Judson Brewer - Unwinding Anxiety, Worry And Fear

Judson is a psychiatrist, neuroscientist, and author of the book, Unwinding Anxiety: New Science Shows How to Break the Cycles of Worry and Fear to Heal your Mind. He has combined his expertise in mindfulness, habit, and behavioral change, and neuroscience to create practical tools to help unwind anxiety. The interview offers several ways to uncover what triggers anxiety and how to identify and break these anxiety habits using a variety of methods, including mindfulness and reward-based learning

Transcript

Welcome to Untangle.

I'm your host,

Patricia Karpis.

We're hoping that your meditation practice is giving you what you need to stay more calm,

Grounded,

And resilient wherever you are.

Today's guest is Judson Brewer,

A psychiatrist,

Neuroscientist.

He's also the director of research and innovation at Brown University's Mindfulness Center and an associate professor of psychiatry at the medical school.

Judson has combined his expertise in mindfulness,

Habit change,

And behavioral change and neuroscience to create some very practical tools to help unwind anxiety.

I've known Judson for several years and was excited to read his latest book.

Today we talk about ways to uncover what triggers our anxiety and how to identify what he calls our anxiety habits and how to use mindfulness and reward-based learning to break the anxiety and panic cycles.

Judson shares a lot of practical wisdom here,

So let's get to it.

Now,

Here's Judson.

Judson,

It's so great to have you back on Untangle.

Thank you for being here.

Thanks for having me.

Do you remember when you were here before?

I think it was maybe two,

Maybe three years ago.

Yes,

It was B.

C.

Before COVID-19,

Such a long time ago.

I have no concept of time anymore.

But I love this new book.

I powered through it over the last week,

As much as you can power through a book on anxiety and habit change,

Trying to understand it and apply things to yourself.

But I'm curious,

What inspired you to write this particular book?

Well,

Many things.

One,

I've had my own issues with anxiety.

I used to get panic attacks in residency.

I was training to become a psychiatrist.

But the other anxiety that I've had is around helping my patients with their own anxiety.

So if you think about this,

Back in the 80s,

This was when.

.

.

Do you remember the song from the Rolling Stones,

Mother's Little Helper?

Yes.

Yes.

She goes running to the shelter of her mother's little helper and it helps her on her way or whatever it goes.

So that song was about benzodiazepines,

Where they were free flowing,

Let's say,

Out of doctors' offices to help people with anxiety.

Let's just say they're not the first line treatment for anxiety anymore.

And in the 80s,

This is when the first selective serotonin reuptake inhibitor,

Prozac,

First came out.

And so this was heralded as this safe,

Miracle,

Non-addictive medication.

Yet when you look at it,

There's this term called a number needed to treat,

Which means how many people you need to treat with a medication before one person benefits.

And that number for gold standard antidepressants,

Which is the gold standard class for anxiety right now,

Is 5.

15,

Meaning I get about a 20% hit rate when a patient comes into me and I prescribe medication for their anxiety.

That's not very calming for me.

Especially if you're trying to help people.

Yes.

So that's my job is to help people.

And I love my job and I love it more when I'm actually helping people.

When it's out of my control and I'm prescribing medication,

I feel like I'm playing the medication lottery.

Not as fun.

So my lab was doing this study where we were developing this app for eating,

For overeating and helping people with habitual eating.

And somebody in that program said to me,

I'm mapping out my habit loops around eating.

And I'm noticing that anxiety is actually triggering me to eat.

And I'd like you to develop a program for anxiety.

And I was thinking,

Well,

I'm a psychiatrist.

I prescribe medications for anxiety yet that kind of put this pee under my mattress,

This bug in my ear.

So I started looking back at the literature as a researcher.

And I was thinking,

Well,

What did we miss?

What have I missed?

What did I not learn in medical school about how to treat anxiety?

And lo and behold,

Back in the 80s,

When Prozac was being focused on there was a guy named Thomas Bork of AC at Penn State who was studying anxiety and worry.

And in particular,

He said,

Hey,

I bet anxiety can be perpetuated through a habitual process through negative reinforcement with worry being the driving mechanism there.

And I thought,

Wow,

That's amazing because I know a little something about habits and helping people to break bad habits.

But I never thought to apply that to anxiety.

So that was a couple of years ago now,

And that formed into our unwinding anxiety app.

And then after doing a bunch of work,

So both research wise,

Where we looked at the studies to see if this process could actually help people change habits.

And then also doing this in my own clinic,

This idea for this book was born.

It's like,

Oh,

This needs to get written down so that anybody can read a book and start to understand how their own mind work and then work with anxiety in any habit.

I really resonated with the idea of anxiety being tied to these habit loops that we have.

You talk for a second about anxiety,

What it looks like in the brain and the body just to set a foundation for us.

Sure.

If you think of the definition of anxiety,

It's something like this feeling of nervousness,

Worry or unease about an imminent event or something with an uncertain outcome.

So that definition kind of sets the stage.

We all know what it feels like to be anxious.

That feeling of clenching,

Of contraction.

Sometimes it feels like heat,

This restless quality of our experience.

And that feeling of worry can also be a mental behavior.

We can go there in a minute,

But let's start by talking about what happens physiologically.

So when we get anxious,

Our heart can race,

Our blood pressure goes up.

This is why they call when somebody goes into the doctor's office to get their blood pressure taken,

They call it white coat hypertension.

It's not that somebody suddenly has hypertension because they see a white coat.

It's because they've associated being in a doctor's office generally not with great things.

It's like,

Oh no,

What are they going to find this time?

We can associate anxiety with these mental things because our brains are going into this chronic on alert mode.

And we can get into how that works mechanistically in a bit,

But I'll just talk about how this works in the brain as well.

So one thing anxiety has been shown to do is activate a part of the brain or a network of brain regions called the default mode network.

And ironically,

It's called the default mode network because this is the network we default to when we're not doing anything in particular.

And it's involved in self-reference and it tends to get activated with things like regretting things we've done in the past or worrying about the future.

So those are some of the mechanisms how anxiety shows up behaviorally,

What it feels like,

How we can do things physiologically like raise our blood pressure,

Make our heart beat faster,

And then also show up in our brains where it activates these networks of brain regions.

You talk about that anxiety is born when the prefrontal cortex doesn't have enough information to predict a safe future.

It's about safety.

And then will you link that to how anxiety becomes a habit or even an addiction?

I'd be happy to.

So we can think of our old survival brains out.

They've got two jobs.

One is to help us find food,

Eat,

And then also to help us avoid danger,

Not be eaten.

Okay.

This is the oldest known mechanism in science.

It's evolutionarily conserved all the way back to the sea slug.

Eric Kandel actually got the Nobel Prize showing this back in 2000.

So very well worked out process.

This process has three elements,

A trigger of behavior and a reward from a neuroscience standpoint.

So you can imagine we go out on the Savannah,

Our brain has to remember where food is.

So we go out,

We find the food,

There's the trigger,

The behaviors,

We eat it.

And then the reward comes through this dopamine hit in our brain that says,

Remember what you ate and where you found it.

This reward based learning is really based on these dopamine hits that are set up to help us remember things.

Okay.

Same thing with the saber tooth tiger.

We got on the Savannah.

We don't know if it's dangerous,

If it's unknown territory.

So we see the saber tooth tiger,

There's the trigger and we run away,

There's the behavior.

And then the reward is that we are not their lunch.

We survive to live another day.

So that process is still alive and well in modern day humans.

And it gets driven by a mental behavior.

Okay.

And this is what Berkovec and others had talked about and I found so fascinating is that anxiety or fear or whatever can actually drive a mental behavior of worry.

Okay.

And that mental behavior of worry makes us feel like we're in control,

Even though we're not really in control when we're worrying.

In fact,

Our prefrontal cortex is going offline because that part of the brain had evolved to help us think and plan.

Yet when we're anxious,

There's this acronym that I have in my clinic called HALT,

Hungry,

Angry,

Lonely,

Tired.

These are times where my patients who have addiction issues are more likely to relapse.

Well,

These are times when people,

Anybody,

Any of us,

When we're anxious or stressed,

Our prefrontal cortex goes offline.

So it can't actually do what it's designed to do,

Think and plan.

So here,

Ironically,

We feel like,

Oh,

Anxiety is helping us or worry is helping us.

But in fact,

It's making our thinking brain go offline.

It's making things worse.

Nobody has shown that anxiety is actually helpful.

I kept thinking about your whole concept of the habit loops and how you invited the reader to come up with all of the different habits that might fit into your definition of that.

And this idea of how a habit of anxiety or a habit or pattern of thought gets put into motion is really interesting.

And how many different ways we behave that are actually habits.

It was a bit of a redefinition of habit,

Even though it seems quite obvious when you think about it.

Yes.

And this is why I'm constantly fascinated,

Not only in my clinic when I'm meeting new patients and learning their stories,

But also just seeing how this plays out everywhere in everyday life.

The simple definition that I've learned in residency,

Even about addiction,

Continued use despite adverse consequences.

This is just habits gone off the rails.

But it's a basic survival mechanism.

And when you think about how often our behaviors are created based on how we were raised,

If you think about how the brain chooses to lay down a habit and how hard it is to learn new things or to learn new behaviors once a habit has been laid down.

And I guess this gets into which we'll talk about that first gear of thinking about awareness,

Like just even being aware that a neural pathway has been laid down that has caused you to behave in a certain way that may not be of your choosing.

I would love for you to talk about maybe even some of the habit loops that you talked about in the book,

Because I want people to understand how broad your definition of habit is.

I'd be happy to.

Even very relevant today are these habit loops that form as compensatory mechanisms for anxiety,

But will actually make the anxiety worse.

So these habits.

So tying our shoes is a habit,

But it tends to be a helpful one because we don't trip as much when we tie our shoes.

Remembering how to get our fork or our spoon into our mouth is a helpful habit because we don't have to relearn that every day.

So there's this spectrum of this continuum from helpful to not so helpful to continue to use despite adverse consequences.

And we can look to see how broadly this applies simply by looking at our own behaviors.

For example,

Texting has been shown to be now more dangerous than drinking and driving.

So there's this continued use despite adverse consequences.

When somebody gets a text on their phone and it burns a hole in their pocket or their purse or whatever,

Where they just have to check to see who it was that texted them while they're driving,

Even though they know that it's not safe.

There's social media,

There's checking our emails,

There's smoking,

There's eating,

There's shopping,

There's gaming.

Anything,

Any behavior can go to an extreme where there's continued use despite adverse consequences.

What's the process for changing that habit loop?

So the process and actually lay out the book in kind of a three step process.

And this is something that I'd observed in my lab,

In my clinic,

In my own life that is surprisingly simple and straightforward,

Though not always easy.

So it's not,

This is magic,

It's science.

And it's interesting when you look at the neuroscience behind this,

The first step for changing any behavior is to recognize what it is.

And what I found over and over to be stunning is how little we know about our own minds.

So I've had patients come into my clinic,

I'll give you an example.

And I write a little bit about this gentleman in my book.

I had a patient who came in who was referred for anxiety.

And I started to take a history and basically he had no idea about how his mind worked.

He'd had anxiety for over 30 years.

It was about 40 years of age.

This started when he was around eight or 10 years of age.

And it was this big black box for him.

And it was so bad.

He had full blown generalized anxiety disorder.

He also had panic disorder because he would have these thoughts come into his head when he was driving on the highway.

Oh no,

I'm in a speeding bullet.

And those thoughts would get so distressing.

Sometimes he'd have a panic attack and eventually he avoided driving on the highway altogether because those thoughts were so distressing.

He never got in a car accident,

But that fear of getting in a car accident was so strong that it led to him completely avoiding driving on the highway.

So the first thing we did was just to simply,

I pulled out a piece of paper and we mapped out what's the trigger,

What's the behavior,

What's the reward in real time.

It took us 30 seconds.

You could just see this light,

The room that was dark forever was lit up because he could see not only how this habit was happening or forming around avoidance,

But that just knowing the process helped him have a much better understanding,

Which felt great because he could see,

Oh,

Here's the process.

And then he could start to work with it.

It's like retraining your brain or coaching your brain.

And you also mentioned four anti-habit strategies,

Which are the strategies that either really don't or might maybe a little bit help in addition to the awareness.

What people think about willpower,

That was one of them.

You're like,

That's not really helpful.

And most people think it's very helpful.

Yeah,

I know.

We've thought this forever.

This is the age of enlightenment,

The age of reason,

And we can just reason our way through everything.

Do you remember this guy,

Bob Newhart?

Yeah.

So for those that aren't in the know,

Because he was the comedian in the 70s,

There was this skit called Just Stop It.

He had and basically this woman walks into a therapist's office and she says,

I have all these fears and I don't want to give away the skit because it's worth watching.

But basically with each one,

He just leans over his desk and he looks at her severely and goes,

Just stop it.

So wouldn't it be great if I could lean over my desk in my office and my patient walks in and says,

I want to quit smoking.

And I say,

Just stop it.

I want to stop overeating.

Just stop it.

I want to stop being anxious.

Just stop it.

I would gladly find another job because I'd only need to see each of those patients once.

Unfortunately,

That's not how our brains work.

We would love to think that we're in control,

But our brains don't work that way.

Our brains are driven by how rewarding a behavior is.

That's why reward-based learning is called reward-based learning.

It's how rewarding or how enticing that behavior is that's going to drive future perpetuation of it.

That dovetails into what you name the second gear.

The first gear is mapping out your habit loops and becoming more aware.

The second gear is tapping into the brain's reward system,

Which is what you're saying distinguishes from willpower or pushing through.

Yes.

And I'll give an example from one of the recent studies my lab has done that really highlights this.

So our brains set up this reward hierarchy.

There's a part of the brain called the orbitofrontal cortex that's intimately involved in this.

The details aren't that important,

But the idea is that given a choice between two behaviors,

If we've laid down a reward value for each of them in the past,

Our brain can just quickly go to that index and say,

Which one's more rewarding?

Do that one.

Instead of us having to go,

Should I eat the broccoli or should I eat the cake?

Let me try each and see which one tastes better.

Our brain says,

Well,

Birthday parties,

Friends,

All this stuff that we've laid down as a strong reward value for cake,

Including the calories from a survival standpoint,

There are more calories back into cake than broccoli.

It's a no brainer for our brain.

So it's going to say cake every time.

So we did a study with this app called eat right now that helps people use mindfulness to change eating habits.

And we could embed a tool to measure just how rewarding that behavior is because the old school just stop it while it's been around for decades and decades.

This is the basis for almost every calorie restriction based diet.

Just follow our point system or just do this or just do that.

And then if you fail at your problem and you have to renew your subscription for another year,

It's a good business model because the formula is correct.

It's just not how our brains work.

We said,

Well,

What about awareness?

The only way it seems from the neuroscience to update the reward value of a behavior is to make sure that we are very clear in this,

In the present moment,

How rewarding it is.

So our brains,

If they've developed a habit of doing something,

They're just going to keep doing it until we say,

Hey,

Let me check to see if this is just as rewarding as it was before.

So for example,

As somebody that's learned the value of cake for every birthday party that they went to and every celebration where they had cake,

It's really important for them to start paying attention as they eat cake now.

So if their trigger is they're stressed and they eat cake,

They can check to see,

Did this fix my stress?

How did it sit in my stomach?

Was I actually hungry?

Did it ruin my appetite?

Did it give me a sugar rush and crash and all this?

And when we pay attention to the result now doesn't mean the cake is suddenly not going to be tasty.

It's going to help us stop overeating when we're eating because of stress,

For example.

And in fact,

My lab found that it takes as few as 10 to 15 times of people really paying attention as they overeat or as they stress eat or whatever that habit is for that reward value to drop below zero,

Meaning they'd start to choose not overeating or not doing that behavior as compared to doing it.

So there's an example of simply bringing awareness in having that awareness help our brains update the reward value.

And that updated reward value helps us change the behavior without willpower.

Notice how none of this has to do with willpower.

It only has to do with awareness.

You also have this quote,

Short moments many times.

It's amazing that there is science to support that if you repeat a new behavior 10 to 15 times,

Or you pay attention 10 to 15 times that you'll see results,

But it's creating that new habit that's making the difference.

Yeah,

Absolutely.

Our brains have to be plastic so that we can adapt in a very rapidly changing world.

If we get stuck in things that are not going to help us survive,

We're not going to survive.

This is part of how our brains learn to adapt and survive.

Yet,

If we're not paying attention,

We could get left behind,

So to speak,

Where we're not seeing how unrewarding the old behavior is.

So it's really that key element of awareness that helps change all of this.

Yeah,

You're adding new tools to mindfulness and self-awareness.

That impacts the behavioral change.

The third gear you talk about in order to step into new habits,

You also need to have a level of curious awareness.

Is that really about not being judgmental of yourself,

Forgiveness?

Then you talk about you have a mantra,

Which I'll let you.

I used it today,

Actually.

I'll let you share that.

This goes back to this reward hierarchy in our brain.

If our brain's in the second step or second gear,

Start to see how unrewarding the old behavior is.

For example,

My patients who come in who want to quit smoking and I have them pay attention as they smoke and they realize that cigarettes taste like crap,

It's much easier for them to stop smoking because every time they imagine smoking again,

They can recall that last time and go,

It wasn't actually that great,

And they become disenchanted.

With that disenchantment,

It opens the door for what I call the BBO,

The bigger,

Better offer.

Our brain,

Again,

It's going to say,

Okay,

If that's not so great,

Give me something else to do.

Here,

We can certainly do other things.

If we're anxious,

We can distract ourselves or we can drink alcohol or we can eat,

But all of those types of compensatory behaviors are short-term and tend to create problems themselves.

I've certainly had a number of patients who've been referred to me for alcohol use disorder,

But their primary issue was anxiety that was driving them to drink.

Then there are plenty of people who have gained weight in the last year,

What is it,

The quarantine 15 because they're habitually overeating when they're not actually hungry.

They're all these or binging on Netflix or whatever.

All of these compensatory behaviors might be a bigger,

Better offer from anxiety,

For example,

But they're ultimately not going to fix the anxiety.

They're just going to distract us for a bit and they can lead to problems on their own.

What I really mean by bigger,

Better offer is finding something that is intrinsically rewarding,

Ideally that's zero calorie and something that we'd never become habituated to.

For example,

Alcohol,

We get tolerant,

So we have to drink more,

For example.

Here I would suggest there are two things that are intrinsic to all of us that fit that definition of the bigger,

Better offer.

I think of them as these two buckets of curiosity and kindness.

My lab did a study where we looked at a bunch of different mental states and had people rate the reward value of the different states.

This will probably seem obvious to folks,

But we had to do the science to prove that it was true.

Anxiety,

Frustration,

Disconnection,

They all feel worse than connection,

Than kindness,

Than curiosity.

Our brains have this natural reward hierarchy that says,

When served on the menu,

Would you like anxiety or would you like curiosity?

We're going to pick curiosity anytime.

Here we can actually train people to tap into their natural capacity to be curious,

To be kind.

In fact,

When we're anxious,

That feeling of anxiety feels closed down,

Feels contracted.

We can bring some curiosity in and get curious.

What does this anxiety feel like?

Where do I feel it most in my body?

Even ask questions like,

Is it more on the right side or the left side of my body?

It doesn't matter what the answer is,

But that,

Hmm,

Well,

Is it more on the right?

Is it more on the left?

Starts to awaken our curiosity.

That opening,

That expansion helps us flip from this contracted experience to more of an expanded experience because we can't be contracted and expanded at the same time.

They're polar opposites.

I like that feeling tone of contraction versus expansion.

Everyone feels that more in their body.

You also talk about that as being really important to habit change.

It's not just when asked what the difference is between cognitive behavioral therapy and this process,

You talk about this idea of having it be a felt sense in the body.

Yes,

That's actually critical because remember,

Our thinking brain,

Which is trying to think and plan for the future,

Goes offline when we're stressed or anxious,

So we can't trust it in those moments.

This is not an intellectual exercise.

This is really about feeling into our direct experience.

Does it feel closed?

Does it feel open?

What makes us feel closed?

Oh,

I went on social media and got caught up in some fight with somebody on Facebook or Instagram or whatever.

Oh,

How'd that feel?

Closed.

Then we can compare that to time when we spend time with our family or spend time with our pets.

What's it like to have that type of a connection?

Oh,

That feels more open.

This whole idea of bringing curiosity.

You talked a little bit about the mantra,

But will you talk about how you use that mantra in your life on a daily basis?

I'll talk about this mantra as long as nobody asks me how to spell it.

I know.

I was thinking about that as I asked the question.

I jokingly say this because historically mantras have been sold and they're secret and all this stuff.

In fact,

A mantra is anything that can anchor us in the present moment and you don't have to pay money for it.

So I will give this one away for free and people can spell it however they would like.

They can be very creative.

Now,

The idea is if we can step out of our thinking experience,

One way to do this is to simply draw in our natural capacity to be curious.

And what I noticed years ago now was that when I got curious,

I would naturally do something which was go,

Somebody asked me a question that I didn't know the answer to.

I'm going,

Hmm,

I don't know.

That's a good question.

Or somebody asked me,

What does that feel like in your body?

And go,

Hmm,

I don't know.

Let me check.

And then that I realized as I started doing mindfulness workshops and teachings across the world,

There's a version of,

Hmm,

In every language that I've ever taught in in France,

It's like,

Oh,

Slightly different.

But that upward inflection of,

Huh,

Or Hmm,

Or Hmm,

That type of thing.

That's the mantra is that mantra of curiosity.

So I think of it as Hmm,

But whatever language,

If somebody speaks in their native language,

There is that version of that.

And what that does is it drops us into our direct experience where we're getting interested.

We're getting curious.

We're turning toward what's happening because we want to know what's going on,

Not intellectually,

But experientially.

It lightens us up a little bit.

If you are in the middle of an anxiety habit loop and you have the awareness to stop and pause and say,

Hmm,

You might even be able to laugh at yourself a little bit.

Yes,

It is much harder to take ourselves seriously when we're Hm-ing our way through life.

We've even tried this with Olympic athletes,

Very serious.

They're serious at their business,

But they're also a lot of fun to work with.

And that,

That Hmm can be really helpful in any type of mental training.

You talked about Carol Dweck's growth or fixed mindset.

And what you're saying is if you don't get out of your comfort zone,

You never move forward.

How does one move from a fixed to a growth mindset?

And how do you actually enjoy this being pushed past your comfort zone?

Yes.

Yes.

This is a really important question,

So I'm glad you're asking it.

So if we think of what constitutes the comfort zone,

It tends to be familiarity.

So our survival brains in the cave,

They know there's no saber tooth tiger,

So we can let down our guard.

When we go out into the Savannah,

We have to go on alert,

So to speak,

Because we don't know if there's danger out there.

So that's moving out of our comfort zone.

Naturally,

Our brain's going to say,

Hey,

I need to check to see if there's danger here or not.

Now,

If we become habituated to trying to run away from discomfort where we distract ourselves or we go to in colleges,

They had this movement around safe spaces.

When somebody didn't agree with the college students opinion that college student could run to a safe space.

I thought college was for actually helping discourse and helping people have debates about different opinions.

But for some reason,

Somebody thought that was a good idea,

Whatever that is,

Whether it's in college or trying to protect our kids from discomfort,

All of that forces people to say,

Hey,

Go find your safe space as quickly as possible.

Go find that comfort zone.

And it makes it much more challenging to have a good degree of distress tolerance,

Right?

Because distress,

That uncertainty is just telling our brain to go get information.

Yet if we say I'd rather not know,

I'm just going to go back to the safety of my comfort zone.

Then whenever we're forced out of our comfort zone,

We move into our panic zone because it's just too uncomfortable to be in that feeling because we're not used to it.

We just tend to go into this panic zone.

The way to work with that is to one learn how our brains work.

That's why I'm explaining all of the background here.

But it's also to be able to lean into uncertainty,

Say,

Oh,

That's my brain saying,

Hey,

This is new territory.

This is unfamiliar.

It's OK to be uncomfortable.

So can we get comfortable with discomfort?

That's the key.

And I think that's where curiosity helps.

It's like,

Oh,

This is new instead of,

Oh,

No,

This is uncomfortable.

Yeah.

And you have to practice it.

It doesn't just happen that you feel comfortable or you push yourself the first time.

I think the more that you're able to get what you're calling distress tolerance or be in an uncomfortable place,

The easier it is time after time.

You get used to that.

Absolutely.

So there's no switch in the brain that we can just flip and say,

OK,

Time to go to the growth zone.

It's really about seeing and it goes back to this closed versus open.

Right.

So can we be open to that feeling of feeling a little closed?

Can we look around in those moments and say,

Hey,

Is there danger here or is this an opportunity to learn?

Well,

I don't know anybody that doesn't like to learn.

We can look at it that way and say,

Wow,

This is different.

Can I lean into this?

What can I learn from a science perspective?

You talk about the posterior singular cortex.

You talked about the default mode network a little bit earlier,

But the posterior singular cortex,

You say that it lights up during craving and diversion and that it quiets down when we meditate.

How does this work with anxiety?

Is there a parallel that you can make there?

Yes.

And there's a fair amount of neuroscience behind this.

So when we are worrying about the future,

So the default mode network,

Again,

Is the self referential network.

It's about me.

And so when I'm worrying about the future,

My default mode network is lighting up like a Christmas tree.

OK,

And that is my lab is actually shown through real time neurofeedback studies where we use fMRI feedback from brain regions and we can give people feedback from their own posterior singular cortex.

We actually had Anderson Cooper come in one time and just do it on camera for 60 minutes.

So you can watch where we say,

Think of a time when you're anxious and his posterior singular goes off the charts.

And then we say,

OK,

Now we have him guide him into a meditation and he starts meditating and that activity drops.

So that brain region gets really activated when we get caught up in anxiety,

When we basically when we get closed down and contracted,

Yet it quiets down.

And we've done I think our first published study was over 10 years ago now where we looked at this,

Where we found that experienced meditators were really good at quieting their posterior singular cortex.

And in fact,

You don't have to be some experienced meditator to do this.

Anybody can tap into their momentary experience and explore what's it like to feel closed down,

What's causing this,

And then what's it like to get curious or if we're judging ourselves.

Right.

That's a good way to feel contracted.

We can ask ourselves,

Oh,

What's it feel like to judge myself?

What am I getting from this?

And then what's it feel like to be kind to myself?

So we bring some kindness in that too can open us up.

When you talk about the studies that you've done in the lab related to meditation,

Is there a particular kind of meditation that the research has really gravitated to or meditation now is like the word sport.

We talk about that all the time.

What is your guidance on that?

Here I would say,

I think the sports analogy is a good one.

So many different sports can help increase our aerobic threshold and get us in shape.

For some people it's running,

For other people it's swimming,

For other people it's whatever.

And in fact,

I think that's true for meditation as well.

I think of the common denominator around different types of meditation is really around helping us see when we're attached to something,

When we're closed down,

When we're identified with something.

And that identification takes this form of contraction where it says anybody can explore this themselves.

So somebody says,

If we come to somebody and say,

I have a great idea and we tell it to somebody and they say,

Well,

That's a terrible idea.

We all know what it feels like to feel that contraction,

That turning away,

That protection.

There's that identification that we had with that idea as compared to going,

Hmm,

You're right.

I think that is a terrible idea.

Or having a debate about whether it is a good idea or not.

So any meditation that can help us start to identify this feeling of closed downness and what it's associated with is going to help us start to open up more just by understanding and seeing how our own minds work.

Whether it's Christian contemplative prayer or centering prayer or mantra meditations,

It doesn't even matter what it is if it can help open us up.

And become more self aware.

I always think about there is meditation and often people meditate for many years and still haven't learned what you call your mindfulness toolbox.

Like there are all these things that you're teaching where you're integrating mindfulness into a lot of other concepts as well.

That makes it a more holistic and integrative way of looking at the world.

But it is a toolbox.

It's not that you sit down to meditate and all of this becomes crystal clear to you.

Yes,

I'm a pragmatic guy.

I'm a clinician.

So I want to do whatever is going to help my patients.

You can think of this as personalized medicine.

So ideally,

Down the road,

We'll have medications that are based on people's genetic profile and their environmental profile and their background.

And they'll be much better at helping people.

Like I mentioned,

The anxiety medications aren't so good.

The way I think about this is really finding what works best for the individual and teaching them the basic concepts of this is how your mind works.

This is how to work with your mind.

Here are some tools to work with your mind.

And then we do the research to make sure that it is true.

So my lab has done the studies.

I highlight this in the book,

Where I give some of these tools that we're talking about.

But also we've done clinical studies where in app,

We have this app unwinding anxiety that follows the same three step process.

We did a study with that where we got a 50 to 57% reduction in clinically validated anxiety scores.

This is a anxious physician.

We did a follow up study with people with generalized anxiety disorder.

These are the Olympians of worry are really good at worrying.

We got a 67% reduction in these clinically validated anxiety scores.

And the number needed to treat just to remind you or anybody listening,

That number needed to treat for medications,

I have to treat about five patients before one person benefits.

The number needed to treat in these studies was 1.

6.

So what lottery would you like to play?

I like that you're talking about it in terms of personalized medicine.

It's like personalized medicine and meditation,

Because people have different challenges that they're dealing with.

Have you applied any of this to chronic pain or to sleep?

I know those are probably giant questions,

But are there some quick things that you can say about how you would bring some of these tools that you've created for anxiety into chronic pain and sleep,

Which are such big challenges for people?

Yes.

We've just finished a study that was funded by the National Institutes of Health on anxiety and sleep.

And this was based on a hypothesis that I had based on seeing a bunch of patients who had sleep issues.

A lot of my patients have sleep issues.

And one of the biggest contributors,

One of the common denominators there,

Was that they have some type of worry or anxiety that keeps them from sleeping.

And then when they can't get to sleep,

They look at the clock and they get more anxious that they can't get to sleep.

And then it just spirals out of control.

So we did a study,

We did this randomized control trial where we looked to see if mindfulness training could actually help people with that anxiety component and if just touching on that could help people sleep better.

And in fact,

We found in several measures of especially related to worry and anxiety and sleep,

That those improved significantly in our mindfulness group,

People using the Unwinding Anxiety app and didn't really change much at all in the control group.

And in fact,

When we then gave the control group the app,

They showed the same improvements,

Which was really neat.

It was like a second replication study right within embedded in the same study.

Yeah,

I would imagine you'd have seen the same results with pains and quite a bit of pain is a result of the fear,

The anxiety,

The worry,

That secondary suffering that you layer on top of the primary pain.

Yes,

Absolutely.

So I've got two final questions.

One is when we talked about the mindfulness toolbox in the book,

You've got some practices that you recommend and I'd love for you to share a little bit about those practices.

And then what is your best advice for people to start setting better habits?

Those are great questions.

So I'll give an example of a tool and I detail a lot about why this works and how this works in the brain and even evolutionarily speaking.

This was prompted by an observation that actually Charles Darwin had first made,

Which was around the eyes.

So we tend to open our eyes wider when we're curious about something.

That's why they call it wide-eyed wonder.

They don't call it narrowed-eyed wonder or closed-eyed wonder.

And we have associated our eyes being wide open with the feeling of curiosity so much that we develop what's called a somatic memory around that.

So when we're curious,

We just naturally open our eyes.

And we can actually hack that by noticing when we're anxious or when we're frustrated what our eyes are doing.

And they tend to be narrowed when we're frustrated because we're focused on trying to fix something or get something done.

And we can just simply open our eyes really wide and see how long that frustration or that anxiety can stick around as we open our eyes really wide.

With that,

We can even add in,

You can combine this with the mantra.

We open our eyes really wide and go,

Hmm,

What's my frustration feel like right now?

So there's a very simple practice of just checking with our eyes.

So there's other,

You have loving kindness and compassion practices and you have the RAIN practice,

Which you've talked about a little bit on the show.

So I didn't invite people to go check that out in the book because you have some great examples in there.

So your best advice,

Like if you had to summarize for people that really want to be with their anxiety in a different way,

What is your best advice on setting new habits?

So here I would say really it comes down to knowing how your mind works.

If you don't know how your mind works,

You can't work with it.

If you know how your mind works,

It's amazing how well you can work with it and you can capitalize on its strength.

But if that's the first place to start and that coupled with awareness,

So this basic understanding and then bringing in awareness at every step,

That's a winning formula.

And knowing how your mind works doesn't mean that everyone's minds work in the same way.

And I think as we're growing up and evolving into adults,

Many people,

I've heard this from my teenage nieces,

You believe that everybody thinks the same way.

And I think it is an important distinction to know that we all do think differently and we're this amalgamation of many things that have impacted us over our lives.

So knowing how your mind works is a job.

I mean,

You have to do that work because we don't all think in the same way.

And I'm glad you highlight that because,

Again,

We don't think the same way.

And it's great to celebrate that diversity and to be open to others' ideas and opinions.

And at the same time,

We do all learn the same way.

This basic mechanism,

As I said,

Is evolutionarily conserved all the way back to the sea sled.

So while we might not think the same way,

And that's a great thing,

It's important to differentiate that from learning.

Everybody forms habits in the same basic way.

If we can understand that piece,

That can help us see where we can celebrate that diversity of different thinking.

Yet we can also tap into this common mechanism,

Which also helps us be able to relate to and put ourselves in the shoes of others so that we can even empathize with them more.

I love the way you articulate all of these concepts.

I understand them in new ways every time I speak to you.

So thank you for helping me create new neural pathways.

Judson,

Thanks so much for being with us on Untangle.

Is there anything major from the book or anything new that you want to share with us before we close?

I'm in the business of helping people,

And we try to put out some tools that can help people understand their minds and all of this.

So we've actually created a website,

Just MapMyHabit.

Com,

Where people can download a free PDF and just start mapping out their own habit loops.

So I think that's a great place for anyone to start,

And it's certainly that price is right.

It's free.

OK,

We'll put that in the outro as well.

So thanks so much for being with us today and for all the great work that you're doing.

It's been my pleasure.

It was great to have Judson with us today,

And I hope you have a great week.

We will see you next time.

Good bye.

Reviews

That was super interesting, helpfull and practical. I am reading the book at the moment, thank you.🙏

Excellent for helping and healing anxiety.

Thank you so much for this talk as I have suffered from stress and anxiety all my life.
Looking at it from understanding how my brain works is a new way for me to deal with
my stress levels. I will replay this talk and research more on how my brain works.
I will also look into reading your book.
Thank you again.

Very interesting. So much valuable information about anxiety, worry etc.

Very helpful information! Will have to revisit this. Thanks!

Great interview. Compelling subject, skilled interviewer and knowledgeable interviewee.

Very interesting! Thank you!