Judson Brewer || Unwinding Anxiety

emotional eating, and anxiety. He's the author of the Craving Mind From Cigarettes to Smartphones, to Love while We Get Hooked and How we Can Break Bad Habits, and more recently, the book Unwinding Anxiety. New Science shows how to break the cycles of worry and fear to heal your mind. Jud, so great to chat with you today on this podcast. It's so great to be here. This is a topic that's just a little bit timely, so you know, I think that there's very few topics that are more important

than this one. But I'd like to start with tracing your the development of your own career because you're a psychiatrist. But I think you said you never planned on becoming a psychiatrist, Is that right? That is true. You know, I did this mdphd program where you do a couple of years of medical school and then you do your PhD for long enough that you forget everything you learned in medical school and then you go back into the

wards and have to kind of catch up. So I actually did psychiatry as my first rotation back on the wards, thinking that, oh, I'm never going to become a psychiatrist, and you know, here I am. It turned out to be really good, much better than expected. Well, I'm glad

to hear it. Something I thought was really cool was this connection you made in your work between the mindfulness work that you were practicing on your own and the addiction where that you're learning as a psychiatri student, and that feeling of craving and clinging and grasping that a lot of people who are addicted to things mentioned. I thought there was a really brilliant connection, and you thought it was a valuable connection too, right, I did, I did?

You know? It was really interesting to see. You know, I've been training for about ten years in mindfulness and was seeing these terms come up over and over around craving and clinging, and then when I started working with patients especially in my psychiatry residency. They were using the same terms, and I was thinking, this cannot be a coincidence, and so I really looked into it a lot more to see, you know, a very very deep connection. Yeah,

why did you start meditating? Was there a particular reason? Well, I was stressed beginning of medical a good reason. Yeah, And around that time, you know, what was the science of meditation showing? So around what year was that, if I may ask, Yeah, I started medical school in nineteen ninety and back then there were probably literally a handful of papers that had been published on the science of mindfulness. You know, I think John cobbitts In had started his

mindfulness base stress production program in the seventies. He started publishing a couple of papers in the early eighties, but there was really a long drought between you, literally just two or three papers being published to until probably the mid two thousands, and then the field really just started exploding. Yeah, and you've contributed quite a bit to it. I've tried to do my piece here and there. You sure have.

You've done more than a little. Yeah. So I really like this phrase you said in your book, I try to science the shit out of anxiety. And that was a reference to the movie right that Matt Dylan was in, Yeah, Demon Matt Damon the Martian, Yes, where he gets stranded on Mars and then he's he's got quite a quandary and instead of you know, getting anxious, he turns that energy into to good use to help him get off

the planet. Good. Well, let's use your powers to good use to help all of us unwine today, because I know that we're all stressed. Great, I'm going to I'm just going to speak for everyone. How's that? And I think you would be speaking pretty adequately. You know, we've seen well we've seen a rise of anxiety over the last four or five years, but there was a huge spike in the year to twenty twenty. Yeah, yeah, for sure. So how can we work with our anxiety and break

these unhelpful habits and addictions. Well, the way I think of this is, you know, and I see this a lot in my clinic, is that a lot of us really don't know how our minds work. And I can certainly speak for myself. I didn't know how my mind worked. Even learning a bunch of medical school stuff didn't really give me a good handle on how my mind worked.

So here, I think it's really helpful to start with just really understanding our minds and not you know, every single neuron in every single brain region, but really understand being some of the most essential basics, like how habits form and why we form habits, and how some of those habits can spin out of control and start move from helping us survive to actually being anti survival when we really get caught up in anxiety. So that's the place that I start. That's a good stritting place. You

have this phrase in your book, every Day Addictions. I think there's like there's quite a bit of controversy in the field about what actually counts as an addiction and what doesn't count as an addiction, Like what is an everyday addiction and what are the features of that. Well, I think of this as related to a definition of addiction that I learned back in residency, which was, you know,

an addiction is continued use despite adverse consequences. And that's basically the definition that the American Society of Addiction Medicine uses now, and it's one that I've used throughout my clinical practice because it's very pragmatic, you know, It doesn't label people as, oh, you use cocaine, or you use heroin,

or you use you know, you smoke cigarettes. It's, you know, is what you're doing causing problems, And that of course covers the classic addictions, but it also helps us see things that we might not have noticed otherwise that are causing us problems. So, for example, you know, when people are text when they drive. It's been shown that texting is more dangerous than drunk driving. So there's an example

of continued use despite adverse consequences. When somebody can't wait to check their phone when somebody has texted them while they're driving, that's a problem, you know. And so there's you know, it can fall into this realm of addiction where we're you know, we're so addicted to our phones, for example, or social media or checking our news. It's really causing adverse consequences, whether it's personally or professionally, or even you know, riffs or breakdowns in our relationships and

our family. Well, can all addictions be reversed? Like are there any addictions or anything? Like how do you know when you've passed the play of no return? I'm like obsessed with that question. Yeah, it's a really great question. I have yet to find an addiction that cannot be reversed and some of the yeah, So it's good news because you know, if we can form them, we can unform them. Well, that's amazing. And sometimes it might just take as long as it took to form them. It

might yeah, and it doesn't have to. So this is one of the beautiful things about our brains. There's so many beautiful aspects of the brain, but one of them is that our brain has to adapt very quickly to rapidly changing circumstances. Otherwise we won't survive. You know, if you think of our ancient ancestors, they didn't have They couldn't afford to be chased by the saber tooth tiger twenty times before they realized that was dangerous. They had

to adapt pretty quickly. And so here, even if we form a longstanding habit or addiction, we can actually unlearn it relatively quickly if we really tap into our brains. Just as an example, you know, I work with a lot of folks that try to quit smoking, and I've had people that have been smoking or dipping for you know, decades, and you know, within months, they're able to quit that that addiction. And this is despite having reinforce those habit loops.

One guy, I actually calculated it with one patient, he'd reinforced this habit loop of smoking two hundred and ninety three thousand times over his forty year smoking career. Yeah, can you imagine that three hundred thousand times. Yeah, this is this is like, this is giving hope. Yes, there is hope. We're not all doomed. You know, really, it really about understand we're not all doomed. Some of only some of us. Are only some of us? Well, because I like, I mean, I can't stop picking my nails.

It's like a lifelong thing. So well, let's zoom in there, because you know, this adverse consequences piece is a really critical element for changing any habit. So it's got to be causing us enough pain, let's say, for us to want want to quit. You know, the classic addiction. You know, somebody hit rock bottom before they actually are motivated to

change the behavior. But for example, my guess is that picking your nails isn't going to get you fired from a job or you know, ruin a relationship or something like that. It's just kind of annoying. Perhaps am I am I on track there? Yeah, it hasn't been a deal break or any dates yet, but if it did become a deal breaker, then I would quit immediately. Yeah, excellent. So there's a great example adverse consequences gets us to change behavior. But the nice thing there is we don't

have to actually hit rock bottom on everything. We can kind of dial in and bring awareness in and help ourselves see very clearly in the moment when we're doing something that it's not that helpful, that actually can help us break those habits without having to go to those extremes. Okay, so why do we prefer cake to broccoli? Like, can you explain that to me? Yeah, I'd be happy to. And this actually forms a whole section of my book

because this is one of the most critical elements. This is like the element of neuroscience if anybody were to pay attention to be to this piece. And so just a tiny bit of background here. You know, I've been studying habit change for a long time and one of them, probably the most predominant tactic or approach that people take to have a change is willpower. You know, just to

eat salid instead of cake or whatever. Yet as we see with the diet industry, for example, you know, BC rates have been going up despite us knowing this formula for decades, despite you know, programs like weight Watchers being around forever. So you know, there's something that we're missing there, And what we're missing is that that's not actually how our brains work. Willpower is more myth than muscle, and at best, it gets depleted throughout the day of Those

data are controversial, but let's just say it best. Willpower is a limited resource. I think most folks could agree with that. So here it's really about looking at what how our brains actually form habits and then taking that and saying, okay, can we turn it on its head? Can we actually change habits using that very very powerful part of the brain. And that's really why, you know why I wrote that whole section around why we prefer

cake to broccoli our brain. There's a part of our brain called the orbitofrontal cortex that actually forms and stores reward value. So you can think of it as making a list of like the most rewarding things in our lives and the least rewarding things, you know, most rewarding at the top least rewarding at the bottom. And what it does is it uses that list to make quick decisions, so you know, we don't have to go in you know, if we're given a choice between say cake and broccoli.

You know, when we've learned the reward value of broccoli and when we've learned the reward value of cake, it kind of stores those and then it can recall that reward value quickly, and instead of having to eat some of each one and decide which one we want, our brain just you know, launches for the cake because it tastes better. From a survival standpoint, that's all about, you know, calorie density. It's a cake is much more calorie dense.

So we prefer cake to broccoli from a neuroscientific standpoint because it's more, it has more calories. From a hedonic standpoint, it just tastes better, and that better taste is what alerts us to pick that behavior in the future when

given a choice. Does that make sense It makes sense to me, excellent, But I no, I hope that makes sense to people, because you know, people just describe distinguished between the wanting and liking system of dopamine, and it's very important to unpack the difference between wanting and liking. Absolutely absolutely, so we can take a moment to geek out on that. You know, the pleasant taste of cake actually alerts our brain. So the first time we eat cake, you know, it could be when we're a kid at

a birthday party or whatever. First time we eat that cake, it's there's a surprise because our brain says, oh, that looks interesting, and we try it, and our brain says, oh, that's pretty good, and we fire dopamine that which down that memory that says, oh, cake taste good, Remember that and eat cake in the future. We also associate that taste with all the environmental cues, all the things around it,

so the context. So if it's a birthday party, it's having fun, opening presents, probably eating some ice cream as well as cake and all of that. So we lay down this composite reward value when we eat cake for the first time. Then our brain starts shifting how it fires dopamine. It shifts away from when we receive when we actually do the behavior to anticipating doing the behavior.

So the next time we go to a birthday party, we see the cake and our brain fires dopamine that says, ooh cake good, go eat it, right, and so it drives us to go do something. So it starts with this, you know, the liking quality, which is probably more than just dopamine. That dopamine fires to lay down that memory that then drives us to want the cake in the future. And this is true for any habit. So if we

form a positive association around drinking alcohol, same thing. If we form a positive association or even a negatively reinforced behavior around smoking. If we're stressed out and we smoke a cigarette and we learn, oh, when I smoke, I feel better, that also lays down that same type of habit loop, so that that urge to go do the behavior is really dopamine driven. Absolutely, that was a great description of it. So, okay, how can we learn and

grow from from this? Though? Like, how can we use our more evolved conscious control centers so that we're not being driven by these more subcortical structures that have learned things in the past. Is that Is that a fair way to ask the question. You can, it's a fair way to ask the question. But I'm actually gonna ask the question, is that actually the way that we can actually change behaviors, right, because that was good. Yeah. I'll suggest that that there are a couple of elements here.

One is that the more evolved centers are younger and they're weaker, so they are actually going to go offline when we get stressed, when we get anxious, for example. So it's harder to utilize those unless we're mister Spock, who doesn't have emotions. So unless we're vulcan, our pre funeral cortex isn't quite evolved enough to be able to outcompete these more primitive centers. And in fact this goes I remember I wrote a little bit about this in

my own Running Anxiety book. There's a relief on the Parthenon in Greece from like four point fifty AD or something very very old relief that depicts a horse and a rider, and the horse denotes the passions, these urges, these cravings, and the rider depicts our reason, our willpower, and the rider is trying to tame this horse. Yet we all know what is stronger. So this debate has been raging literally for centuries, like how do we actually

utilize willpower? And what neuroscience is suggesting is that that might not be the best way to go. And the reason I say that is, you know, besides the fact that this is the youngest and weakest part of our brain, if we want to change a behavior, what is now pretty clear is that we have the only way to change a habit, for example, is to update the reward value or to change the reward value in our orbito front on cortex. And this has been shown since the

nineteen seventies. There are these two researchers with Scola and Wagner, who now have this famous reinforcement learning or reward value curve called the Rascorla Wagner model, which basically says you're going to keep doing a behavior if it's especially if it's habitual, if you don't update the reward value, and

if you bring awareness into the equation. And this is what I love about the interplay between Buddhist psychology and modern day psychology and even modern day neuroscience, is that there's what Rascola and Wagner pointed out was that there was this error term that they called either a positive or a negative prediction error, meaning that if we don't pay attention and there's the behavior, you know, eat the k we see the cake we eat the cake and

we're not paying attention, that reward value is going to stay the same, or we're just going to keep that same reward value in our brain if we pay attention when we eat the cake. Let's say it's we've gone to a new bakery or something and we eat a new, new chocolate cake, so we're really paying attention. We're like, what's this like and it's the best chocolate cake that we've ever had, or brain goes, oh, wow, that was

really good. That gives our brain what's called a positive predictionary, and it says, ooh, cake from this bakery is killer. You got to go back there. So we lay down this memory that says, oh, that's really good cake at that bakery. Or if we eat the cake at the bakery and it's eh, it's not that good, our brain says it gets a negative predictionary. It's expecting it to be good, especially if it looks like other cake that we've had before and it's lower. Our brain says, eh,

not that great. We get this negative prediction error, and then we're less likely to go back and eat cake from that bakery. That's the only way that we can update reward value. And change habit is through that. Notice how no willpower is involved there, only awareness is needed for that. And so we can actually capitalize on this

we by really bringing in the essential elements. So if we want to change a habit, So ironically, what I do with my patients who want to quit smoking and they come in and you know, they want to quit smoking, I tell them to smoke, and they look at me like I'm crazy, because they're like, Doc, I want to

quit smoking. Why are you telling me to smoke? And I say, pay attention when you smoke, and maybe I'll explain a little of the neuroscience, maybe not, you know, just to help them really get a sense for why they're doing this. But nobody has ever come back to my office and said, you know, Doc, thank you so much. I never realized how good a cigarette tastes. They always come back and they're like, wow, I never realized that cigarette tastes like shit? How did I not notice that before?

And I'm thinking, well, it's because it's a habit. You're not paying attention. But as they realize that, they get a negative prediction error and that helps them become disenchanted with the behavior. So they naturally start to move in the direction of quitting. And in fact, my lab just

finished a study we did this with overeating. So we have this eat right now app that we were studying, and we built in this function to have people, you know, walk people through a mindfulness exercise as they were overeating, and it took as few as ten or fifteen times of people paying attention for that reward value to drop below zero. We can calculate this all out using these models. It dropped below zero where they flipped their behavior from

overeating to not overeating. So this goes back to you know, it can take years to break a bad habit. No, it can actually happen pretty quickly if we're really really paying attention. Does that make sense? Yeah, But it requires a certain sense of discipline as well. I mean, are there individual differences in discipline itself required to do that? I think certainly there are individual differences in discipline. Yet

we all have the same capacity to be aware. And so talking about discipline, I would say, you know, if somebody is interested enough, so there's a level you know, interest will drive discipline. If we're really interested in doing something, we're going to be disciplined to do it. If we're really interested in changing a behavior, that interest is going to drive discipline in any and all of us. If

we're not that interested. So for example, let's go back, you know, you use the example earlier of like picking nails. You know, if we're not that interested, because we're not that you know, it's it's not that painful for us, it's going to be hard to change that behavior, whether it's picking our nails or overeating, or smoking or using opioids. It really spans the entire range there. How does how do like different mindfulness personality types come into play here?

Because I want to get to the individual differences level a bit. Yeah, So what we've an interesting question that we asked probably about ten years ago now where we've been. I had a friend, Jake Davis, who's a poly scholar, who so who really knows the ancient language in which the Buddhist teachings were written down, And there was this fifth century commentary called the Path of Purification. I love that title, the Path of Purification. Yeah, and in that

it doesn't sound fun, No, it doesn't. It doesn't sound like you know, this this long, arduous process. But the idea there was, you know, there was a section of that of that commentary in which different basically different personality types were described, and those personality types line up very nicely with modern day you know, propensities to kind of approach. You know, it's the fight, flight, freeze thing where we've

got these you know, these very basic instincts too. You know, if there's danger, we're either going to fight or we're going to run away, or we're going to freeze, and

you know, try to look like we're not there. And in fact, they really did a nice job of, let's say, describing the tendencies that we all have, where some of us have more of a tendency to approach things, some of us have more of a tendency to pull away, and some of us have more of a tendency to kind of freeze or do whatever everybody else is doing.

So we did a study where we developed this basically a personality questionnaire around these different you can call them mindfulness personality types, let's say, just as an overarching thing. And you know, with thirteen questions, basically anybody can kind of get a good sense of what their propensity is. And it's not that it's you know, sometimes it could

be predominantly one. Sometimes it could be a combination, just like any other personality type of thing, and with those we can start to see where our strengths are and where our weaknesses are. So, for example, folks that tend to be more likely to approach things they're they're gonna with mindfulness practices. They're going to be more likely to easily practice things like loving kindness or these practices that

have more of a positive feel to them. Whereas folks that are more of the avoid type, they tend to be more analytical, and they're going to benefit from doing practices. You know, they're going to starting with practices that are

more fit with that personality type. So getting somebody started with the mindfulness practice, it can be helpful to know what that predominance is, so you can pick something that's easy for them to pick up and they can get some quick wins and some immediate gains, and then over time they know what's going to challenge them, so then they can start shifting into some of these other practices that might not be so easy for them to kind of challenge their skill sets, so they can really, you know,

keep going at times when they've kind of mastered some of the earlier practices. Cool, How can like people take the test? That is a great question. So we published published this, I think in plus one, which is an open access journal, several years ago. There's also a list of the questions and scoring mechanism in my in my book on Wending anxiety, and I think there's also an appendix in The Craving Mind in my first book where people can also take the CLIs Okay, So how does

all this relate to anxiety? Because all this stuff is linked, right, so you know, where does the anxiety part come into play? When you know, because we so far we've be talking a lot about addiction and being mindful and change and habit change, where does anxiety come into play? So this is this was a turn in the road for me that I had not actually noticed, which prompted several years of research and then writing this entire book because I was so blown away by something that I had missed

in medical school and in residency. So there's this medical term called number needed to treat. You're probably familiar with that, but for folks that aren't, it's basically a quick and dirty way of telling how well a treatment works, and basically the higher the number, the more people, you know,

the worse the treatment. So, for example, with medications, when I prescribe gold standard medications for anxiety, the number needed to treat as five point two, meaning that I have to treat just over five patients before one of them shows a significant benefit. So there one I was playing the medication lottery because I didn't know which one of the five, you know, five people walked in my door. I didn't know which one was going to benefit on average.

And the other part was, well, I didn't know what I was going to do with the other eighty percent you know that weren't showing a significant benefit. So at the time that I was developing my own anxiety around helping my patients, I was studying the seat right now app and somebody in that program was saying, you know, she said, you know, I'm realizing that anxiety drives me to stress eat. Can you develop a program for anxiety? And I was thinking, well, I prescribed medications. I'm not

you know, this isn't really my lane. But it put a bug in my ear, and so I went back and looked at the research literature to see if there was something that I had maybe I slept through a class in medical school or residency or something like that. And back in the eighties, so this is when Benzo's were being prescribed like candy. You know, do you remember the Stone song Mother's Little Helper, right, that's about Benzo's. She goes running to the shelter of Mother's Little Helper.

So Benzo's are being prescribed like candy. They're no longer first line treatment for anxiety in modern day. You know, a lot of problems there, and the SSRIs were first starting to be developed. I think Prozac the first one was on the market around mid eighties, so people were really focusing on medication, yet they were ignoring a literature that was starting to blossom. Thomas Borkovik at Penn State and others were suggesting that anxiety could be driven like

any other habit, through the mental behavior of worry. And when I read this, it just light bulb moment. I was thinking, Wow, I never realized that anxiety could be driven this way, and I know something about habits, So so I put the two together and I said, well, let's develop you know, a habit driven program in terms of helping people approach anxiety from a habit perspective. So we developed this on Winning anxiety app and I and of course, as a clinician, I wanted to see how

we could help people. As a researcher, I wanted to see if this thing actually worked, because you know, this was an old literature. You know, it wasn't really people weren't really talking about it that much in modern day. So I wasn't sure if it was just you know, overlooked, or it just you know, hadn't panned out. So we did some clinical studies. We developed this on Wending Anxiety app.

We did a study with anxious physicians right for this, we got a fifty seven percent reduction in clinically validated anxiety score. So that was pretty good. I was like, wow, that's that's pretty good we did. It's amazing. Yeah, And so we followed that with the randomized controlled trial of people with generalized anxiety disorder. Okay, you ready for this, got a sixty seven reduction in anxiety scores. And here

we could calculate the number needed to treat. So if you remember, for medications, that number is five point two, So I have to treat five patients before one person benefits with this on lending anxiety app. That number needed to treat was one point six. What does it mean to be half of a person? Yeah, I'm joking or two thirds? I try to treat the whole person. But yes, these are these are statistics, these are numbers. Well that's

that's really amazing, amazing effects science. Wow. Now is this an app that that people listening today can can download and can use? Yes, anybody can download this from you know, the from the app store, Google Player or the app store on their iPhone. I'm just going to do that right now. I forget the rest of the interview. I need I need this. Wow, that that's truly effect. What do you think was you know, the underlying causal mechanism there that that played the biggest role in such a

large effect. Funny that you ask, because you know, we got these nice clinical results, but of course I wanted to know what was happening mechanistically so we we could actually look at that and we found that. So we had measured a number of things like increases in mindfulness and in particular looking at emotional reactivity. So the theory is that with mindfulness, people will become less reactive to their emotions. So if they're anxious, they'll be less likely

to just jump in and worry. So that was that was one aspect that we looked at. We also looked at worry itself, because worry is a core component of anxiety. It's even baked into the definition and is a big element that's measured whether you look at generalized anxiety or other types of anxiety. So we looked at worry, and then of course we looked at these clinically valid anxiety scores.

We looked at we used the generalized anxiety to or seven measure, which is one that I use in the clinic, and we found that mindfulness training specifically increased non reactivity, and that non reactivity mediated a decrease in worry, and that decrease in worry mediated a decrease in anxiety. So I should also back up and mention we were specifically training people to map out these anxiety worry habit loops.

So anxiety so you need three three elements for any habit, a trigger of behavior, and a result, So anxiety was the trigger, worry was that mental behavior, and then the result. What they started to pay attention to was seeing that the result of worry was that it wasn't actually that rewarding. Now, often we'll lay down the habit of worrying because it feels like we're you know, we're in control, or it's distracting us a little bit from the worst feeling feeling

of anxiety. But in fact, when we help have people pay attention and they realize they're not really in control of whatever they're worrying about, and that anxiety feeds back and I'm sorry, that worry feeds back and drives more anxiety. So anxiety triggers worry, Worry feeds back and drives more anxiety, and then people get into this vicious leap of anxiety, worry, anxiety, worry.

They realize that it wasn't that rewarding. You know, if you go back to these Rescolo Wagner models, it helps people see, oh, worrying's not actually making me feel better, it's making me feel worse. So that they can then, you know, not learn to become less reactive to the anxiety, learn to be with those physical sensations and have that not not trigger worry. So that's mechanistically what we were finding. They're less reactive, they worry less, and that led to

a big reduction in anxiety. Well, that's huge, that's so huge. So tell the people the name of the app again, is it just called Unwind Anxiety? It's called Unwinding Anxiety. Yes, I'm sure everyone's going to their app store right now. This is huge. How much does it cost? You know, I don't remember. That's I don't pay attention that much. It's probably I don't know, it's I honestly don't know. Okay,

So people, it's certainly that. Yeah. And I think they were trying to price it around the cost of a copay for somebody to see their primary care physician here once a month or something like that. So I think they're trying to make it reasonable. Great. Great, okay, So

what's good about rainy Days? Yeah, that's a that's a kind of a chapter title that I used because there's this practice, this mindfulness practice that we've been studying a lot in my lab called RAIN And the idea behind that is that you know, we can use so the acronym RAIN stands for recognize, allow, investigate, and note and the ways that your model. No, it's it's built offter Well.

Tara has popularized it. When I traced it back. Michelle McDonald was the one that first put this forward, and you know, Tara really did a great job of popularizing as used it beautifully in her writings and her teachings, and she's it's interesting, you know she when I first learned it, that end stood for non identification, which is a little conceptual for my clinic patients, some of them.

And so we actually adapted that to a note where there's this Burmese practice of kind of noting experience moment to moment, and we've I found that that started testing this in my in my VA when I was at the VA Hospital, taste testing it with my outpatient clinics

and found that that was very accessible. You know, somebody could note whether it was seeing, feeling, hearing, tasting or whatever the fifth sense is that I'm missing, you know, they could basically note any of their senses plus thinking, and that noting practice help them not be as caught up in whatever the thought or the emotion or the feeling was. So so we started testing this first with our smoking program. So we have this app called Craving

to Quit. So we started developing it and testing it there. Used it also for helping people with overeating, you know, when they had an urge to eat. And then also people can use this with anxiety. So if they're let's use the eating example, because we've been talking about cake a lot. If somebody has an urge to eat some cake, that R comes in. If they want to use this practice, they can recognize, oh, I've got a craving, right, because if we don't recognize that we have a craving, we're

just going to be lost. We're going to be an autopilot, We're just going to eat it. So we first have to recognize what's happening. That AA stands for allow. So often when we have a craving, we'll try to resist it and we'll think, oh, bad craving. I need to make that go away, so I don't eat the cake. Well, we can only resist for so long. And you probably know the saying what we resist persists, So you know, these things tend to get stronger. Craving stif to get

stronger if we resist them. So instead of resisting, we invite them in and say, Okay, here's a craving. You know, come on in, let's see, let's see what you're all about. And that let's see what you're all about is what that eye stands for, where we investigate what's happening in our experience. And I love this, you know. Basically it's about being curious about what's happening. And one thing that's beautiful about that is curiosity. If you compare a craving

to curiosity, curiosity feels much better than a craving. So in that moment where we've got this unpleasant urge to eat the cake, we can bring in curiosity and go, oh, what does this urge feel like? And we kind of break it down into its component elements, where this is where the end the noting comes in. We can note, Okay, what is craving feel like. Huh, well, it's tightness, it's

it's heat, it's you know, it's restlessness. Okay, now it is you know, it's this, Now it's that, And from moment to moment we can start to dissect it into its component elements where we can see, oh, instead of this being some big, bad, scary craving that feels like, you know, my head's going to explode. I actually had a patient walk into my office saying his head was going to explode if he didn't smoke. That's how scary

it can be. Instead of that, we can break it down and say, okay, well, how scary is tightness, Well, it's just tightness. It's not that scary. How scary is heat, Well, it's just kind of heat. How scary is burning? How scary is restlessness? You know? And these things themselves are not that scary. Also, as we note from moment to moment, we see that these experiences they might get a little more intense, but then they eventually fade and we can see, oh,

I don't have to actually act on this craving. I don't have to eat the cake, I don't have to smoke the cigarette. You know, I don't have to do whatever. If I just bring curiosity in, it helped me ride that wave out. So the rain practice helps anybody that's got an urge to do something, you know, if it's a craving for cake or a cigarette or whatever, to really help them be in the moment and start to

break that link between urge and action. And in fact, you know, of course, my love to study, so we did a study on this, and we found that after four weeks of mindfulness training, smokers in particular could completely break that link between that urge that craving to smoke and the smoking itself. This is incredible. But there's so many complexities when we talk about humans because we have first order desires and we have second order desires, and

we have third order desires. I'm still not sure I fully understand who the real me is, Like, like, how do I? How do I? I mean I've argued that there is no real me and a bus this thing is real. Mean when we talk about authenticity, I mean we have where these we have so many like evolutionary modules that are pulling us in so many different directions based on environmental stimuli and triggers and things and internal

things going on as well. But you know, we might have an urge docing, but then we have the urge that says I don't want to want that urge. You know what if you know, I mean sometimes what someone can ever just do things that are you know, in moderation are just fine? Is it just is? Is the problem when it gets out of control and it kind of like overtakes the whole system? Is that is that

the problem? Yes? And that's one of the beautiful again, beautiful aspects of our brains is that you know, if you go back to this definition of addiction, you know, continued use despite adverse consequences. So if we bring awareness in that and we start to see a habit loops, say around eating, and we bring awareness in and we really pay attention as we eat, it's not that suddenly we're going to magically not like cake. That's not how

our brains work. But what we can do is see when we're over consuming, we can start to see where that pleasure plateaus, and that naturally helps us start to moderate behavior when it previously we would just overeat and not pay attention. And so you know, I even have some of folks in our programs or my patients and my clinic have them pay attention with each bite and say just ask, you know, is this better than same

as or worse than the last bite? So they can kind of map out that that pleasure plateau in their experience right in that moment, and they can and that also helps them bring curiosity in is this as good as? Is it better than? Is it worse than the last one? And it helps them start to see, oh, you know, it's plateauing. It's really not that great. Oh, it's actually worse than when I than that last bite. Now is

a good time to stop. So with things like eating food, awareness itself helps us moderate our behavior where we don't have to you know, we don't have to go all psychological on our on ourselves too much if we're really you know, if we're really just focused on that awareness of that behavior in that moment. Wow, this is this is this is so useful and practical information for people

and hopeful. What is what is anxiety? Sobriety? Well here, you know, I like that term because I was so which so this this came to me when I was so with any Anybody using our apps can join a live group. We run a Zoom group on Wednesdays at noon Eastern, so anybody can join that group and ask questions basically where we can you know, we can help clarify concepts, help people work through struggles, things like that.

And there was a guy on there that joined us one day that said to me, you know, he said, you know, I feel pretty anxious. How can I work with my anxiety? And I said, well, you know what tools of the program that you've been using and how well have they worked? And he said, you know, I can, I can. I think he was using rain or he was using some of the tools, and and he said, you know, in the moment, I actually notice how calm

I can feel when i'm when I'm mindful. But I get real, you know, I'm I'm I might get really anxious later. And so and he kept coming in with his butt. But but and he was always having spinning out into the future, which is, you know, anxiety is basically fear of the future. You know, that's a big,

big piece here. And so that it occurred to me that he was describing something that a lot of my patients with addiction struggle with, which is, you know, I have a patient who's got alcohol's disorder, and they say, you know, I don't know if I can be sober in a week, you know, and I really don't know if I can be sober in a month. What I have them do is I have them dial it back, and I say, Okay, if you're not sure you can be sober in a week, how about can you know

if you can be sober tomorrow? And they say, well, I don't know, a lot of things could happen between today and tomorrow. And so we dial it back and we say, well, how about you know, if I'm meeting with them in the morning, how about noon today, can you be sober for the next couple of hours? And that actually kind of brings their future into more focused because it's more immediate, and they're like, well, I could probably be sober, you know, for two more hours. And

then I say, let's dial it back right now. Are you sober right now? And they say, yeah, Well, I'm sitting in your office. And not everybody's always say you know, but in general, folks come to my office sober, and so it's like, okay, take it one moment at a time, right. So with AA, they talk about one day at a time. Time.

If you think too far into the future, you're going to run into trouble because our brains are not good at predicting the future, especially if a lot of things can happen between now and tomorrow or next week or next month. So this anxiety sobriety term came to mind when I was talking to this guy, and I was thinking, oh, this sounds a lot like what my patients struggle with addictions. He was struggling with thinking way too far into the future, and so what I had him do. We kind of

worked through this in real time. I said, okay, well, if you're not sure, if you cannot be anxious tomorrow, can you dial it back to two hours, can you dial it back to one hour? And we dialed it back to right now, and I said, well, how do you feel right now? He's liked, well, I feel relatively calm. And I said, well, you know, in the next five minutes, if you feel anxious, can you bring in your mindfulness tools? And he said, yeah, I can do that, and I said, okay,

take it five minutes at a time. And so in this way we all can develop our anxiety sobriety by one noticing when our mind is spinning out into the future, worrying about I don't know if I'll be in acxious tomorrow, and then two dialing it back and taking it one day or one hour or one moment at a time, because in this moment we can actually work with what's happening and work with our anxiety. This groundbreaking. How does

this relate to suicidal thoughts? Great question? So you know people can have suicidal thoughts based on a number of different things. So when I have a patient who might be having some suicidal thoughts. One thing I work with them with is to help them identify those, you know, is the thoughts that they're having, the emotions that they're having, and even bring it into very concrete terms like what

is it that's driving the thought? For some people, suicidal thoughts can actually be somewhat can be driven in the same manner as other habits or addictions, where there's some type of reward that their brain's getting from having that thought. And you know, on a very basic level, you know,

think of a trigger behavior result pathway. The you know, if somebody's really stressed out or really has a lot of existential anster is feeling really depressed, that feeling that negative emotion can drive them to have a thought about, boy, it would be better if I just weren't around, you know, and that thought can give them this you know, this where they can project into the future and like they get this role where that like, oh, yeah, it'd it'd

be better if I weren't around. So they have this thought, oh yeah, it'd be you know, it just feels better in that moment, and then that that drives back and feeds, you know, the next time they have that really negative emotion, their brains more likely to have that suicidal thought. So here we can even start to map out this process itself with with anything, whether it's a suicidal thoughts or you know, or a cigarette or or anything that there's

this shared mechanism there in the brain. Yeah. And then after six years and five minutes of anxiety is sobriety? Then what then we take it that next moment? Why do you why do you label? Tell me about the significance of six years and five minutes? Oh okay. So at the very end of my book, I wrote about so I had when we first developed our first digital therapeutic,

this first app for smoking craving a quid app. I was down, I think I was giving a ted X talk down in Virginia, somewhere near d C. And there's a talk on flow. And since I was in d C, I figured I had a friend Tim Ryan, who's a congressman from Ohio, and I said, I'll look him up

and you know, see if we can get together. And so I stopped by his office and I said, hey, you know, we just developed this app for smoking, and you know, he's very interested in mindfulness related things, and he said, oh, that's interesting, you know, tell me about it. And I was telling him about it, and he got this glint in his eye and there was this He suddenly calls out to one of his young aides and he goes, hey, you get in here, and he goes,

you smoke, don't you? And the poor kids? You know, it's scared to death. You know, what's he going to make me do now? And Congressman Ryan goes, hey, you know you don't have to quit smoking, but just try this app and tell me if it's any good. And so, you know, the kid down is the app. So he starts trying it out, and in fact, he I think he wrote me an email saying, you know this. A couple of weeks later he said, you know, I wasn't actually interested in quitting, but I tried it, and you know,

and I actually quit smoking. You know, I was never expecting to do that. So the six years later thing is, Tim and I were giving talks at this at a conference six years later, and he was sitting next to me right before I went up to get my talk, and he leans over and whispers in my ear and he goes, hey, you remember this guy And I go, yeah, of course, and he goes he's still smoke free, and I just you know, I just got these tears in myles. I was like, wow, that was that's amazing. You know.

So six years later, this guy, you know, was just trying this app out because Congressman Ryan was asking him to, and he learned, you know, basically these basic mindfulness skills that helped literally, you know, prevent you know, smoking is one of the leading causes of morbidity immortality in the US, and so he had just he had helped himself in a way that you know, his body was going to thank him for for the rest of his life. And so it was just really nice to see that, you know,

six years later it still had taken. Wow, I can't wait to try this app and maybe it can help me stop picking my nails. You know. Funny you mentioned that because folks have used our our smoking app for everything from internet porn to trick atilomania like hair pulling to skin picking. Because the skills are the same, it's just what you apply it to. So let me know, let me know what you find. Yeah, Hey, doctor Brewer, just thank you so much for coming on the show

today and given dropping your wisdom. It's so important during this time, and like I said at the beginning of this chat, I can't think of too many topics that are more important than this right now. So thank you so much. That's my pleasure. Thanks for listening to this episode of The Psychology Podcast. If you'd like to react in some way to something you heard, I encourage you to join in the discussion at the Psychology podcast dot com.

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