in London published the first big study on people on Psilocybin. And they found that Psilocybin, mind expanding drug, deactivates the same brain network that we found that gets deactivated with meditation.

Dr. Z: ¬†Ah, man, and this work on default mode network is what first actually introduced me to your work because I was fascinated by that and you’ve done the seminal work on that and this idea that there is this aspect of brain that creates a self-center, a self-referential thought, this so-called discursive thought that’s just, I need this, that and the inward sort of rumination and that psychedelics actually decrease that brain activity. And then, and the openness and the selfless experience of the present moment becomes evident. It’s almost like default mode network helps us to survive by creating a sense of separation and a sense of rumination so that we can plan and, you know, be us versus the world, get food, get mates, all of that, get rewards. But our innate nature is selfless present moment awareness in this moment and that has a hard time surviving on the savanna. So, you know, I don’t know what your thoughts are on that in the three minutes we have left.

Dr. Brewer: Yeah, well, I would say the two can actually co-exist and work pretty well together. So if you think of getting caught up in anxiety, so let’s use the savanna example, right? So we can’t be on high alert all the time. So you can think of our, people describe this as our safety, our safe zone or safe place, right? So think of that as the cave where our brain says, “Okay, I know there’s no saber tooth tiger in the cave, so I can relax here.” When we go out the savanna we have to go on high alert because we don’t know if there’s danger out there until we map out that territory. Now, if we’re so used to our safe spaces or whatnot, and we go out on the savanna, we freak out, we have intolerance to uncertainty. We actually go into our panic zone where ironically our thinking and planning brain goes offline. So we basically either freak out and fall off a cliff, or we run back to the cave and say, “Wow, that was terrible. I’m never going out of the cave again.” So here we can bring in curiosity and instead of going out and moving into our panic zone, and we can move into our growth zone. We can say, instead of going, “Oh no, this is different.” We can go, “Oh, this is different.” And we can open to the experience and learn from it. And so that helps our planning brain come online so that we can actually survive, but survive even better because we’re open to new experiences. And we can, with that, we’re much more able to work with one certainty which is that the world is constantly changing. We have to be able to work with constant change.

Dr. Z: ¬†So going from uncertainty to one certainty, that uncertainty is the rule. I love it, I love it, dude, dude, you’re woke, Jud Brewer, woke! I mean, in the sense that I say awake and I, ah man, will you come back and talk more with me? Because I mean, you got to go. I think you have a hard out, but I got to say this like, oh, there’s so much further to talk about with this because this idea of curiosity, replacing this, you know, this openness replacing the fear of uncertainty is something in a pandemic we could all really, really, really benefit from.

Dr. Brewer: So let’s bookmark this, we’ll call this part one. We can talk about that. And then we can move into how does this have to do with, you know, how do we get attached to ourselves or how we get divided in society, ’cause those are directly related.

Dr. Z: ¬†That is what I, so this approach that you’re talking about an open curiosity and openness is what I call the alt middle. It’s a radical place where you listen to all ideas and synthesize and think for yourself. And so, by the way, you said bookmark because you’re a shameless shill. You’re reminding me the book. “Unwinding Anxiety,” Judson Brewer, my brother from another mother. Jud, man, what a thrill. I’ll put links to your book. I’ll put links to your website. They can check out your apps. Check out your research, check you out, buddy ’cause of your BBO. See what I did there? Am I cancelled yet?

Dr. Brewer: Yes.

Dr. Z:  Probably.

Dr. Brewer: For sure.

Dr. Z:  Jud, thanks a million, man. And until next time, Z-Pac. We are out. Peace.

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