So if you zoom in on fear as a negatively reinforced behavior, fear helps us survive, right? Think of our ancient ancestors out on the savanna. They are foraging for food. Right. But they don't know if it's dangerous. So they're moving from their safe zone, their cave out into more of an uncertain space, the savannah. So fear helps us learn where things are safe and where things aren't safe so we can avoid the unsafe places. But if you pair fear with a lack of certainty, which is what the prefrontal cortex is trying to help us do, is trying to help us predict the future based on past experiences.
If there is no precedent, if there's a lack of certainty, that fear plus uncertainty leads to anxiety and people think, oh, anxiety is going to help me survive. No, it doesn't. There is no evidence for helping us survive. It makes our thinking and planning brain go offline. And if you think of the extreme form of anxiety, panic, right. Which is wildly unthinking behavior, that's that far end of the spectrum of anxiety. I'm Dr.
Jan Brewer and this is the Rich Role podcast. The Rich Roll podcast. Hey, everybody, welcome to the podcast. So here we are inching up on the one year anniversary of the pandemic, which I think provides an opportune moment for all of us to reflect on how we are handling, reacting, responding and adapting to it, for better or for worse. In other words, how is your anxiety level? What habits, good or bad, have you formed or doubled down on these past 12 months to cope with the utter insanity and uncertainty of having our lives upended and placed on indefinite hold?
And most importantly, how are these habits serving or not serving you? And I posit all of this as context for today's conversation with my friend, Dr. Judd Bruer, psychiatrist and neuroscientist specializing in habit change, who has extensively studied anxiety and what science tells us about how we can break the cycle of fear and worry that cripple some. But I think in so many ways it's fair to say affect all of us to some degree or another. I've got a few more things to say about all of this.
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But for those of you who are new to him and his work, Judd is the director of research and innovation at the Mindfulness Center. He's a research affiliate at MIT and an associate professor in behavioral and social sciences and psychiatry at the School of Public Health and Medicine at Brown University. You might have stumbled upon Judd's TED talk, which has something like 10 million views. Or maybe you caught him on 60 Minutes with Anderson Cooper. He's also been featured in Time magazine, NPR for and many other places.
And whereas our first conversation focused on craving and addiction, today we extend that exploration to Dr. Judd's latest book, which is called Unwinding Anxiety. And this book provides a really helpful scientific framework to help all of us better understand what causes everything from mild unease to full blown panic and the relationship between anxiety and addiction. The many ways we can actually train and rewire our minds to feel, perform and live better and many other topics. Judd is among the very best and brightest at the intersection of neuroscience and have a change.
And given that hundreds of millions of people suffer from anxiety, my hope and my instinct is that you will find this conversation quite useful.
So this is me and Dr. Judd Brewer, and I wish I could see your new studio.
Oh, man, I wish you were here. It's pretty dope. So next time you find yourself in Los Angeles, for sure, I will take you up on that.
I would love to come visit. And, you know, I you know, this also sounds I don't want to. Well, I'll just say it. I'd love to go for a run with you some time. One hundred percent.
OK, I was thinking about you the other day. I was on a long bike ride along the coast and wrapping my head around what I wanted to talk to you about. And the surf. The lineup was looking pretty good. It's calling your name. Oh, well, we could go surfing too. Yeah, I would like that. I could I could use a little. I'm a very average surfer, so I need all the help I can get in that department.
Well, same here. Same here. Trying to trying to rewire my brain to master that skill set is no small thing at fifty four anyway.
Man let's just roll into it. How's it going. How is your, how is your covid experience Ben. Which is kind of relevant to everything that we're going to get into today.
Yeah well I could say interesting, but that could be a gazillion things so I'll be a little more specific. You know, I have to say my wife taught me this term FGO. I'm sure many folks know what that is, but I had not heard it as of a few years ago. The African growth opportunity. You can you can make that orated if you want, but yeah, man, this has been such a growth opportunity here in terms of kind of all this adversity coming up and leaning in rather than running away.
You know, you've probably heard this term, this phrase, the only way out is through. Have you heard that?
Yeah, unfortunately, more times than I care to remember. Yeah. Yeah.
I mean, that's a very optimistic, you know, spin on it, of course.
Well what are the alternatives? I mean, we could either we could either go for it or we could be running our whole life. And I have to say running is pretty exhausting in my experience. Right.
Well, you're quite the man for the moment. I think, you know, everything that you've been studying for many, many years is now coming to the forefront of what people are thinking about and grappling with, specifically anxiety. You know, I think it's the rare person who isn't experiencing some kind of anxiety, you know, in this predicament that we find ourselves in. Yeah. And that's what we're going to talk about today. So so maybe the best way to launch into this is first to just define our terms when we're talking about anxiety, what are we talking about specifically and how does that differ from other kind of kindred emotions like fear and worry and and the like?
Yeah, I think that's a great place to start. So if you look at I think the dictionary definition of anxiety goes something like, you know, feeling. Worried nervousness or unease about an imminent event or something with an uncertain outcome. Mm hmm. It's interesting in that definition, worry is an interesting word because it can be a noun like this feeling of unease, but it can also be a verb where I am worrying. So I think let's bookmark that and come back to that, because I think that's a really critical distinction.
Mm hmm. That in both of those can actually the noun can lead to the verb, which can feed back to the noun of worrying. But looking at it from a scientific standpoint, I think a lot of people associate anxiety with something that's kind of necessary, needed for survival, especially right now. And that's something that I dove into a lot in my book because I've been really interested with this idea. There's this whole idea of performance anxiety and I actually haven't found any evidence to support it.
So let's bookmark that as well and talk about some of these origins here. Mm hmm. So think of fear as a survival mechanism. OK, we've talked before about habits and setting up habits for survival. Right. To remember where food is and to remember where dangerous. So these learning mechanisms go way back, you know, evolutionarily conserved, although this sea slug like this is the oldest learning mechanism known in science, positive and negative reinforcement. So if you zoom in on fear as a negatively reinforced behavior, fear helps us survive.
Right. To think of our ancient ancestors out on the savanna. They are foraging for food, right. But they don't know if it's dangerous. So they're moving from their safe zone, their cave out into more of an uncertain space, the savannah. So their brain naturally goes on high alert to start to learn things like, oh, there's food, go there again, there's danger, don't go there again. OK, so fear helps us learn where things are safe and where things aren't safe so we can avoid the unsafe places.
That fear mechanism is, is this old part of the brain. And then layered on top of it is a thinking and planning part of the brain, the neocortex or the prefrontal cortex in particular. And this is interesting because it helps us survive in a different way. It helps us survive through thinking and planning, yet it needs information and preferably accurate information. So in this day and age, there's a lot of misinformation which gets in the way. But it also is helpful for it to have precedent.
So when it's going into unchartered territory, it's really hard to think and plan. You know, like, oh, let's let's go explore Saturn. Well, we've never done that before. So so we've got to you know, you've got to you've got to think of a bunch of things and try to approximate. But it'd be much easier if somebody else had explored Saturn and wrote a book about it, said, don't do this, don't do that.
OK, so the prefrontal cortex, think of fear helps us survive. The prefrontal cortex helps us survive. But if you pair fear with a lack of certainty, which is what the prefrontal cortex is trying to help us do is trying to help us predict the future based on past experiences. If there is no precedent, if there's a lack of certainty, that fear plus uncertainty leads to anxiety and people think, oh, anxiety, it's going to help me survive.
No, it does. Right. There is no evidence for it helping us survive. It makes our thinking and planning brain go offline. And if you think of the extreme form of anxiety, panic, right. Which is wildly unthinking behavior, that's that far end of the spectrum of anxiety.
Right. It's an interesting but subtle and important distinction in that it is the uncertainty that's driving the irrationality. Right. You could be afraid when you have a certain set of predictable parameters to deal with, but when you don't know what you're venturing into, that's what provokes the anxiety. So you kind of extend that. What's fascinating about that is it's not the dire consequence that creates the anxiety. It's the lack of certainty around whether that consequence is going to be dire or not so dire.
And just to be super clear for your listeners, it's not that fear is a problem. Right? Fear helps us learn in new situations in particular.
But fear doesn't have the same neurochemical reaction in the brain as anxiety like neurochemically like how do these two things distinguish themselves?
Yeah, I don't think all of the neurochemistry has been worked out, but I think one way to think about this is on a temporal scale. So if you look at the time scales, you can actually differentiate them pretty well. I'll use an example of, let's say, stepping out into the street. So let's say in this day and age when everybody is distracted by their what is going well, say, ah, well. Bins of mass distraction.
Everybody's looking at their phone, so somebody steps out in the street and doesn't see the bus coming, bearing down on them. They instinctively jump back onto the safety of the sidewalk. And I say instinctively, because this is much faster than our thinking brain. Imagine you look up to the bus and go. Is that really going fast enough? You know, is it going to veer flat? Right. We don't have time for that. So we jump back onto the safety of the sidewalk and then we have a fear response to all of our you know, our basically our fight or flight response kicks in and says, wow, that was crazy.
And I had to be more precise. That fight or flight response is where we get these catecholamines. We get all these basically the adrenaline surge that says, hey, you got to you got to run if you need to. If you're not if you're not safe at this point. Right. But that also helps us have this fear response that says, wow, you could have almost gotten killed. You should learn from this look both ways, you know, relearned what you learned as a kid.
The problem is so that's I think of that is super rapid. Is that instinctual response? The rapid response is that fear response. But then ideally that drains out of our system, you know, and we move on when we've learned. Right. So this is what differentiates that from anxiety is with the anxiety. Maybe we keep replaying it in our head.
Oh, I could have gotten killed. I'm an idiot. I shouldn't have done that. That is just kind of keeping that fear response going chronically. That could happen for hours, days, weeks, years, you know, and this is where people you know, it's not like we need a lifetime of psychotherapy for a fear response. Right. But what we do what we do need is the ability to see the difference between a helpful response and us literally getting spun out of control because our minds going out of control, making us continue to think about it.
And I think we're all experiencing, you know, some variation on those two things over the past year, whether it's fear or unhealthy anxiety, you know, amidst a global pandemic and, you know, are weapons of mass destruction that are feeding us conflicting information about X, Y and Z. I would suspect that, you know, this has created an unbelievably robust petri dish for you to really, you know, immerse yourself in the subject matter in which you are an expert.
And I know that, you know, early in the pandemic, like last May, you were writing pretty extensively about anxiety and how we were grappling with how to, you know, manage this this crazy shift in all of our lifestyles. But here we are almost a year later, it would seem to follow that there's less uncertainty now, perhaps the same amount of fear. But have you seen any kind of differentiation in how your patients or or the population at large is kind of coping with covid?
So I would say there are two main things that I'm noticing both in my clinic and then just at large, one is that there is that big spike of, wow, this is crazy. This is really going to be a pandemic, is it? Wow, this really is a pandemic, you know. And then how dangerous is this? How infectious is this? All of that that uncertainty has gone down a little bit and the death rate has gone down when people figured out things like using steroids to help severely ill patients.
So that part has helped. Yet we've seen continual spikes and these are intermittent ones. We don't know when they're going to happen with other forms of uncertainty, like the variance o of this variant popped up and now there's and then those things feed a whole nother level of uncertainty. We've also seen things that really haven't changed that much in terms of the uncertainty. You know, small businesses, for example, the economy, for example, this is totally unprecedented.
So everybody is kind of feeling their way through this, whether it's a a very poor small business owner. I've seen so many who've just put their life savings in there, like just one more month. Just one more month. Right. And then they crash and burn or the the feds who are trying to figure out how to prop up the economy without throwing us into whatever wild inflation or whatever. That's not my lane.
So I don't know. But the other piece that I've seen on top of this is how people are coping. And I say coping with air quotes because, you know, you've probably heard of the quarantine 15 and where people have gained weight and people are turning to these short term coping strategies because they're immediate and feel good in the moment, whether it's drinking, you know, drinking has gone up. Actually, it's interesting. Drinking has gone up in a significant part of the population.
And some people have just basically cut out their drinking, probably due to lack of social resources in the usual places that they do. So drinking has gone up. Netflix has had quite a run. You know, social media, all these things have gone up as coping mechanisms that are probably going to get laid down even harder as negative habits the people are going to have that's going to give this pandemic a long tail. And then, you know, I think the anxiety piece is going to have an even longer tail.
Some are describing this as the becoming epidemic of anxiety. Right, right.
What's interesting about what you just said is this nexus between anxiety and addictive behavior patterns. Right? I mean, it's logical if you really think about it, but this is something that your new book really gets into in depth, the extent to which addictive behaviors really are a close cousin to chronic anxiety and how that works. Neurochemically, can you talk a little bit about what that connection is?
Yeah, I'd be happy to. This was actually a big aha moment that I had several years ago now. So just to set the stage as a budding addiction psychiatrist, I had a lot of patients, not only with addictions, but a lot of folks with anxiety, anxiety and depression are the bread and butter of the psychiatric profession. Right. And I learned in medical school to basically give people medications for anxiety. And the best medications out there are actually in a class of antidepressants, ironically, because there aren't, you know, the anxiolytic.
The benzodiazepines are now no longer recommended as a first line treatment for anxiety. So the best evidence for these shows that you need to treat about five people before one person benefits. This is called the number needed to treat. And so as a psychiatrist, you can imagine it's not very satisfying for me to treat five people in. One person shows a significant benefit. So I was struggling in my outpatient clinic helping my patients with anxiety, and I was even trained in cognitive behavioral therapy.
The response rate to cognitive behavioral therapy is about 50 percent. If you can get a good therapist, you. So there are a lot of barriers to good treatment for anxiety. So I was really struggling and somebody in we were studying one of these apps that we developed for eating called Eat Right Now. And somebody said, you know, my habit pattern around eating goes like this. I'm anxious and I eat, you know, repeat.
And she said, you know, could you develop a program for anxiety? And I was thinking, well, you know, I'm a psychiatrist. I generally prescribe medications. But as a researcher, you know, I knew a little something about habits. We'd been studying this for a long time. So I went back and looked at the literature. And back in the 80s, right, this is when the Stones this is how popular benzodiazepines were. Do you remember the song Mother Little's mother's little helper?
Of course. Yes.
Do you want to sing a few bars for us?
No, I'm not going to subject anybody to my singing voice, but go ahead, feel free.
Well, I. One thing, but it says something like, she goes running to the shelter of Mother's little helper and it helps her through her day to day to do yes. So the Stones were singing about Benz's because they were so wildly popular in the 70s and 80s and the psychiatric field was looking for new medications. So they came up with the SSRI. Prozac was I think it was invented in eighty five or something like that. So everybody is heralding the the the miracle of Prozac while the Stones are singing about the the Ben ZOS.
And there was this guy at Penn State who was quietly studying anxiety. His name is Tomac Thomas Berkovic. And he said, you know, I'm and he was very interested in the psychological aspects. And he said, you know, I think anxiety could actually be perpetuated in the same way as any other habit through negative reinforcement. And that's when all the bells went off for me. When I read that, I went back because I never learned this in residency or medical school.
When I saw this literature, it was pretty solid. And I was thinking, wow, I never thought about that. Could anxiety actually be driven habitually? And so I started looking at that. And lo and behold, it can be negatively reinforced just like any other bad habit. And that's where things really took off for me.
And I started exploring that both in my research and also in my clinic, right in the way that an addict experienced some level of emotional discomfort and reaches for the substance to self medicate. That anxiety is extremely similar in that you're feeling agitated and you then try to ameliorate that through any number of different behaviors. Right. And this is something you talk about in the book. It's less about the anxiety and it's more about like the behavior that you're reaching out to to to self medicate.
Yeah, absolutely. So I've had a number of patients and I think I write about one of them in the book who are referred to me for alcohol use disorder and in fact, their primary disorder, quote unquote. I don't like that word. Their primary issue, let's say, is anxiety and their anxiety prompts them to drink and then that gives them this brief relief and then rinse and repeat every day. Right. The other thing in this this comes back to the definition of anxiety.
What Berkovic talked about was that anxiety as a noun. So that negative feeling, that unpleasant feeling or emotion can trigger worry as a mental behavior. And I want to highlight that because a lot of people think of behaviors as eating, smoking, drinking, whatever. Worry is a mental behavior because we're doing something it's just not obvious to everybody else, and that worry gives people a couple of things. One is a feeling of control because at least they're doing something and or it can also distract them from that worst feeling, feeling of fear or anxiety.
And so worry as that mental behavior can actually feed back and drive anxiety, habit loops that then, you know, when people realize they're not really in control, then they go over that event horizon into the black hole of anxiety because they get worried and then they get more anxious and they get more worried and, you know, and it just spirals out of control. Right.
I grew up with a parent who is a is a chronic worrier.
And, you know, in the way that, you know, you know, a virus like covid-19 can get passed from person to person. These are emotions that travel virally in a way that's, you know, perhaps worse than a virus because of our social media apps, et cetera. And I know you've talked about this, but it took me a long time to deprogram that, the amount of anxiety that was layered upon me throughout my youth that made me a very afraid person.
But I've come to recognize the extent to which this parent relied upon worry as basically, you know, a behavior that had some reward for her. My mother, in that it made it did make her feel like she was doing something. And it was all couched under this umbrella of of love.
Right. As a way of rationalizing something that was, in truth, like very unhealthy and pernicious.
Yeah, well, imagine a mother of a teenager. So let's say Rich is a high school student, goes out partying with his friends and his mother worries all night until she hears the doorknob click or the garage door open or whatever, and then she can get to sleep. Well, I'm going to guess that her worrying did not keep rich safe. Mm mm.
No, but it did color my my world view. And what I enjoy or entertained is possible for my life. Like it made me very conservative in my choices. Like my my risk analysis was very conservative. And it, I think it limited me until I got enough adequate therapy to kind of see more broadly what was actually going on. But I think what's interesting about that, it's almost you know, I don't know if it's epigenetic, but the extent to which the anxiety or the worry or the fear that's carried by the people in your immediate environment affect those around those people.
And it's so pervasive that there is a scientific term for this called social contagion. And I think like you alluded to with social media, you know, you can prevent the spread of a of a virus, a physical virus by social distancing and masking and all those things. But somebody can sneeze on your brain from anywhere in the world, especially if they're if we're going on social media and constantly getting getting sneezed on. Yeah.
I mean, ten minutes before we started this podcast, I was like looking at Twitter, which I shouldn't be doing, but I was and I watched the video of of the the engine on the United Airlines flight from Denver to Honolulu that, like, caught on fire and was exploding. And suddenly I was super agitated. I was like unnecessarily agitated, like, it's terrible to see that. And I'm glad that everybody's safe and that that had a happy ending to it.
But that caused me to enter into this conversation in a state that, you know, I would have preferred to not be in. And I did it to myself.
Mm hmm. So I think the lesson is we need to be more circumspect with these these these tools of of of social contagion. Yes.
And I and I think here often people, they beat themselves up. And I think this is a case for you. But I think a lot of people say, well, I shouldn't use social media so much or I shouldn't go on social media right before a big meeting so I can calm down or whatever. And then they have another reason they get in the habit of beating themselves up because they can't just force themselves to stop. Which goes back to this, you know, this willpower myth, it's more myth than muscle.
So I think that's one important thing for folks to keep in mind. There may be other ways to help us get off social media, not just telling. Right, right, right.
Right there. There is an interesting relationship between uncertainty and control. And I suspect that people have, you know, various relationships with their respective control issues. But those seem to be kind of intricately intertwined when you enter into a situation in which you feel like you don't have agency or control, that propagates a certain level of uncertainty. And somebody who has robust control issues, it seems to me, would be more susceptible to an anxious response. Is that does that track absolutely search?
Yeah. You can think of this going back to this idea of our survival brains. The cave is a safe place because we're in control, no saber tooth tigers in the cave when we got into Savannah. If we are if we're just of the kind of the habitual mindset of that, like I've got to be in control, we can actually that uncertainty can feel like panic. And so we move from our safety zone into our panic zone. And then, of course, while the unthinking behavior either we run back to the safety of the cave and we starve to death because we don't get food or we freak out and run off a cliff or do something that's not thinking.
So here, I think it's really important to see how we how we work with that uncertainty. And in fact, we can move instead of moving into the panic zone. This is it goes back to the lean in. If we can lean into what's happening, we can actually move into our growth zone. So instead of thinking, oh, no, this is happening again, this is terrible. This is awful, we can go, oh, this is different.
And we can start to see this is as that fgo the African growth opportunity. Right. And if you I live Carol Dweck's work know she was a professor at Stanford, talks about fixed versus growth mindset, you know, fixed mindset. Is that safety or the panic where we're we're in some habitual way of being either never venturing out or always freaking out. And that growth zone is the oh, what can I learn from this zone?
Right. But the first step in that process, is it not having the the ability to, on some level, step outside yourself so that you can recognize what's going on? I mean, you have this rain acronym that kind of speaks to that like most of us are on some level of autopilot where we're not recognizing the triggers, the behaviors. The results were just repeating a cycle without any kind of mindfulness whatsoever. So talk a little bit about how you initiate that process of becoming a little bit more self aware of what is actually transpiring so that you can then look at it as a growth opportunity or recognize that there's something that you can actually do about it.
Sure. I think of this as a three step process. And this actually came to me as I was working more and more with my clinic patients and with our folks in our in our eating group, actually, before we'd even developed an anxiety program. And the first step is really just kind of mapping out these habits. So if we can't map them out, if we can't see that we're stuck, we have no way, there's no way that we can use rain acronyms or anything else to get out of them because we don't know what we're running from.
So here, maybe I'll give an example, a concrete example. I had a patient who was referred to me for anxiety, and when he walked into my office, I could see that he was anxious. So that was pretty straightforward. But when I started taking his history, he started describing how when he would be driving on the highway, he felt like he was in a speeding bullet. And so he said that thought was the trigger that triggered him to start avoiding driving on the highway because he would get panic attacks.
And so that avoidance behavior helped him avoid getting panic attacks. And then he stopped driving on the highway. In fact, he had even gotten a bit anxious just driving the local roads to get to my office. So the first thing we did, I pulled out a piece of paper and a pen and I just wrote Trigger Behavior Result out on piece of paper. And I said, OK, let's go through this. What are your what's your trigger needs like those thoughts?
What's the behavior? Will I avoid driving? And then with the result? Well, now I'm kind of stuck because I I'm really limited in what I do. Yet it helped me avoid having future panic attacks. So there's a great example of just taking five minutes. Literally, Timothy's out so anybody can do this. I don't need a psychiatrist to sit down with them to do it. But that's the first step. If we don't know our habits like we have it loops, we can't work with them.
And so that's what I sent him home to do. I said I gave up. We have we've been on one anxiety app. I sent him home with that. And I said, just start mapping out your habit loops. And interestingly, I'll just I'll just say a little bit more about him. He he came back two weeks later.
So I said, let's set up a follow up appointment for two weeks. He came back two weeks later and he said something really striking that I had not expected him to say, OK, and this actually leads into that second step. So first step is mapping out these habits. The second step is kind of seeing how rewarding they are. And what I failed to mention was that this gentleman was one hundred and eighty pounds overweight when he walked into my office.
So he also, when I took his full history, had it hypertension. He had high blood pressure. He had a fatty liver. He had obstructive sleep apnea.
So when he walks in for his follow up visit, his he looks less anxious. But the first thing he said to me was, hey, doc, I lost fourteen pounds. Yeah. And I said, what?
Because. I think did we talk about weight loss? I think we talked about weight loss. We're going to say that until he worked on his anxiety and he said is that, you know, he saw that I was a little confused and he said, OK, I was mapping out my habit loops like you suggested. And I realized that anxiety was driving me to stress it and that stress eating was not actually fixing my anxiety.
And it was making me feel worse about myself because I know I need to lose weight because I'm at a very unhealthy weight.
So he he just just by mapping out these habit loops, he started to see that some of his compensatory behaviors were actually not very rewarding for him. And this gentleman went on to lose over one hundred pounds. He's still going strong with that. But the way he describes it is that 14 pounds in that next 86 pounds or whatever, he said it was effortless because I didn't feel like I need to lose weight. I was just paying attention and mapping out my habit loops around stress, eating and realizing that they weren't rewarding.
So that's really the second step here, which is tapping into our brains reward system and helping it get updated.
So this is is this Dave who has the recurring narrative throughout the book? Right. And if I'm not mistaken, at some point he looks at you driving down a busy street so he's able to conquer his fear of driving along the way, which was the initial thing that brought him into you, right? Yeah. Yeah. It's it's amazing because it's it seems almost too simple to be true, but very powerful. And if you kind of extend like the extreme example of someone like this person who's going out of their way to avoid the thing that's causing them anxiety, you know, ultimately leads them to become like a shut in.
Right. Avoid anything that would cause that would provoke you to have any kind of anxiety response that then creates a scenario that's far worse than the anxiety itself.
Yes, absolutely. Right in. I'm trying to square this a little bit with with 12 step, wherein there's this adage that that self-awareness will avail you nothing. And here is an example of self-awareness, availing availing you quite a bit. Right. But that self-awareness has to be followed with the action.
Like you had a patient who who had a level of of willingness to actually roll up his sleeves and do do the work. Right. And just being aware that this is the case is not enough. It was his dedication to actually tracking these triggers, behaviors and results that led him to kind of course, correct?
Yes. And I would say so here. I would say self-awareness, coupled with just some basic understanding of how our brains work and this reward based learning system really gets us pretty far. And so I'd be curious to hear, because I obviously I know some about 12 step programs working as an addiction psychiatrist. But I'm curious, this self-awareness of value, nothing. I'm I have not not many of my patients talk about that.
Well, it's interesting. Yeah. It's just it's one of the many, you know, many, many catchphrases. I think what at the heart of what that's getting at is the fact that you can't just passively become sober like you actually have to do the steps and, you know, all the other stuff that comes with it, like just attending meetings and sitting in the back. Listening isn't going to provide you with the solution or just coming to the realization that you have a problem that's important.
But rectifying the problem is going to require you to get out of your comfort zone and do a little bit of heavy lifting that, you know, is going to be unfamiliar for you.
So, yeah, that makes sense. If I'm understanding what you're saying. It's kind of like somebody could even that self-awareness could even perpetuate a self identification with the behavior. So if somebody says, you know, I am an alcoholic, I have tons of patients who say I'm just an anxious person.
Mm hmm. And what I say to them is, well, let's see if that if that's a habit or if that's a persona that you've taken on that you can actually let go of. And and actually, Dave, you mentioned him. He had been so identified with anxiety, he had started getting anxious around the age of eight. And he was 40 when he came to see me. So he'd been wearing this sweater, let's say, for over 30 years.
When he started to reduce his anxiety. One visit, he came in to my office and he said, Doc, it's kind of weird. I'm starting to feel prolonged periods of calmness and peace and all this, and it feels strange. So I'm getting on. It's just that I'm not anxious.
Right, right, right, right.
So it's it's like the person who, you know, grew up in a dysfunctional household and is then attracted to, you know, a mate that has the attributes of that dysfunctional parents and of course, is in a string of really bad relationships. Finally meet somebody who's healthy and they self-destruct that relationship because it's so unfamiliar, like the healthy habit feels wrong until it feels right. So there's an acclimation period, especially when identity is so, you know, deeply woven into the fabric of of how this person, you know, sort of navigates and sees the world.
One hundred percent. And I remember somebody who is pilot testing on wedding anxiety program, sent me an email and said, I feel like this anxiety is deeply etched in my bones. That's how I identified she was with it.
And what's interesting is that that's sort of in my mind when I when I hear that, I'm like, well, that's going to be a tough road to hoe. Like, how are you going to get that person? I mean, because you're basically telling them they have to grow into, you know, a completely new sense of who they are, like, how does that transpire? And yet the success rates that you're experiencing, you know, demonstrate how powerful this is.
Well, and so I can talk about that briefly, what I would say as a clinician, I was looking for solutions. As a researcher, I'm not going to believe anything until I see that it actually works, including my own work. You know, I'm the easiest person to fool thinking, oh, I'm going to create a program. It's going to work for everybody. It could just be a, you know, oh, this worked for me and have one.
And therefore, if it doesn't work for you, there's something wrong with you as compared to me. So, you know, the nice thing about being a neuroscientist is I can actually study this stuff in addition to developing it. Long story short, you know, we've run several clinical trials now. We started with anxious physicians because they are really hard to work with. And I say that as a card carrying member, we can be a pain in the ass.
And I think a lot of it is conditioned culturally where we have to be the Masters. You know, there's this phrase armor up where we have to armor up. You know, we have to take care of everyone else. But there's no time to take care of ourselves because we could have been spending that time taking care of our patients. So a lot of physicians don't take care of themselves. And we now see an epidemic of burnout with physicians.
So we worked with anxious physicians. It was, unfortunately, the easiest study I ever recruited for because there were so many people that were eligible. And long story short, we tested out this on one anxiety app and after three months we saw fifty seven percent reduction in these clinically validated anxiety scores. We also saw significant reductions in measures of burnout because the two can be correlated, especially callousness and things like that. So that was interesting, but it was a small trial, single arm.
You know, we didn't have a control group, so we got NIH funding to do a randomized controlled trial with people with generalized anxiety disorder. I think of these is the Olympian's of worry. They're really good, really practiced at worrying. We did a randomized controlled trial, had people do the usual clinical care or clinical care, plus this unwinding anxiety. And we got a sixty seven percent reduction in these clinically validated anxiety scores. And just to put that in perspective, so remember that number needed to treat I mentioned earlier.
So I need to treat over five patients for one person to benefit from the medication. The number needed to treat here was one point six. Mm.
That's crazy. I mean that's that, you know, when you're when you're looking at going from basically a 20 percent success rate to an over 60 percent success rate, it's almost unheard of. Yeah. Your field. Right.
And this was within app. You're right.
Not even in person treatment. Yeah. Now, to be fair, as part of this app based program, I want to give people support so we have an online community that I and other experts moderate and I lead a live weekly group that anybody can join for an hour and they can ask questions and you kind of ask the doc type of thing. So we do try to give people support, but the majority of folks just use the app and do pretty darn well.
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All right, let's get back into it. So you drop a statistic in the book. I believe it's something like two hundred and sixty four million people are dealing with anxiety. Is that globally or in the United States? I can't recall.
I've mostly looked at data in the U.S. and so what I can say and I'm terrible at remembering statistics, that's why I write them down and then promptly forget them. But in the U.S., the most prevalent category of disorders, again, I don't like that term is anxiety disorders. So I think it's basically one in three people in their lifetime is going to be diagnosed with an anxiety disorder. That's just the disorder spectrum. So, you know, anxiety is pretty darn prominent, I think, in the United States.
It's those data are probably from at least the Western world, if not the US. But let's just say anxiety is pretty prevalent all over the world. Right.
So so chances are there's a there's a high percentage of people that are listening or watching this right now who, you know, maybe they're not having full blown panic attacks, but are are contending with anxiety and some kind of material way on a daily basis in their lives. So I think it would be really helpful and instructive to kind of walk through this therapeutic process of how we unpack anxiety and get people to, you know, develop that self-awareness with the tools to confront it and create healthier responses.
I'd be happy to do so.
And we've actually already talked about the first step, which is just to map out these habits, which anybody can do, and we even put out a free resource. I think it's my habit, Dotcom, where someone can download a PDF that gives them a habit knopper and explains it and gives them worksheets where they can just map it out on their daily basis, which is something, you know, it's free that anybody can do that. And the idea is just to help people start to develop that first level of awareness.
Oh, I didn't notice, you know, X habits. And often there can be habit that builds on habit, that builds on habit.
So after that first step, we talked a little bit about the second step, about tapping into the reward value of the brain. This step is somewhat counterintuitive because and this I'd love to hear your perspective on this. This may be this Western mindset of just do it where, OK, I've identified the problem. Now I'm going to fix the problem. Right. If we could tell ourselves, if we could think our way out of anxiety, I would happily find another job.
It's just not how our brains work. Right. So there's this idea of just telling ourselves to stop being anxious. Did you ever see there was a Bob Newhart skit from his show in the 70s called Just Stop It? No, I don't. I don't think I ever saw that.
OK, so there's this five minute skit where this woman walks into his office as the therapist's office and she says, you know, I have this fear of being buried alive in a box. And basically the skit where he just leans over his desk and he says, just stop it. And there are various iterations of this. And then eventually he says, you know, just stop it or I'll bury you alive in a box, know? So that that's the concept around anxiety's.
Oh, you're anxious to stop it, you know, same with addiction.
Yeah. Yes. It's no different. And just cut it out. Yeah.
Stop doing that thing that's killing you. Yeah. What's the matter with you and that Ewbank person. Right.
It opens it up to a broader conversation about self well and the inability to leverage self well to confront these problems.
Yes. Yeah. So basically at best, willpower can be depleted throughout the day at worst. And I think the science is leaning in this direction where we may not really have a whole lot of willpower. It may be more a myth than muscle. And there's a fair amount of research suggesting that, you know, but these debates have been going on since the Greece ancient Greeks even probably before that. There was this relief on the Parthenon about this writer and this horse, you know, in trying to tame the wild horse.
The horse was passions. You can think of anxiety that way. And the rider is reason, you know. And so, you know, we haven't we haven't gotten any better at taming our passions, whether they're right, whether their addictions or anxiety. So here are what I would say as well. What we do know in modern day is a little bit of neuroscience that that wasn't known back in ancient Greece. And one of the pieces that we do know is that reward based learning is the strongest mechanism in our brain.
So why not start there rather than the prefrontal cortex, which ironically goes offline when we're stressed or we're tired? That's where the whole acronym comes from. Hungry, angry, lonely, tired. That's when our prefrontal cortex goes offline.
So if that's not accessible or useful or strong enough, why not tap into the reward based learning part of the brain? And it too is relatively simple and is. In the research has been known for decades about how this works and it's pretty. So basically there are these two researchers in the 70s, Rescorla and Waggner, they developed this model are the Rescorla Wagner model where we developed this basically a prediction value or a reward value of different behaviors. And the way this is set up is to help us not have to relearn everything every day.
So if given a choice between two behaviors, we don't have to try A and then try B and then compare the two. You know, we've tried the them enough before that we say, oh yeah, I'm going to do B because I know it's more rewarding than A. So our brains are going to pick what's more rewarding. So, for example, I don't know, tying our shoes, let's say, is not tying your shoes, but your shoes.
You realize if you tie your shoes, you don't trip. It's more rewarding. We just do it as a habit. OK, so the only way to change a behavior is by updating that reward value and that reward value can get laid down for a long time. I don't know. We could use eating or smoking as an example. Right. So think of all the times we've eaten cake, you know, birthday parties, celebrations, all these things that could laid down is this rewarding behavior.
And then we see cake and eat cake because our brain says that's rewarding. The only way to change that is to bring awareness to it. And the Rescorla Wagner model talks about these terms that are sound fancy, but they're pretty straightforward, positive prediction error or a negative prediction or so using cake as an example. If we see a piece of chocolate cake and we haven't had it from a certain bakery before, we we expected to have you know, I like chocolate cake.
We expect it to have a certain reward value. Then we eat it and we go, oh, my goodness, this is the best chocolate cake I've ever had in my life. And suddenly there's this positive prediction error because we predicted it to be of reward and it was actually X plus a thousand is much more rewarding. So we were like, oh, I've got to remember that bakery and we learn to go back there for good chocolate cake. Let's say we go to the same bakery and they put a bunch of salts in the recipe instead of sugar.
Oops. And we eat it and we go, What? What, you know, boy, this is not very and we get this negative prediction error that says, man, don't go back to that bakery again. OK, so that's how reward value is updated, all based on one thing, which is awareness. We have to pay attention to the behavior or we're just going to keep doing it right. And you can see how this applies to addictions.
But sorry, I don't. Go ahead. Oh, no, no, no. Finish your thought and say it's easy to see how that applies to addictions. So, for example, in our smoking program, we have people pay attention when they smoke and they realize that cigarettes taste like shit and they stop that reward value goes down. We give and we did a study recently with our Eat Right Now app where we actually found that within ten to twelve times of people paying attention, we give them this craving tool in the app to really pay attention as they eat that reward value drops below zero.
So it doesn't actually take that long to update a reward value, whether it's addiction like cigarette smoking or even a habit like over eating cake. Right.
That's super fascinating, I'm just thinking about, you know, I can only couch this in my own experience and I'm thinking about my alcoholism and the self-awareness that I would have before picking up a drink, knowing if I pick up one that ain't going to be the only drink and God knows what's going to happen. But 100 percent, I'm going to at a minimum, I'm going to wake up feeling terrible. And there's the possibility that I'm creating that all kinds of havoc is is going to ensue.
It's going to have a very negative impact on my life. And yet I make the choice anyway. There's a powerlessness over it.
So maybe that's a little bit of a distinction between somebody who's fully addicted to something versus an anxiety response. Because the counter to that, you have an example in the book of the woman who does the very thing you just mentioned, which is goes to the bakery, is used to getting some kind of sweet and savory food. She opts for the Blackberries instead, and she feels better afterwards. And so she's creating a new reward mechanism. I think piggybacking on top of that and this is what I would like you to get into a little bit, is she's opting out of that kind of vicious cycle that takes place after you've made the choice, you know, you're not supposed to make that makes you feel bad.
And then you beat yourself up and you just continue to dig that hole deeper. So she arrests that cycle. She doesn't have the same reaction. She actually feels better physically. Hence, she's more likely to make the correct choice the next time she's carving that new neural pathway.
Yes. Yeah. And that's really the secret sauce in terms of learning anything, whether it's letting go of an unhealthy habit or even fostering a healthy habit is to reflect back on what it was like last time. So as you described, you know that playing the tape forward, what am I going to get from this? Well, the only way we can project into the future is based on past experience. And if anybody has enough experience, let's say, drinking to excess, that they can clearly see, you know, 99 out of 100 times, I'm going to wake up with a hangover.
And you know what? The worst relationship with my partner or whatever. Then that starts to take hold as a reduced reward value. And if they can recall that, then their brain says, do I really want to have a drink?
And the same thing is true for the eating example. It's like if I overeat again, what am I going to get from this? So I actually like the very simple. I have folks in this step two of the bug.
Just ask the simple question, what do I get from this? Right. And again, it's not intellectual. It's experiential like yeah, yeah, yeah, yeah.
Like try to really connect with the emotional experience of of following through on that unhealthy behavior. I mean, one of the things that I've learned in recovery is called playing it through. And it's not it's about having a longer view, like, OK, if I'm going to drink like, oh, I'm going to I'm going to ameliorate this emotional, you know, feeling of disease that I'm experiencing right now. That's what's triggering me to do it. But play it through, like, OK, tomorrow I'm going to wake up and feel like shit.
I'm not going to be able to do my job or study or whatever it is that I have in store. My partner is going to give me a little bit of side, you know, like just like play it all the way to its conclusion, not just the reward, but what's on the other side of that reward.
Absolutely. Yeah. Yeah.
A big part of of rewiring this reward system has to do with not just mindfulness, but also curiosity and kindness. So I want to spend a couple of minutes talking about curiosity. And what I loved about what you wrote in the book is there's a distinction. There are two different kinds of curiosity. There's deprivation, curiosity, and there's interest, curiosity, because you hear a lot about curiosity and the mindfulness space. Just be curious, but it is a little bit more complicated and nuanced than that.
You know, and I'm laughing because I didn't even know there were two types until I think it was about two and a half years ago.
And I was just, you know, you're probably this way. I was just a naturally curious kid. Like, I love to learn how things work. I used to in destroy my toys to see how they how they worked. And so I just thought, oh, curiosity is one flavor to that. But it turns out there's a fair amount of science suggesting that there are two types and it's helpful to differentiate them because they both work in different ways.
So the first flavor is deprivation, curiosity, which is basically a lack of information. So when we don't know the answer to something, you know, this is our brain seeing, oh, this there's uncertainty here. It is driven literally in a survival mechanism way. Same type of urges that we get when we're going to get food or whatever. We're driven to go get the answer to that. You know, whether it's a trivia question or where is water know?
Because I'm I don't know where water is and there's a lot that can be negatively reinforced. So the trigger is I don't know the answer. The behavior might be if it's a trivia question, we go to our weapon of mass destruction and look it up and then the relief comes from knowing the answer.
So I think of this as a destination curiosity. You know, once we get to the destination, it's it's status. We're satisfied. But until we get there, it's called deprivation because we feel deprived. And that deprivation drives us to go and seek out that information.
Right. Like a like a heroin addict in a new city, the deprivation curiosity would be like, where am I going to score? You know, and and the level of intentionality and determination that gets channeled into that into that curiosity is could power a nuclear power city. Right. Like that person is going to figure it out and find their heroine. Not such a good curiosity. Yes, exactly. Yeah. I get don't get in their way basically.
Yeah. Yeah, they will be like that. But then you'll be hit by that bus. Yeah.
One hundred percent. All right. So distinguish that from from interest curiosity.
So the other flavor is interest, curiosity and in contrast to the destination, I think of this as the journey where we are just. You know, finding that it's very joyful to discover new things to learn, right, so it doesn't matter, there's no destination in mind, we're just happy to learn new things. It's kind of like being in our growth sun when we can go instead of go. Oh, no, we can go.
Oh, what can I learn from this? This can be in any situation where we're out of our comfort zone, or it could be when we're specifically learning a new topic or look, learning some new sporting events like, oh, you know, learning some new sport and we're struggling. We can go all of a sudden this is terrible and go, oh, well, that was that was different. You know, let me try this and we can be open to that experience and it feels very, very different.
So instead of it being negatively reinforced, so the deprivation is driven by this urge, you know, get out of my way. I got to find this. The interest is very much more open where we are curious and like, oh, you know, and that actually puts us in a growth mindset so we can actually learn a lot more rather than just, OK, here's this one.
I need to find where the heroin is now. I found it done. We haven't really learned a whole lot except that one specific thing.
Right. I would think that that type of curiosity and the extent to which somebody is able to develop. The open mindedness required to explore that is going to calibrate pretty closely with how much that challenges their core values or their identity. I mean, this is something that I talked about in a different context with Adam Grant, just like how do you have conversations with people that see the world differently? Well, one of the things you do is you lead with curiosity.
If if if you're in a situation in which that person's worldview is so different from your own that it feels like a threat to who you are or how you see the world, it's going to be more difficult to marshal that level of curiosity. So how does that map on to anxiety? If you have a, you know, a patient or individual who is so self identifying with their anxiety as part and parcel of who they are, I would I would imagine that that's going to be a tougher case than somebody who's.
Relatively less aware of the extent to which anxiety is driving their behavior. Yes. So I think even going to that example of of trying to have a conversation with somebody, you know, if we are trying to put ourselves in their shoes and truly understand where they're coming from as compared to, you know, we don't have a destination in mind. We're not trying to beat them over the head with our point of view and keep yelling at them until they until they acquiesce or, you know, that that curiosity itself, going back to social contagion can be contagious where they see, oh, this person really wants to understand who I am.
And of course, people love to talk about themselves. And so you can actually capitalize on that piece where we're sneezing, curiosity on that other person. And so that can be translated into the clinical setting where as a therapist or as a psychiatrist, it's really helpful if I am truly curious about my patients as compared to them walking in the door looking anxious and then I just peg them as, oh yeah, you're anxious. Take this medication. Right.
That's not going to be that helpful. So I'm truly curious. And the nice thing about people is everybody has their own story. So there's tons to be curious about. And I'm sure you're this way. It's just like hearing people's story makes my day. It just fills me with energy because I'm learning something about somebody and everybody has a unique and interesting story. So it starts there with a therapist or even having a conversation with somebody. It's like, oh, you know, so when somebody walks in my door and they're anxious if I can sneeze curiosity on them, it helps them open up to starting to see their own.
Their own habit loops around anxiety, for example. Right. And then the next thing I can do once they've kind of gotten a taste of that is I can give them specific things to practice, to awaken that curiosity, because we all have it. It's not like something you, you know, you have to buy at the store a little short. I have to go pick that up at the store. This is about just awakening, something that we already have.
That's our own natural capacity. And so simple things like if somebody is anxious, we even have a tool built into our own wings. The app to do this, we have somebody feel into their anxiety and then ask themselves when they feel into where they feel it's strongest in their body, ask themselves, is this stronger on the right side or the left side of my body?
And the idea there is to go, hmm, well, I don't know. It doesn't matter what the answer is, but that is that first hint of curiosity that they're starting to awaken curiosity instead of being sucked into their anxiety. And what this can help do is it's like the observer effect in physics. You know, when they were trying to measure the mass of an electron, they would hit it with photons, with light. And by hitting it with photons, you're actually changing the the velocity and therefore the measurement.
So they call this the observer effect by observing you're actually going to affect the results. And the same thing is true in psychology or psychiatry. If we are very identified with our thoughts and emotions, it's hard to change them. But if we can observe them by observing, we are less identified. And so we can start to see, oh, there's anxiety.
Oh, that's more on the right side of the left side of my body.
So we can see start to see it more clearly simply through that awakening process. And that's truly fostered by curiosity that helps us be able to step back and observe more. Mm. Yeah.
It, it seems, it seems that it would follow that curiosity works as a salve to the shame response to experiencing these types of emotions. Right. I'm imagining the person who is in perhaps they're having a panic attack or some kind of anxious response. They don't really want to reflect on it because then they start to feel bad about it and themselves. So so I've seen people just they shut down emotionally or they avoid any kind of conversational confrontation about that because it provokes so much difficult emotion around it.
But curiosity seems to just kind of allow that to evaporate. It creates space. Right. And so maybe that's where the kindness piece comes in.
Yes, I think of these two. So curiosity and kindness as being complimentary buckets. So there are many you know, there are many pieces or things in each of those buckets that can help support each of these. So, for example, with kindness, gratitude is a great way to reflect on kindness, whether it was the kindness of others or whatever, that helps us tap into that feeling of kindness. So on a broad scale, my loves actually did us done a study where we queried several hundred people to see where on the reward value spectrum, different emotions are different mindstate states.
And we found uniformally, probably not surprisingly, that anxiety, frustration, anger all feel less rewarding and more closed down. I think kindness and curiosity basically and so connected you can think of connection as being in the bucket of kindness, let's say. So here, when we look at this uniformly, kindness and curiosity feel more open and expanded, then feeling anxious or disconnected or whatever, or being being mean or being the the object of somebody's anger. So here just being able to tap into what it feels like to be have kindness bestowed upon us or to be kind to others and to truly being kind in a selfless way, not thinking to hold the door.
So she's more likely to smile at me or whatever, not looking for anything in return. So that's where these two share this overlap of openness, of connection, of expansion that is just more rewarding because it feels better than being closed down or disconnected.
Is there a difference between kindness towards others versus self-conscious in terms of how that how that affects someone's anxiety?
I would say pragmatically, it can be more challenging for a lot of people to tap into the feeling of self kindness. But the feeling itself, whether it's kindness toward others or kindness toward ourselves, that expanding feeling is the same. Right?
Right. I would say it seems that. A gesture of kindness to another person, regardless of motive, still has an impact, and it could be just a simple gesture. But to do that to yourself is very unfamiliar for a lot of people. They feel like it's indulgent or they don't deserve it. It seems like it's a more complicated web to unravel.
Yeah, I think it can be. And I see this a lot when people are working with their eating habits, where they mix up self-indulgence with self kindness and so they have a bad day in their habit is to stress, eat or eat some ice cream at the end of the day and summon a lot of people say, well, how do I know whether it's it's it feels like I'm just being kind to myself by eating that tub of ice cream.
And I say, check in with yourself.
How kind is that? You know, what do you get from that?
And, you know, typically it's they numb themselves for a little bit, but then they feel guilty and they don't feel they get that gut bomb and all of these things. And when they add up the real word value, they can clearly see, oh, that's self-indulgence. That's a habit versus, you know, I've had a hard day. And then they can ask themselves, well, what do I need? You know, maybe a little bit of ice cream, but not a whole tub, maybe a little bit of chocolate.
And when they really pay attention, they can actually find that pleasure plateau where, you know, it's just enough and then they can stop simply by bringing awareness to that. And so I think that's one of the big challenges for people, is to differentiate that self-indulgence versus the self kindness. Right.
And I think built into something that you just said, which is super important, is that no matter what behavior, errant behavior you're indulging in, you are getting something out of that. You are being rewarded. Right. It's not all bad. There's a reason why this is locked in for you. And so the process of reconfiguring that whole thing is identifying that reward. I mean, it goes back to your your paradigm here. But understanding like I you know, I eat ice cream because, you know, I hate myself.
Well, no, actually, it's it is doing something positive for you in a certain way that also leads to negative effects. But recognizing what that positive thing is, I think is an important step. Absolutely.
And that actually leads us to the third step, which is, you know, for a lot of us, we haven't. That's been the plateau of our pleasure, of our reward, where we think excitement or eating ice cream or binge watching Netflix or whatever is the peak of experience. You know, there only but there is such a thing as too much of a good thing. We can't go on vacation forever. We can't have sex forever. We can't just keep eating ice cream forever.
You know, our body says enough. Uh huh. So here we can learn to see not only how unrewarding some of you know, when we peak at that pleasure plateau and then start going off the other edge, we can see how unrewarding these things are, including habits around guilt and all these things which are echo habit typically on top of these other habit. And then we can go back to that brain paradigm and give ourself something better. So I think of this is the BBA, the bigger, better offer.
So our brain, again, setting up reward hierarchies. If it starts to see that one behavior is not as rewarding, there's that negative prediction error. It's going to say, OK, give me something better. And this is where kindness and curiosity come in so we can win. We're kind to ourselves versus beating ourselves up, which feels better, you know, when we're when we have a fixed view versus being curious in a conversation which feels better when which when helps us feel more connected with the other person, which helps us learn something or discover something new about that person to our brains.
Literally, it's a no brainer.
You mentioned bringing mindfulness to all of this, which is kind of like the umbrella component to all of this. I think for a lot of people, we talked about this extensively last time you were on. Everybody should go back and listen to that episode. But for a lot of people, that that that lands kind of in an esoteric space. Like what does that mean? Like, oh, bring mindfulness to my bad behavior pattern. Like, walk us through what specifically you're talking about and how that can be helpful.
You know, less and less these days I, I use the term mindfulness because it's a concept. It was it was actually from this old term Sakti, which means to remember. And you're thinking, how does two remember have to do with paying attention and all this stuff. So in modern day, this you know, there are many definitions of mindfulness. John Culbertson, most famous, I think, in the Western sphere for giving this definition of paying attention on purpose in the present moment, nonjudgmental.
Well, honestly, that's a pretty long definition that could trip people up along the way. What does it mean to be nonjudgmental? So here I like to break it down into its elements, components. And there are two you can think of. This is two sides of a coin. One is awareness. We all know what awareness is, right, where they're aware or not aware and the other you've already touched on, which is curiosity. And so you can think of the positive framing of non judgment as curiosity, being curious, not jumping to conclusions, not assuming we know what's happening, truly bringing a fresh perspective, which is why in a lot of the Buddhist circles, they talk about beginner's mind and Zen or they talk in Vipassana, they talk the basin literally means seeing clearly where we've taken off our subjective bias glasses, where we see the world a certain way.
We've taken those off and we're just seeing things without any of those biases. I want to pivot and talk a little bit about about teens. There is an epidemic of teen anxiety going on right now. I you know, I've got a 17 year old daughter who's having an unbelievably difficult time with the pandemic and having to do all of her schooling on Zoome. We tell our kids, you know, get off the screens now. It's get on the screens.
It's very confusing. My daughter's an extrovert. She's unable to see her friends to the extent that she would like. She doesn't have the freedoms that perhaps she would have if things were a little bit different. And it's taking quite a toll. And we've been struggling with trying to figure out how to be of service to her and the most productive way. So I'm interested in in in whether you have any experience working with teens specifically or what it is about the teen experience that perhaps is a little bit qualitatively different from maybe people like you and I.
So we've done a little bit of research with teens, for example, the teenage smokers. We've done a little bit of pilot work with our own winning anxiety program to make sure it was accessible to teenagers. But by no means am I an adolescent psychiatrist. I just want to start with that. What I can say from my own experience as an anxious teen, we moved around a bit when I was a kid. And that can be challenging, you know, in terms of being anxious, going into a new school, not knowing anybody and all that stuff.
What I can say is that it's really, really challenging. But what I can also say is that here, you know, I think kids are actually best. I mean, younger kids in particular are really good at being curious. And I think somewhere that starts to get teens were beaten out of them, but that's probably too strong. But somewhere as we move toward adulthood, you know, we're told things like, you know, make sure you know everything, you know, try to act like you're in control.
You know, all this stuff that actually gets in the way. Our thoughts are our natural curiosity. You know, there's not a lot of reward for being curious, although if you actually look at it, the curious people, the authentic people tend to do pretty darn well in life. So here I would say teenagers are super interested in knowing themselves. I think that's where a lot of adolescence is really focused, is like who am I as a as a person?
How can I differentiate myself, you know, whatever, at least in the Western world. So here I would say helping teenagers fostered their own curiosity. And in particular, you know, they love to learn how their own minds work. And I would even add to that, if there's a pain point like anxiety that can be a doorway in, that's non-threatening because they're they're hurting. They're looking for that pain reliever to say, oh, you know, let's let's help you understand how your mind works around in general, how everybody's minds work.
So that gives teenagers kind of a window into the world and then they feel like they're a little more control because they can see how the world works, but also give them a window into their own minds and their own anxiety where they can not only work with their anxiety, but but work with themselves, learn how to live happier, healthier lives. So here I would say helping foster that curiosity by being truly curious as parents, not always easy to do, but being truly curious and not jumping to conclusions might be a really good place to start.
Yeah, that's helpful. I mean, I just at times feel, you know, powerless.
I can't I can't solve the problem, you know, for her. And we're trying to figure out what the best way of communicating with her is. But there's also a lot of hormones going on. Like it's you know, it's a it's a very volatile situation at times, as anybody who is parenting a teenager can probably relate to. Sure. So I think it's a common thing. Thank you for that.
Let's you mentioned at the beginning of the conversation performance anxiety and that perhaps would pivot back to that. So maybe we could talk a little bit about that for a few minutes.
I'd be happy to.
So I've gotten so many questions when I do workshops or retreats or even in our own wedding anxiety app about, well, if I'm not anxious, am I not going to be able to get through the day or perform at a meeting or in music or sport or whatever. And so I went as a researcher. I wanted to actually see what the research shows. And it turns out I read this very interesting review article from Twenty Fifteen that's titled something like, you know, the the Yorke's Dodson curve from from legend to law or from law to folklore or something like that.
And what this review article highlighted was that many people have heard of this this curve Yorke's Dodson law. I don't know if you've heard of it, but it's OK. So nineteen Oades. These two researchers, Yorke's and Dodson, were studying Japanese dancing mice. Don't ask me why Japanese dancing mice, but that what they were studying and they found that it was like they were measuring Goldilocks for some reason. So it's like I'm going to shock them a little bit, a medium amount or a lot and see how well they perform in a maze or some some measure that they could look at.
And of course, if they shocked them a medium amount, they did the best. And so they concluded that, you know, a little bit a moderate amount of arousal is going to help these mice perform well in a maze. Now, I don't know how they would measure things like motivation of the mouse is like and you know, you know, when you shock them a little bit or they're like, dude, that hurt them a lot.
But anyway, that was nineteen eighty eight. Nobody really paid attention to that paper. It was cited like four times in the next 50 years. Yet this very famous psychologist and in the nineteen fifties hunsley in an address to some conference, he gave a talk where he speculated without any data that anxiety might help improve performance in the same way that this arousal piece in Japanese dancing mice did. And then one of his old students took it and ran with it where he took rats and he used holding their head underwater is the arousal or the stressor.
And the longer he held their head underwater, the worse they did. And again, I don't know how he accounted for them, like just catching their breath before swimming. But that was his experiment. And what he did was that he used the terms, anxiety and arousal interchangeably. And he said, you know, this irrevocably, undeniably says that this Yorke's Dodson law, he called it a law was true.
OK, so this sets the stage, you know, still relatively quiet and then the Internet comes along. OK, so I think it was before the year nineteen ninety this year started, some paper had only been cited ten times. And then between 1990 and 2000, if I've got this right, it was cited one hundred times and then between 2000 and 2010 it was cited over a thousand times. And people were writing books about this and saying, you know, you need to have some anxiety to perform well.
Yeah. This review article also highlighted when you look at the data, four percent of studies suggested that increased anxiety. Improved performance that that Goldilocks piece and 10 times that number, it was over 40 percent suggested that there was a direct inverse relationship. More anxiety equals more worse performance, regardless of how much anxiety there is. And you know this yourself. I think anybody that looks at this when you're performing your best, you know you're in flow. I think that is that is the optimal performance.
And there no anxiety is not within miles when we're in flow.
Yeah, I think that's 100 percent correct. I mean, first of all, is there a difference between arousal and anxiety? Because I do feel. Well, let me just say this.
Part of like I, I sort of self identify with some level of anxiety as being a precursor to performance, I'll approach a podcast in the same way that I would approach a swim race as a kid. And if you know a little bit of butterflies, like I'm excited, that tells me that I care that this is important to me. I want it to be good. All of those things are are information that help me feel like I'm in the right place at the right time.
But if it tips over and it's a little bit too much, suddenly I can't think straight. I can't find the words or my body isn't doing what my brain tells me to do. And I've often wondered, like, is this necessary at all? Because I know as somebody who's done a little bit of public speaking, more often than not, I get up on stage and I have tremendous performance anxiety and I don't deliver on the level that I know I'm capable of and that every once in a while, like I don't care or like I'm just super casual about the whole thing.
And I go up and I'm very relaxed and those are always the best performances. So I think for me, I've spent a lot of time thinking about the story that I've crafted around that arousal state and how important it is when in truth, I'm not sure it's really relevant at all. Your drop's is undermining me. Yes. And I would I would agree. And that perhaps it's undermining you is an experiment that you or anybody or any of us can do.
This goes back to something that my old mentor used to say. Lou Moglia, great guy. He used to say, Judd, is it true, true and unrelated or is there actual causal connection? And so we can think of performance anxiety, we get anxious. True, we perform well, or you're describing how we might not perform as well as we hope, but let's say we perform well and then our brain makes this causal inference that says, oh, that anxiety is what made me perform well when in fact we don't have any causal evidence that that was true.
And yet we might even be able to tap into evidence to the contrary, like you're suggesting when we're relaxed and go into a performance or whatever, we tend to do better. I love there was a performance at the was it the twenty eighteen Winter Olympics? Chloe Kim, who's a snowboarder on the halfpipe, she rocked it and got the gold medal and she was just so relaxed when she did it, it was like, wow. And I caught her social contagion when she was doing, you know, I've never snowboarded in my life, but like, I could catch that.
Or if you look at Usain Bolt when when he used to be cruising past people, he had this shit eating grin on his face. It's like he's having so much fun, you know. Right.
That he's he's connected to the joy. Like, the problem that I run into is that I have a certain level of of perfectionism that works at cross purposes with my goals. And I'm also a bit of a I can be a bit of a control freak and I'm a grinder. And so to use the podcast as an example. You know, I want to be as prepared as I could possibly be, and I want to feel like revved up and excited to get in, if I don't if I'm not experiencing that internally, then the story that I tell myself is you didn't work hard enough.
Like you're not earning this. Like, I have to be in some level of pain, you know, that's telling me, like, OK, you've you've exerted yourself appropriately. You're rising to the occasion and it's all bullshit. And I know that. And yet it's so difficult for me to counterprogram against that. Like, if I just waltzed into this podcast to talk to you, it's like I didn't really look at his book, but like, you know, I know I could talk to him.
I've done a bunch of these podcasts. It'll be good. I feel like I'm not doing you an adequate service and I'm not respecting the audience, so.
I feel like I need to experience suffering in order for it to be good, and I know intellectually that those two things don't necessarily calibrate and yet I'm powerless to change it.
So so I think this is a great example that we could use to kind of highlight these aspects of how to change behaviors, whether it's anxiety or anything else. So, for example, if you you know, if you were unprepared for your podcast, which I've never heard you be in this one reason I love talking to you, which is why I continue to do this, because everyone's like, you're so prepared.
So then I've set the bar at a certain level.
Right. And I said, let me live up to that. I put that pressure on myself and I'll experience shame. If I can't live up to that judge, what am I going to do?
So let me ask you this. When you feel shame or when you have all that anxiety, does that actually help you prepare better versus when you are just truly interested in the subject matter and like, oh, this looks like an interesting book. No, but I will say that when there's that that pressure will get me to do the work because I want to avoid the sensation of feeling unprepared, because that's that's very uncomfortable for me. Yeah, yeah.
So that's that negative reinforcement. If I if the behavior is coming unprepared to a podcast and then you can't really get an in-depth into a conversation, which is I think what you're really great at doing, then that negative reinforcement says, oh, that didn't go so well, you need to be more prepared next time. Yet here you can ask yourself and I'm not trying to give you advice, but I'm just using this as a hypothetical experiment is, you know, OK, so the anxiety helps me prepare.
What if you just you cloned yourself and you prepared through curiosity? Did that would that get you just as prepared and would it be less painful in the process? Does that make sense?
Yeah, I'm sure it would be. And that would be that new healthier behavior pattern that's so uncomfortable. Right.
And that's the work. But it's not like I wrote I wrote performance anxiety down in my notes, like this was not on the list of things that we were going to talk about. But this is what's coming up. And this is probably the most fun and the most, you know, interesting part of the conversation. So I have the awareness that when I can let go of, you know, trying to direct this whole thing, that I make the space for it to be something better than I would have originally anticipated.
But but that leap of faith and faith is something you talk about in the book, too. Like you have to have that kind of faith that there's something better on the other side if you're willing to, like, release your your hard grip on your way of doing it, because it's the way you've always done it.
Well, and I think that's just bringing this to one aspect I don't think you're naming, so I will name it, which is authenticity and wisdom. So when we try to control things, we have this closed down view of the world and we try to let's say you're doing a podcast, you're trying to force answers or trying to force a great right b line or whatever, because I don't want anyone to find out that I don't know what I'm talking about.
And yet you are you are curious. And it's not these podcasts are not about you. This is why I love listening to your podcast, Blowing Smoke. It's not about you talking about your experience all the time and letting the guest, like, say things here and there to support what you think about yourself in the world. This is about you truly being curious and having a really interesting conversation. And you've got the wisdom from having done this a bunch of times to know that that always works better than the other alternative.
Except I just did make it all about myself for a couple minutes there, like I did for the record. I did. Yeah. As an example. Yeah, yeah, yeah, yeah.
But it's but but it's it's instructive for me because it helps me develop greater self awareness of the triggers, the behaviors that are leading me awry. What's beneath the anxiety. Like if I, if I, if I try to excavate like what is driving me to behave in this way, it's that, you know, I want I want to create the best podcast that I can. I want to equip myself responsibly. I want to be liked. I want to respect me.
I want the audience to know there's a lot of like like infantile emotions baked into that as well, like being a people pleaser or what have you, you know, that are also, you know, a mountain that I need to climb in terms of, you know, self-esteem, et cetera. Yeah.
And all of that begins with awareness comes back to just being aware of those things, but not just being aware, like you talked about right at the beginning, but being aware and knowing how our minds work. Right. Then it then it inspires us to climb the mountain rather than seeing it as a grueling slog.
Mm. I want to round this out in a couple of minutes, but I can't let you go without talking a little bit about breath work and how breath work can be really beneficial in this process.
Sure. So I think there are a gazillion ways to talk about breath work, you know, whether it's yoga or mindfulness or, or whatever. But I think of I think of breath work in particular as helping develop curiosity where, you know, our breathing is generally a neutral object unless we have COPD or some other asthma or something else that that affects our our breathing process where it can or panic attacks sometimes that, you know, we can associate breathing shallowly and rapidly with with anxiety.
But the breath is something that we're all doing all the time. And the bigger problems, if we're not and we can we can use that as an anchor to keep us in the present moment. So here I think of helping foster that awareness and. Curiosity through something that's neutral and always changing, so not only can we use curiosity to help us anchor, I like to have especially students who are just starting meditating or whatever, I have them ask themselves, well, how do I know that I'm breathing right now?
Hmm? What's letting in?
So that awakens their curiosity. Not like, hey, pay attention, your breath, blah, blah, blah. I count to ten, whatever. How do you know that you're breathing? I'm doing this right now. It's my my diaphragm, I'm feeling my abdomen stick out. That's what's telling me most prominently right now that I'm breathing, and so that awakens the curiosity and then we can use that curiosity as an anchor and ask ourselves things like, well, what are the sensations that are that are letting me know that I'm breathing as we breathe and we can even ask questions like, how do I know?
Is this a long breath or a short breath? Is it deep or shallow? Because we don't know what the next breath is going to be. Our body is just doing regulating itself. And so that can foster curiosity. It can also anchor us in the present moment. It can help us see that things are constantly changing. And with that anchor, it can help us start to see when our mind gets lost in a thought pattern. So, for example, related to anxiety, we get lost in a thought.
We're sucked into it or identified with it. We're lost.
Well, that anchor and it's like that ship yanking on the anchor when the winds blow boom. Oh, you know, oh, I'm lost. And then we can wake up without that anchor. We just adrift at sea. So I think of breath work in that way as one way to help us really start to anchor in the present moment, stay more present, see the things are constantly changing and also start to see how identified we are with our thoughts, emotions and body sensations and start to be able to have a greater perspective where we can observe them more.
And is there like a specific protocol that that you could share with people, or is it more of just an amorphous paying attention?
I think? Well, there are many different techniques to do this, and each person has to find what works best for them. Right. And out of full disclosure, I spent probably 10 years banging my head against the proverbial wall, trying to focus on my breath. I would even write, you know, my first silent meditation retreat, you know, for seven days. Right. Silence. I by day three, I was crying uncontrollably on the retreat manager's shoulder because, you know, here it was so I could I could make it through college, I could get into medical school, but I couldn't pay attention to my breath.
And so the first thing I would say to people is this is not about that forced willpower based paying attention your breath, which is what I was doing, that that's not the way to do it. It's really about curiosity. And I would say, you know, finding something that helps us be curious and say about the breath as an anchor, but we can also use other physical sensations in the body. We can use hearing as an anchor. For some people, that's easier.
So finding whatever anchor it is that helps us be curious and then awakening that curiosity and using that curiosity to explore our own sensations. So just like I was saying, you know, it could be as simple as how do you know that you're breathing and then follow your breath and just be curious about when the breath ends. Be curious about how long that pauses and then be curious about when the outbreath starts and when it ends so those can be anchor points.
As we explore what are these physical sensations that help us stay present and curious, so it could be as simple as that, like asking you having these anchoring questions, that layer on top of this simple but not easy practice of just paying attention to these changing physical sensations that we're breathing.
One of the things that I talked about with Andrew Habermann, neuroscientist, was the way in which you can use eye movement to kind of essentially, like reset your state. Do you have thoughts on how all of that works if you practice that or studied that at all?
I've I've not practiced or studied it, but I've been at conferences. So the most common technique that I've seen that's been studied is MDR, that eye movement desensitization response or something like the lateral.
Is that the lateral movement? Yeah.
Yeah. And the idea there that I understand and so I could be getting this wrong is that one core aspect of that is helping people anchor on physical experience. So when you have somebody move their eyes laterally from this side of this side to this side, they have to focus on doing a task that is physical and it gets them out of their thinking head right into their physical body. And if you think of this by by focusing on something like that, you can you can take up all of the working memory in your dorsolateral prefrontal cortex.
That part's not important, but like in this working memory, part of our brain and kind of reboot the system because our brains only have a certain amount of working memory, a certain amount of ram, so to speak, so we can use things like MDR or other eye movement techniques.
But you can even think of this more broadly. One practice related to the breath that I love in particular is called Five Finger Breathing, and I love this in particular because people can teach it to their young kids and then have their kids walk them through it when they're anxious. And the idea is to just take the index finger of one hand and places the base of the pinky, on the other hand, and then as they breathe in, feel the physical sensations as of their breath and their fingers and look at their fingers at the same time, pause at the top as they breathe out, trace down the inside of their pinky as they breathe, then trace up the outside of their ring, finger down.
So, for example, if you make five full breaths, you've traced your whole hand. If you do 10, you can trace back from your thumb to your pinky. And what that does is it takes up a lot of working memory because we're paying attention. We're seeing we're feeling three different aspects of our experience, you know, two fingers in our breath and that reboots the whole working memory system. And at the same time, paying attention to breathing often helps regulate our physiology where it comes down.
So if those worry thoughts come back in, they actually need a level of arousal that meets them. We're used to being worried and feeling worried, thinking, worried, feeling worried.
Well, if we're thinking worried and we're not feeling worried, that body is going to say, hey, that's just a thought. And we can identify and let go of thoughts more easily because there's a mismatch between the arousal. So and it's the physical body that drives experience and behavior more than thinking brain. So that one's going to win if we can really help regulate that physiology.
Sure. It's so crazy that these I mean, it's it's so simple that it is like, OK, breathe and like, look at your fingers. And you could have, like, such a powerful impact on, you know, on the mind.
There's so much science, you know, if we actually understand one final thing.
I mean, there's so much interesting science that's occurring right now in the study of the mind in the brain. And yet so much of it remains unmapped. There's so much that we still are grappling with trying to understand from your perspective, like what is the study that you would like to see performed that has yet been performed that would help elucidate a lot of the things that you're that you are curious about?
Well, there are a gazillion things that I'm curious about. Yet one thing that I'm really interested in is this this idea of personalized medicine. This has been a buzzword in medicine for a long time, and it hasn't really yet come to fruition where the idea would be to take some of these genes and all these environment and behavior and find what medication works best for them or tailor a medication to them. If you approach that same personalized medicine away from the taking a pill perspective, which is where I focus more.
The idea here is, can we actually personalized medicine through understanding someone's habitual reactions to their world? And we've done we did one pilot study that gave us some really interesting data that says to me that this is possible where we can actually take what we're calling a psychological phenotype of asking people just 19 questions at a baseline before they start a program. And we can predict who's going to do better than somebody else and with a pretty striking result. And so what my next experiment that I want to do is to do this at scale where we really look at, you know, is there a way to simply and cheaply get a sense, at least for somebody, the anxiety profile, let's say?
And can we use that as a way to not only determine who's going to do best with our own anxiety app, but also ask, well, why are the people that aren't doing well? And this is fortunately a small minority, but the the folks that are not doing well, why aren't they doing well? And what do we need to do to help them do better? Because I'm sure you can relate to this. I'm always looking like, how can I how can I do better?
You know, how can I help my patients more? How can we do research that helps people at a broader level in the population? Right.
Well, that's a laudable aspiration. You know, I'm still hung up on the fact that two hundred million plus people are suffering from anxiety right now. There's just there is so much. Suffering that's occurring right now and it's encouraging and hopeful to hear about the solutions that you're working on, so I applaud you for for the work that you do. So much respect for your field and your servant to humankind. Thank you. Appreciate you. I feel like my anxiety has been unwanted as a result.
This hour and a half, you've succeeded at doing what you do best, my friend.
I feel good success. Cool.
So the new book is called Unwinding Anxiety. Of course, Judd also has these amazing apps. If you're struggling with everything from quitting smoking to trying to ameliorate your anxiety, crave to quit is the one app that you still have. Right. And you have an unwinding anxiety app, which is really kind of a compendium piece to the to the book itself.
Yes, right, and if you want to learn more about Dr. Judd Dotcom, anything else coming up that you want to alert people to other than the new book? I think that's it.
Folks are on Twitter. They can hit me up on Twitter at Jan Brewer. But other than that, I think the Dr. Judd, you know, websites got it all. I'll just mention we've got a bunch of free resources on the website as well. So if anybody is just looking to learn a little bit more about their habits or how their minds work, you know, I love to put together short animations that describe these things in simple terms. That's one of my challenges that I and passions.
And so folks are interested in those things. Take a look. And in particular, I would say I'm really proud of this very short two minute animation that we put together with Sharecare that talks about spreading kindness virally as compared to fear. So if anybody's interested in checking that out, there's this. You can probably find it on my Twitter feed or also on my Dr. Judd website. We'll link that up in the show notes as well. Awesome. How do you feel?
You don't feel anxious.
Do you know? This is great. I feel energized. Cool.
Well, hopefully at some point in the not too distant future, we'll get together for a run and a surf out here. Have you back on the show? You're welcome. Any time. So thank you again. That would be awesome. Thank you. These lights.
Thanks for listening, everybody.
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