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In this episode of Insights at the Edge, my guest is Dr. Judson Brewer—Dr. Jud as he’s called. Dr. Jud is an internationally renowned addiction psychiatrist, neuroscientist, habit change expert, and author. He’s a professor in the School of Public Health and the medical school at Brown University. His 2016 TED Talk, “A Simple Way to Break a Bad Habit,” has been viewed more than 19 million times. He’s the author of several books, including The Craving Mind, the New York Times bestseller Unwinding Anxiety, and a new book. It’s coming out on February 20, 2024. It’s called The Hunger Habit: Why We Eat When We’re Not Hungry and How to Stop. Dr. Jud, welcome.
Judson Brewer, MD, PhD: Thanks for having me.
TS: OK, I want to start with something that I learned from reading your book Unwinding Anxiety that I would say is one of those, what? Really, could this be true? Which is that anxiety in your view, from your perspective, is a “bad habit” that we can break. And as somebody who has worked with my own anxiety my whole life, I never thought of it as a habit. I always thought of it as a condition. And so I’d like to understand and have our listeners track with us how you came to this discovery. I realize it’s a big opening question here, that anxiety could be looked at as a “bad habit.”
JB: Well, it actually started with me struggling—so I’ve certainly had my own run-ins with anxiety. I used to get panic attacks during residency. But I was getting anxious with trying to help my own patients with anxiety, because prescribing medications, the best ones out there, it’s about one in five that show a significant reduction in symptoms. The term is called “number needed to treat” and it’s 5.2, meaning it’s about one in five. So basically I was playing the medication lottery. I didn’t know which of the next five patients that came in was going to benefit and what to do with the other four.
And I started wondering what the heck I could do to help my patients besides prescribe medications. And my lab at the time had been studying habit change, and I bring that in because I started looking at the scientific literature. And it turns out that back in the 1980s, ironically around the same time that Prozac was first released, there was a psychologist named Thomas Borkovec who suggested that anxiety could be driven through a process called negative reinforcement.
And when I read that, I had this aha moment, because negative reinforcement is what I’d been studying in terms of habit formation and habit change. And I’d never thought to apply that mechanistic perspective to anxiety itself. And the way it works is that the feeling of anxiety tends to drive the mental behavior of worrying. And that was the big connection that I hadn’t seen before until I read about it. And then I saw it all the time in my patients in my clinic, where it’s like the feeling of anxiety drives this mental behavior of worrying.
And what the research had shown was that it’s rewarding enough—that worrying—because people feel like they’re in control. Even if it doesn’t give them any more control than they had before, it makes them feel like they’re in control or at least doing something. And from a brain perspective, that’s enough of a reward for our brain to say, “Hey, remember that behavior? Do it again the next time you feel anxious.”
TS: OK, I think I’m with you in terms of I feel the sensations of anxiety and now I’m going to start worrying. OK, I have control over whether or not I continue worrying or I don’t continue worrying?
JB: Well, any behavior can be learned, and any behavior can be unlearned if it can be learned. And so we have some level of control, and we also don’t have—we may not have control, and where we can gain control is by learning how the system works as compared to trying to force the system. So I’m sure there are plenty of people that have noticed that worry isn’t that helpful in their life, and they just try to stop worrying. And if they’ve tried that, they’ve probably also noticed that just trying to apply willpower doesn’t work so well. And so here I would say we have control once we know how the controller works.
TS: Tell me more.
JB: Yeah, well, I will start by saying—and we can double-click on this later if it’s helpful—but the willpower piece seems to be where most people have been focused, whether it’s anxiety or overeating or anything in terms of changing any behavior. But from a neuroscience standpoint, willpower is not even in the equations when it comes to habit formation and habit change.
TS: That makes really good sense to me and has also been my instinct as someone who has a really strong will. I have not found it helpful when the worrying train is off and to the races.
JB: So here what we’ve found over the years is that just understanding how the process works is a really helpful start for people. And our brains are set up to not like uncertainty. So uncertainty is a driver for us to do something. If you think of our ancestors and they heard some rustling out in the bushes outside of the cave or whatever, they couldn’t just roll over and go to sleep and say, “It’s probably nothing.” Because it probably could be something that’s going to eat them.
And so our brains are set up to really try to minimize uncertainty. And what that does is give us this mechanism so that we will go and get information. Now, that’s all well and good from a survival standpoint, but in modern day when we take that uncertainty and we apply it to future experiences where we don’t actually have control or we can’t actually get information, that’s where we get this evolutionary bottleneck where—think of the uncertainty piece. That’s what drives fear often, and fear is a very helpful survival mechanism, but when you apply fear to the future, then we tend not to do so well from a survival standpoint.
Now, just to be clear, planning and thinking about the future is one thing that can actually be helpful, and that’s more recent evolutionary mechanism that humans have. But when you take that and you mix it together with fear, when it becomes fear of the future as compared to planning of the future, that’s when we start to get stuck in these worry loops. And what’s been shown is that when we worry, we actually have more trouble planning and thinking into the future and we just feel pretty bad right now.
TS: All right, Dr. Jud. Here, I think most people are tracking with you and they’re saying, to themselves inside, “A lot of the things I worry about are very uncertain. There are no answers. If I could find answers, my worry, go look this up, go do this, go do that. Find the answer from this person. How are they really feeling about you? Get more certainty about economics, about future weather patterns, about the political situation, all kinds of things. Uncertain, uncertain, uncertain.” So that’s the information that comes back. We’re left with our worry that isn’t being productive. Now what?
JB: So this is where we can start to map out when we are getting stuck in a worry habit loop. And so there are three elements for any habit loop to form. The first element’s a trigger, the second’s a behavior, and the third is a reward, from a neuroscience standpoint. I like to think of it pragmatically as a result. And so if we map this out with regard to anxiety, the feeling of anxiety is the trigger for the mental behavior of worrying. And that mental behavior of worrying results in this feeling of control, which then feeds back through this negative reinforcement loop to say, “Hey, next time you feel anxious, you should worry.” And so there we can just start to map out these processes. I can give an example if it’s helpful with a—
TS: Sure.
JB: —clinic patient. So I am thinking of a patient who was referred to me for anxiety. Uncertainty. I have no idea what his anxiety was related to. And when he walked in my office door, he looked pretty anxious. And so when I started taking his history, he was describing how he’d been anxious. He was about 40 years of age when he came to see me, and he had pretty severe anxiety for the last 30 years since he was about ten. He used to get pretty severe panic attacks, and his panic was getting so bad that he was getting panic attacks when driving on the highway and then he was avoiding driving on the highway.
And so I just sat down after taking his history, sat down with him and just pulled out a sticky note, like a five-by-seven yellow sticky note. And I wrote on there Trigger, Behavior, Result. And I said, “Let me see if I’ve got this right. These thoughts that you might get in a car accident that trigger you to avoid driving on the highway, which results in you not having a panic attack.” And he said, “Yeah, that’s right.” And then I drew arrows between those three and showed that that’s actually a loop.
And his eyes got really wide, and he said, “I never knew that my brain worked that way.” And so for me, I find it very helpful as a good place to start is just to help people map out some of these loops that they might be stuck in and help them understand that this is a survival mechanism that just might’ve gotten a little mis-wired in modern day.
TS: Can you share with us from your own experience a loop that you were able to identify and then how you broke that repetitive pattern?
JB: Sure. I will think of one. Fortunately, I’m thinking I haven’t had a severe panic attack in a while, but I am thinking of a time when I was in the ocean. And it was not too long ago and I was caught in the middle of some wave sets that were kind of coming down on my head. And so starting to panic a little bit, because not so helpful if you can’t breathe. And I noticed that that panic was coming up and, at this point, I’d been practicing mindfulness for about 25 years, and so I could start to notice those as thoughts and I could start to notice the feeling of panic.
And by noting those, I could also see that that wasn’t going to actually help me in that moment. It was actually going to make things worse. Panicking was going to use up my energy and not help me do what I needed to do. And so just noting those and being aware of them helped me not get caught up in that, in getting into a panic cycle, and then go back up for air and do what I needed to do. And then obviously I made it through that.
TS: When it comes to generalized anxiety, sometimes I think it’s hard to know what the trigger is. It’s the end of the day. Now I’m not working anymore. I have a chance to just sort of be with myself. And I’m not even sure what I’m feeling anxious about what happened. Was it what I said during X, Y, Z conversation? I could have done this. Or why is it what this other person’s thinking? Is it, who knows? So do we need to know what the trigger is to start to break and unwind, as you say, anxiety?
JB: I’m glad you bring that forward, because that is often what the logical brain thinks. It’s like, if I can just find the triggers, I could deal with them, I could avoid them, I could work with them, I could change them. When you look at it from a neuroscience perspective, the triggers are only the thing that sets the wheel in motion, but they’re not what strengthens it or weakens it. And so from a reinforcement learning standpoint, this is called reward-based learning for a reason. Because if something’s rewarding, we’re going to keep doing it. And if it’s not rewarding, we’re going to stop doing it.
And so here the triggers are actually the least important part of the equation. And with generalized anxiety, for example, people often wake up in the morning and just feel anxious first upon waking, and then they start to worry and then spiral out throughout the entire day. So more often than not, most often I would say, they can’t actually find specific triggers and it just drives the cycle even more.
So often just that feeling of anxiety triggers the mental behavior of worrying. And when we can zoom in on the worrying itself, we can work and see that it’s a cycle. We can not only help to unwind the behavior of worrying, but we can also learn to change our relationship to the feeling of anxiety itself.
TS: Let’s talk about that, because I think it’s one thing to interrupt the pattern of worry, that mental addiction, if you will. “OK, this isn’t helping, but now I have all these feelings in my body. They’re very uncomfortable; they’re very uncomfortable. I feel…” People could use different words: “I feel dysregulated, I feel butterflies in my stomach, I feel a shakiness inside, wobbliness inside,” whatever the language might be to describe this feeling of “I’m not solid inside.” Oh my, what do I do with all of that, all of those sensations?
JB: Well, the first thing that can be helpful is just to understand what our survival brain’s going to want us to do. And it’s going to try to drive us in a certain direction. So anything that’s unpleasant is by nature going to drive our brain to say, “Hey, do something to make this unpleasant thing go away.” That’s the basis of negative reinforcement. And so just knowing that helps us start to understand and map out the process. So once we’ve been able to recognize that and map that out, we can then start to see what our habitual reactions are to that unpleasantness.
And typically, especially in these days, I see a lot of people distract themselves. So I love the term that Cornell West gave our smartphones: he calls them these “weapons of mass distraction.” [LAUGHS] So often we have a distraction tool right at our fingertips. And so whether it’s checking our social media, our email, checking the newsfeed, doing whatever, there’s something out there that can surely distract us for a few moments.
So just recognizing what some of these old habits are and how well they serve us is a helpful start, because if we can see that they’re actually just serving to give us this brief distraction but actually not helping us change our relationship to these unpleasant sensations, they’re just going to keep us stuck in that cycle. And at the same time, we’re not going to learn what I think is a critical survival tool in modern day, which is distress tolerance, meaning if there’s something unpleasant, we can actually learn to be with things that are unpleasant, like emotionally unpleasant, unpleasant thoughts, et cetera.
But in modern day, more and more and more we’re being trained in very subtle ways to not tolerate any type of distress—whether it’s a little bit of physical pain, quick take a painkiller, whether it’s emotional pain, quick distract yourself or eat some food or something like that, as compared to saying, “Hey, discomfort, that’s actually part of life.” Not that we should look to make our lives to wallow in suffering, but just to see that this is a natural part of life and that we don’t have to run from it all the time.
TS: Now I want to talk more about growing our distress tolerance, but before we do, let’s talk more about distraction. It works, it seems, for a few. It seems like if I watch a movie, if I scroll on my phone, if I do that for a period of time, I notice I feel better afterwards. And I think, “Huh, did I waste a couple hours, or did I somehow ‘self-medicate’ in a way that didn’t actually cause any harm?” Nothing bad happened. I didn’t go to open the refrigerator and eat a bunch of stuff or smoke a bunch of stuff or say mean things. I just played with my weapon of mass distraction, and I feel kind of better. So why do I feel better when I’m distracted? And what’s so bad about that?
JB: Yeah, so this isn’t to say that there’s something terrible about distraction, and sometimes that’s the only mechanism that some people have at their fingertips in the moment. What it doesn’t help us with is learning to develop that distress tolerance. And the other thing that it can develop is our dependence upon distraction.
And so there are a couple of things there that we can all explore in our own experience. One is that we become—our brains are set up to habituate to different behaviors. And so if my distraction tool is to look at cute pictures of puppies on Instagram, for example, over time my brain’s going to, if I go to Instagram every time I feel anxious, my brain’s going to say, “OK, show me the cute puppies.” And then it’s going to say, “OK, I need cuter puppies because these are not cute enough anymore.” And then it says, “OK, puppies and kittens. Puppies, kittens, and babies.”
You get the idea, which is very similar to somebody starting to drink alcohol as a way to try to distract themselves from anxiety. Then they have to drink more, and they become tolerant, et cetera. So it’s the same mechanism. It’s just slightly different from a chemical standpoint, because alcohol is directly affecting the dopamine system, whereas these behaviors are affecting the dopamine system but not specifically hitting the benzodiazepine receptors, for example.
So I don’t know if that gives you a little bit of a sense for how distraction can be helpful in the moment but might not be a long-term solution. I think of it as if we have poison ivy and it itches and we scratch it, it might feel better in the moment, but it’s actually going to keep that rash around for a while longer.
TS: Well, the reason I’m bringing this up, and I’m going to stick with it just for another moment, is in Unwinding Anxiety you talk about the importance of the disenchantment process when we become disenchanted with whatever—this is my language now—whatever coping strategy we have to not feel quite so terrible, to deal with our distress. And it’s one thing—I can understand getting disenchanted. You use the example right now of scratching the poison ivy. It’s easy for me to see getting disenchanted with that, because the poison ivy spreads and the red thing gets much worse and it’s all over my arm and face now, and I don’t want to do that.
And even with worrying, I can see I’m getting so upset and I’m just becoming like a dark mess. I don’t want to do that. I’m getting disenchanted. But when I’m distracting myself, I’m going quiet in a way. Help me get disenchanted with distraction, Dr. Jud.
JB: Well, and I think you’re bringing up a really good point, which is if it’s helpful and we don’t see the downsides to it, we’re probably not going to get disenchanted with distraction. On the other hand, if there are moments where we try to distract ourselves and it doesn’t work or we don’t have our tools of distraction, whether maybe you don’t have your phone or maybe there’s some reason that we can’t distract ourselves, then our brain really goes nuts and says, “Hey, I need my distraction. Where is it? What are you going to do for me?” And things can actually get worse.
So there we get to learn about our dependence on these distraction tools, and then we can start asking, “Well, is there a better way?” And that’s where we start to become disenchanted with things. If something doesn’t work all the time, I’m going to be less excited about it than if it worked all the time. And so here I think the disenchantment comes when we can find something that is more reliable and at the same time helps us live a better life, live a happier, healthier life.
And I would suggest that learning how our mind works and learning how to work with our mind helps us not only be able to tolerate unpleasantness more, and so it empowers us, but also helps us develop wisdom so we can generalize some of these learnings to other aspects of our lives.
TS: OK, help us develop our distress tolerance for those of us now who are, “We’re willing. We’re interested. We get it, that distraction isn’t really the best we can do. We’re inspired.”
JB: Well, our research has shown that the first—well, there are a couple of steps. So I think of this as a three-step process. The first step is just mapping out whatever the issue is. So let’s say anxiety and worry, because we’ve been talking about that. So if we’re able to map out that when we feel anxious, we start to worry—and we can also use distraction as well—we can start to ask ourselves a question which moves us into the next step, which is, “What am I getting from this?”
And here it’s really interesting, because we can look at modern psychology and say, “Well, why is this an important question?” We can look at modern neuroscience, which actually highlights these—there are actual equations of behavior change, which focus very much on what’s called “changing the reward value” of a behavior. And we can also look as far back as Buddhist psychology, where the Buddha’s reported to have said karma is based on cause and effect.
And so if you look at cause and effect, it’s actually a very nice description of modern-day psychology in terms of reinforcement learning. And what I mean by that is if we do a behavior and it’s rewarding, we’re going to keep doing it. If we do the behavior and we pay attention and it’s not rewarding, we’re going to become disenchanted with it and stop doing it. And there are actually explicit passages in the Pāli Canon about this where—I’ll summarize—where the Buddha talks about exploring gratification to its end. And he said, “It wasn’t until I explored gratification to its end, that knowledge and vision arose.”
So that sounds important. And so we said, “Well, can we apply that to modern day? How does that work?” And it’s actually pretty simple. So for example, when my patients come in and they want to quit smoking, instead of telling them to stop smoking, which they’ve all tried—they tried their willpower and it hasn’t worked; otherwise, they wouldn’t need to see me.
Instead I say, “Hey, pay attention as you smoke that cigarette and tell me just how good it is.” And so I send them home, and they come back, and they come back often with this wild-eyed look and they say, “How did I not notice this before?” And they describe how cigarettes taste crappy. It feels like burning going into their lungs. It smelled really bad. As one patient put it, he said, “All the cigarettes I smoked today were disgusting.” He wasn’t telling himself that they were disgusting. He simply paid attention.
And so there’s a great example of exploring gratification to its end, where he just paid attention as he smoked and he realized that cigarettes were actually pretty crappy. And that helped him become disenchanted with the cigarettes. We see the same thing with worrying. If we really look at worrying and ask, “What am I getting from this? It’s not keeping my family member safe. It’s not helping me solve a problem.” Whatever our brain has told us that worrying is going to help us with, when we really look at it and see that it’s not doing that, then we become disenchanted with it.
And we’ve even seen this with eating and overeating, where we have people pay attention as they overeat. And it only takes 10 or 15 times for that reward value to drop below zero and for them to shift their behavior. So that’s the second step. And I would say that is a critical step for helping people step out of these habit loops.
TS: Now, in your new book, The Hunger Habit, I was curious to see that you had a chapter on trauma. And I’m bringing that up at this point because when I hear you talk about anxiety, I think of the nervous system being stuck in the past, somehow stuck in the past. So I’m telling myself, “Worrying doesn’t work. I’m definitely disenchanted with it. It doesn’t work. It makes me feel terrible.” But it seems like this deep, body-based nervous system thing is doing its own thing.
And that’s—once again, I’m coming back to my very original question: Is this a condition, or is it addiction that I have a choice over, that I can change? And so I was interested to see how you now are writing about trauma and if that impacts your views at all on habit change.
JB: It does, absolutely. And so here, the best analogy that I’ve come up with is that our brain’s like a smoke detector in the kitchen. And when it’s calibrated, when the smoke detector is calibrated correctly, it’s going to help us detect when there’s a fire on the stove versus boiling water and its steam. Now, if it’s miscalibrated, it’s going to go off and give us false alarms when there’s actually no danger.
And that’s what I see with conditions like—and I’m not a huge fan of terms like “conditions.” The only condition I think that we really have is the human condition, but there are all these things that they use in psychiatry, so bear with me there. So when somebody has had a traumatic history, let’s say, their brain is often miscalibrated in the sense that they’ve had something very traumatic happen to them. And I say, my heart goes out to anybody that’s had a traumatic experience where their brain has gotten locked in this danger signal, where their brain is registering in modern-day danger, danger, danger when there might not actually be danger.
And that causes two problems. One is it’s harder for them to see when there is actual danger, because their brain is constantly saying, “This is dangerous, this is dangerous, this is dangerous.” And it’s also putting them in this heightened state of arousal that’s just not only unpleasant but is not great for flourishing, let me just put it that way. And so the way I think about trauma is that just understanding how this works on a neurobiologic level can help us start to find ways that can help us recalibrate that system.
And one thing that I’ve found helpful as a tool to work with some of my patients is to help them see how that danger signal can actually be somewhat habitual, because their brain is signaling danger when it’s triggered by something that’s not actually dangerous. When they see that, they can also take a moment to honor their past self, which often it came up with a strategy in the moment to keep them safe, and then it kept that strategy going forward, and that strategy may not be as helpful for them now.
And the way I think of that is it’s like a pair of shoes that somebody put on, and they fit at the time and it helped them not damage their feet, but now they may have outgrown those shoes and those shoes may actually be hurting them in that sense. And so being able to honor our past selves and really give that place in life its due and say, “I did the best that I could in those times,” gives us the opportunity to open to the present moment and ask, “Hey, is this helping me now?” And if it’s not, open to being able to change the habitual behavior that comes with that hyperarousal. I’m not saying it’s easy, but that can help us start to explore that, as compared to just being stuck in it.
TS: OK. So say a bit more about this, and maybe you could give an example of someone that you’ve worked with who had a trauma history, and it could be inherited family trauma or early childhood trauma. And they say, “I understand conceptually what you’re saying about honoring this old pair of shoes that I don’t want to wear anymore. It does not fit. I don’t want it. But my nervous system biology still has this wiring in it, and I haven’t yet developed the distress tolerance you’re talking about. I want to, so I want to hear more about that, but there’s a lot of distress here that feels outside of my ability to work with it. It just goes off; it’s unconscious. The calibration is so far off.”
JB: Yeah, absolutely, absolutely. So I’m thinking of just a representative of many people. So a patient that, I think he was in his 60s when we started talking about this. And he had had early childhood trauma, and his only—as a kid, the only thing he had control over was his own mind. And so he started worrying as his coping mechanism, because that was what made him feel like he had some semblance of control. And he had carried this forward with him for five, six decades.
And when we started talking about this—this is where the shoes analogy came up; it was actually working with him—and he realized that it was actually holding him back. And so what I do with anybody that’s struggling in this way is, first, find ways that they can ground themselves in those moments. And there are lots of wonderful techniques that can help people ground, whether it’s bringing awareness externally. I sometimes have people just use this mantra, “Feel my feet.” I learned that from somebody years ago where it’s just like our feet tend to be a pretty safe place, and they can help ground us.
And so just bringing awareness to our feet for a few moments or taking some grounding breaths. Or you may be familiar with the five-finger breathing exercise where as we breathe in, we trace up the outside of our pinky. As we breathe out, we trace down. And in the course of five breaths, we can trace each finger. We can do that again, pinky to thumb, thumb back to pinky, over a course of ten breaths. But something that helps us ground enough so we can ask a simple question, which is, “Am I actually in danger right now?”
And it’s an important question not just to ask conceptually, but to ask experientially. Look around and really show our brains what’s actually happening, so that our brain, which is saying danger, danger, danger, can—if there is danger there, if we’re about to walk into a busy street or something, we can take appropriate action. But if there’s no danger there, it helps our brain see very, very clearly that no, this is a miscue. And when we’re grounded a little bit, we can start to separate and unwind that learned association between whatever the trigger was and this hyperarousal in our autonomic nervous system.
And over time, that’s where we can start to unwind it. So there are lots of techniques like EMDR and other practices that help people do this type of dissocia—dissociation is not the right word—unlearning. And in these—even simple practices, simple grounding and simple mindfulness practices, can be helpful here as well. But I find pairing that in the environment with that simple question is also really helpful for the rewiring piece.
TS: OK. I’m going to ask you a really direct question, Dr. Jud. Do you think that anxiety is a mental addiction?
JB: Not necessarily. So the feeling of anxiety, I wouldn’t—so the feeling itself is just the feeling. The definition that I learned in residency of addiction is “continued use despite adverse consequences.” And so here I would look at the mental behavior of worrying. And for some people they would swear that they are addicted to worrying.
And so if you put the definition in, continued use despite adverse consequences, the consequences might not be terribly adverse like we think about with some chemical substances, but they can be pretty adverse for someone if somebody’s worrying all the time to the point where it’s interfering with their life. So I would say there’s a spectrum, and for some people I would say they worry so much and it’s interfering with their life so much, it might fit that definition, but not the feeling of anxiety itself.
TS: Right. OK, good. I think that’s a good, helpful distinction. So in terms of being with the distress of the feeling of anxiety, being with it, is it your experience working [with] people that the more we’re able to be with it, that that creates some kind of natural resolution? Being with it, being curious about it, feeling it, questioning it, wondering about it, dropping our attention into this feeling—what comes from that? My experience sometimes is that I can spend a lot of time in that state. It doesn’t necessarily just like, “Oh, and now it’s turned into something else.” It’s like, “Wow, OK. Spending a lot of time here.”
JB: Yeah, yeah, it’s a really good question. So here I’m going to actually go back to some of the ancient Buddhist psychology, because I think it’s really interesting some of the overlaps that we’ve seen between that and the modern psychology. And there’s a concept that’s described as “dependent origination.” And the details aren’t important, but what it describes is what’s called a “cycle of saṃsāra,” this endless wandering. And in that cycle there are a bunch of links, but there are a couple that are really important.
One is they describe these unpleasant or even pleasant feeling tones lead to craving, because if something’s pleasant, we crave more of it. If it’s unpleasant, we have aversion; we crave less of it. But that leads to what some can be translated as clinging, but also can be—the word is “upādāna.” I’m probably not pronouncing it correctly, but it can also be translated as “fuel” or “sustenance.” And that is really important because if we think of a fire burning, and often these cycles are described using the analogy of a fire. When a fire is burning, what keeps the fire burning is fuel or sustenance.
And so when we have anxiety, think of anxiety as a fire. If we worry, that is like adding fuel to the fire. And so we can say, “OK, how do I let this fire burn down?” And that’s through not adding more fuel to the fire. And so here, to get at your question, there are two ways that we can learn to work with the anxiety. One is to see if we’re fueling it. Are we fueling it through distraction? Are we fueling it through worrying? And if we are, those are behaviors that we have control over. We can explore those, we can become disenchanted with them, and we can see what it’s like not to distract ourselves.
And on top of that, we can add in—maybe think of it as digging a fire line around the fire so it doesn’t spread, where we learn to… I think of this as bringing in curiosity as a superpower, I’ll put it that way. And what I mean by that is that often when we feel anxious, we have this “oh no” reaction. “Oh no, here’s anxiety. I need to make it go away.” And that’s where we do something which actually just—it’s like blowing on the fire. It makes it worse.
Instead, what if we flip that and we say, “Oh!” And this is where phrases like “the obstacle becomes the way” or this Stoic turn of words that was attributed to Marcus Aurelius, “What stands in the way becomes the way.” And what makes this interesting is that we can look at anxiety and we can, instead of running away from it, we can ask ourselves, “What happens if I turn toward it?” And if we turn toward the experience and what helps us turn, we don’t try to force ourselves to turn toward it, but we use that curiosity as that guiding hand that says, “Oh, what does anxiety feel like? Is it tightness? Is it burning? Where is it in my body? What happens when I actually turn toward it?,” we start to learn something really interesting and really important, which is that these feelings make up the concept of anxiety. And when we look at each element by itself, it’s not nearly as scary as this big bad concept of anxiety. And on top of that, we start to notice that these sensations are constantly changing. So often we think, “Oh no. Anxiety, it’s going to be here forever.” But when we really turn and go, “Oh, well, is this sensation—what happens when I look at it?” These things start to change, and they’re constantly changing. We can notice that change, and with that, we can start to learn, “This isn’t as bad as I thought. I can actually learn to be with this.”
And this is where the ability to develop distress tolerance comes in. It comes from learning to just lean in instead of run away. And when we lean in, that fear starts to dissolve somewhat because we can see what things actually are. We reduce the uncertainty. And we can also see that these things aren’t permanent. They change on their own without us having to do anything.
TS: OK. I like this fire metaphor. So if it’s OK, I want to make sure that I fully get it, because I understand the notion that if you add worry fuel in the form of worry logs, the fire’s going to get bigger. I have a fireplace here where I have natural logs, and so I like to sit in front of it so I get it. If I don’t put the worry logs on, it’s going to go out.
Now, you said distraction also is a way that we feed the fire. And that’s where I had a moment of thinking I don’t understand that. How does distraction feed the fire?
JB: It’s a good question. So I’m just trying to think how that would fit with the analogy, because I think worry fits pretty well. Distraction might be not paying attention. And so when we don’t pay attention, when we don’t tend the fire, it’s going to be more likely to spread if there is fuel around it. And so I don’t know if that fits for you.
TS: That helps.
JB: Yeah. So I would say when we distract ourselves, there might be other tinder in the box that’s going to catch fire because we don’t know how to manage it.
TS: And then we’re curious about it, where you could say that’s a form of just watching it change and go out on its own accord. And that’s what happens. Our curiosity is just that.
JB: Yes, absolutely. And what I found from my own experience with anxiety is that when there is less fear around it—certainly anxiety still comes up. I still get anxiety, but I am OK with it. It’s like, OK, here, this is pretty unpleasant. It’s going to be here for a while. I don’t know how long it’s going to be here, but as long as I don’t resist it—there’s this saying, “What we resist persists”—as long as I don’t resist it, it’s going to go on its own accord. I don’t have to do anything, and it may not stick around as long.
TS: Your new book, The Hunger Habit, looks at how we can look at this whole question of what’s driving our cravings and our desires around food. In terms of the conversation we’ve had about anxiety, would you say this part of the conversation translates really well to issues of eating and food cravings, overeating, et cetera? And this part maybe doesn’t map on quite so well, or it’s all the same inner mechanisms? How do you look at it?
JB: Well, what our research has shown is that the mechanisms are pretty similar. So the reinforcement learning piece is actually based on these ancient survival mechanisms around eating. We had to remember where food was. And so we learn where to find food through the mechanism of positive reinforcement, right? The trigger is we see food, the behavior is we eat it, and then our stomach sends this dopamine signal to our brain that says, “Remember what you ate and where you found it.”
And then this negative reinforcement piece where we learn to avoid danger comes into play in modern day. Actually, both of these come into play in modern day, where we learn to associate food, for example, with celebration. So how many times have we eaten food when we aren’t hungry, right? That’s not a survival mechanism per se, because our body’s saying, “Hey, not really hungry.” But we’re like, “Hey, this is a party. Let’s eat.”
And on top of that, we learn to eat food to comfort ourselves. That’s where the term “comfort food” comes from or “stress eating,” where if we’re bored, angry, sad, think of all the different emotions that we’ve learned to associate with eating as a distraction. And then we learn through negative reinforcement, “If I eat this food, I’m going to comfort myself. I’m going to feel better.”
So both of those are at play so much in modern day that there’s a term that has been—I don’t know when the term came about—but recently there’s a term called the “hedonic hunger” that’s used in scientific studies. It’s a misnomer, because we’re not actually hungry, but it’s highlighting moments when we’re eating in the absence of hunger driven by emotion, hence the hedonic hunger. That’s in contrast to homeostatic hunger, which is the survival mechanism that says, “Hey, my stomach’s empty. Let’s fill that up.”
TS: Can you give us an example of someone you worked with who had a comfort eating habit and how your work was able to help them break the habit?
JB: Sure. Actually, we can go back to my patient that I talked about before that had panic disorder. Because the thing I didn’t mention about him was that when he first came to see me, he was 400 pounds. He was at a very unhealthy weight, and his weight was causing health issues for him. So he had fatty liver, he had hypertension, he had obstructive sleep apnea, and all of these were related to how much he weighed.
And so he had, as I mentioned before, he had started getting panic attacks when he was about ten, and early in life he had started eating food as a way to try to cope with his panic, because he couldn’t figure out a way to help it. And fast-forward 30 years, he described that he was addicted to fast food, and so he would eat fast food as a way to cope with his anxiety.
So in his first visit, we just mapped out these anxiety habit loops, and I sent him home and had him start mapping out these anxiety habit loops. And two weeks later at his first follow-up, he came back and he said, “Hey, Doc, I lost 14 pounds.” And I looked at him because I didn’t think that we had actually talked about his weight at that point. We were just focusing on his anxiety. And he said, “Yeah, yeah, we didn’t talk about this. But I was mapping out my anxiety habit loops, and I realized that anxiety was triggering me to eat fast food, and the fast food was actually just making my health anxiety worse. So I stopped doing that,” in his words.
And so the way I would put that is that he became disenchanted with eating fast food. It was no longer rewarding for him. It was actually anti-rewarding, if we can put it that way. And by becoming disenchanted, it was much easier for him to break that habit of eating as a way to cope with his anxiety. He went on to lose over a hundred pounds over the next year and said it was the easiest weight loss he’d ever had, because he had tried everything before.
But once he had learned how his mind worked, he could learn that he actually felt much better when he didn’t eat fast food. And as he gradually lost weight, it was getting him into a healthier range where his high blood pressure went away, he was sleeping better, his hypertension went down. It was actually helping him be healthier physically as well.
TS: OK. Now, Dr. Jud, I want to make sure that the people who are joining us and are listening who are thinking, “OK, I want to apply this in some way. I have this habit of eating—” I don’t know, just come up with something. Potato chips seems like—I am hungry. I drive to—OK, I’ll just pick them up on my way out of the convenience store, whatever it might be. I know that I don’t feel well afterwards, so I get that. I can map that out, and then I feel bad about myself. I get all that. How is Dr. Jud’s “break a bad habit” method here going to help me? What am I going to do? How am I going to work this on my own?
JB: Yeah. Well, I’ll illustrate this with an example and then walk through how we can apply this. So I had a patient who used to eat an entire bag of—large bag of potato chips every night while watching television with her daughter. And what I had her do was just start paying attention as she ate the potato chips. And I said, “Just see how many you need to satisfy, scratch that itch of craving.” And for her, you guess how many it took? I won’t—
TS: I don’t know, 20 chips?
JB: Yeah, it was actually two.
TS: Uh-huh.
JB: And for her, that was enough salt and fat when she truly paid attention. She was like, “OK, that’s enough for tonight.” [LAUGHS] And what that highlights—for many people, it’s probably not two. And so I remember her because it was a pretty striking—I never imagined that she’d come back and say, “Yeah, it was just two, Doc. That was it.” But what we can all notice is where we hit what I think of as our “pleasure plateau.” So what that means is with each bite, we can pay attention and ask ourselves, “Is this better than, worse than, or the same as the last bite?”
And what that helps us do is—and I want to highlight this is not about thinking, “I should only eat two bites of cookie or two potato chips”—but this is really feeling. We have to feel into this. Our feeling body is much stronger and wiser than our thinking brain. And so here, we just feel into the experience when we eat the potato chip, and we can really feel—I’m just imagining this now. Last time I had a potato chip, for me, potato chips are pretty salty. I haven’t found a potato chip that’s not salty. And so within a couple of potato chips, especially if I’m not hungry, my body’s like, OK, you’ve hit your salt quotient for now. And it’s much easier to put them down by imagining what it would be like to eat the next one.
And so here we can really just leverage this power of awareness, this power of curiosity, so that we can really see how much is enough. And we can do that in the moment with potato chips. And then we can also look back—for example, if we haven’t paid attention and we’ve eaten a whole bag—we can look at it afterwards and ask the question, “What did I get from this?” And here we even did a study where we have this app called Eat Right Now, and we have basically awareness of where eating exercise as part of that, where we can use that to calculate the change in reward value in somebody’s experience, so that when that reward value drops below zero, they shift behavior.
And it only takes about 10 to 15 times of somebody really paying attention, for example, as they overeat for that reward value to drop below zero and for them to shift behavior. So pragmatically speaking, really the key thing to do, or the key ingredient for behavior change, is awareness. We become aware of the habit loop. We become aware as we’re eating, and we ask this simple question, whether it’s how much is enough or what am I getting from this, so that we can really feel into our body and have our body tell us when we’ve had too much, or whether it’s a food that we’re really just not as excited about now as we might’ve been before.
TS: Well, a couple things here. One is in the example you gave, you have to really slow down. We’re talking about eating those two potato chips. You’re not just shoving a bunch of them in your mouth kind of thing, and then saying, “I wonder how this feels?” It’s a serious, slow eating with awareness process. Yes?
JB: Yes. And I would say we don’t have to spend 30 minutes eating a single potato chip, right?
TS: That’s good.
JB: So it doesn’t take that long to eat a potato chip. And so as long as we pay careful attention, we’re not distracted, we’re not shoveling a bunch down, we can get the picture pretty quickly. One thing I’ll add to that is if we’re hungry, it’s important to note that it takes about 15 to 20 minutes for our bodies to register satiety. And so if we’re really hungry, our body’s going to say, whatever the food is, it’s going to say, “Hey, get more calories in.” And if we eat those really quickly and we don’t give ourselves 15 or 20 minutes to register whether we’ve had enough, we’re going to be more likely to eat beyond satiety.
TS: Now, you said curiosity is our superpower. And it seems like curiosity is the kale of our time, meaning I hear people talking about curiosity all the time. And I wonder how much it lands. Do people understand what that means exactly? What does it mean? I’m going to use this superpower of curiosity to change my bad habits. Really? What does it actually mean?
JB: Yeah. So first, well, let me ask you, did you know that there are two different types of curiosity?
TS: Only because I read Unwinding Anxiety do I know this.
JB: [LAUGHS] OK, so had you not read the book—
TS: I did not know that.
JB: OK. So I bring that forward because it’s a great way to highlight the contrast between the two types. And so for anybody that doesn’t know that there are two types, I’ll just ask people to explore in their own experience, what does it feel like not to know? And that not knowing is actually one type of curiosity called “deprivation curiosity,” which in a nutshell means we’re deprived of information. As I said earlier, our brains don’t like uncertainty, and that is the mechanism that gets us to go and do something to find that piece of information. And so that itch of, “What is that? I don’t know. I need to go find that out,” that’s deprivation curiosity.
And I mention that because that’s not the curiosity that I’m talking about here. Certainly deprivation curiosity, very helpful for survival. But the curiosity that I think of as a superpower is the other type, which is called “interest curiosity.” And interest curiosity, I like to think of these as deprivation is like a destination. When you get that piece of information, you’re at your destination, you’re there, you’re back to baseline. And so you’re deprived. When you get to the destination, you’re not deprived anymore.
Interest curiosity, on the other hand, is more like the journey. It’s the joy of discovery as we go along life. So we’re not looking for any particular answer; we’re just enjoying the learning process. And pragmatically, I don’t assume that anybody knows exactly what curiosity is, but I like to have people really explore it in the moment. And let’s use worry and anxiety as the examples where we can use the contrast. So if somebody feels anxious, the mind tends to go into, have this, let’s say, mental tone of voice that says, “Oh no,” right? “Oh no, I’m anxious. How long is this going to last? What’s going to happen?,” where we start to worry. And that “oh no” tends to feel more closed down and contracted.
In contrast, interest curiosity is more of that, “What’s this?” And so we’re just exploring. And when we go, “What’s this?,” we tend to lean in and we tend to open to our experience. And so we can look at that as a marker, that opening as a marker, for tapping into this natural capacity that we all have of interest curiosity. And so that’s something we can all explore ourselves. I like to have people play with one of two mantras, whichever works best for them. One is that “Oh!” When we’re feeling “oh no,” we can go, “Oh, what’s that?” Or another is, “Hmm, what’s this?” And that gets us out of our heads and into our direct experience. Hmm really is a way to tap into that natural interest curiosity. Does that describe it enough?
TS: Yeah. I have a question though, which is, so let’s say I’m experiencing—because I am—deprivation curiosity about solving anxiety forever as an issue. I feel deprived of that answer, and that makes me very curious. And what’s wrong with that? Why is that a problem? That’s a type of curiosity. I want to get to the bottom of something. I feel deprived of the answer.
JB: So again, deprivation curiosity, very helpful. And we can certainly look for answers. And if we find the answers, great. It’s been very helpful. For something like anxiety, we can be looking our entire lives and not find it. And ironically, deprivation curiosity when we’re not getting the answer can make us more anxious.
TS: Hmm.
JB: Hmm.
TS: Now, I’m not going to say hmm. That excited hmm I think feels a little farfetched to me in some situations. But the more subdued hmm, I think I might be able to get there. That’s interesting. Like hmm, that’s interesting. Hmm, I want to know more about that.
JB: Yeah. And—
TS: Is that an interest curiosity?
JB: Absolutely.
TS: Hmm. I want to know more.
JB: So I think of it as a scale. It’s not like it has to be off the charts, rainbows and unicorns. Wow, amazing. Like we’re in awe. Like, “Oh, wow, isn’t it amazing? I have anxiety.” [LAUGHS] But we can start wherever we are. And one thing that I’ve found helpful when somebody’s like, “I have no idea what you’re talking about when it comes to curiosity,” we just do this little exploration, which is, “Hmm, what’s it feel like not to be curious?” And with that, we have them explore, “Hmm, I don’t know. What does it feel like?” And they’re actually starting to tap into at least a little bit of curiosity in that moment.
TS: OK. Two more questions about unwinding anxiety. One, this hmm, hmm, hmm. You mention in the book Unwinding Anxiety that we can use this hmm as a kind of mantra and actually bring the sound into our body in some way. And I found that I was very interested. My interest curiosity peaked highly at that point. And I wonder if you can share with our listeners how we do that.
JB: Yes. Well, so there are a couple of ways we can do that. I like the auditory hmm, where we just—it’s kind of like warming-up vocal exercises. So we can warm up our curiosity just by going, “Hmm.” What’s it like to hmm? Or “Oh!” I wonder what it’s like, how do I feel when I go, “Oh”? So it’s kind of like me, me, me, la, la la, hmm, hmm, hmm, whoo, whoo, whoo, that type of thing.
And the other thing that’s so fascinating—I love science. There’s so many interesting things about learning about our world. This actually goes back, I want to say that even Darwin wrote about this, but I may be wrong. So if we look at our eyes, our eyes can be a big tell, not only in poker, but in life. And what I mean by that is we can look to see what our eyes are doing and how we’ve learned to associate different eye patterns with different emotions. So for example, when we are angry, anger tends to be associated with focused behavior, because it says, “I don’t like this. I’m going to make this change.” And we can all think, “What’s it like when we are angry? What do our eyes do?” Well, our eyes tend to narrow down, because we’re not taking in information at that time. We’re focused on action.
In contrast to that, when we’re really curious, what do our eyes do? They tend to open really wide. “Oh!” Our eyes open because they’re taking in information. And so can actually hack what’s called somatic memory, where we’ve learned to associate different eye patterns with different emotions. When we’re not feeling that curious, we can actually open our eyes really wide and see if they actually help kick-start that process. It’s kind of like throwing a car in second gear as you roll down a hill to jump-start it.
TS: OK. I’m going to open my eyes really wide. I’m curious about the title Unwinding. Unwinding Anxiety. I read that was your wife’s idea, but tell me about this image of unwinding.
JB: Well, with anxiety, we feel all wound up. We feel closed down. We feel contracted. And so when we bring curiosity in, we naturally let that spring—when we’re all wound up, springs are not, they’re not—from an entropic standpoint, springs want to naturally spring. They want to become sprung or whatever the verb is for that. And our bodies are not naturally prone to getting all contracted and wound up. We do that to ourselves. We add energy to the system and wind ourselves up.
And so here, by bringing curiosity in, for example, and bringing kindness to ourselves, we can naturally let that unwind. And I think my wife’s title for that is just a beautiful portrayal of what naturally happens when we bring in curiosity and kindness to ourselves.
TS: I’ve been talking to Dr. Judson Brewer. He’s the author of the New York Times bestseller Unwinding Anxiety and a new book. It’s out on February 20, 2024. It’s called The Hunger Habit: Why We Eat When We’re Not Hungry and How to Stop. And I just want to thank you, Dr. Jud, because sometimes when I’ve spoken to people who are habit change experts, I don’t feel the level of compassion and respect for early trauma and the kind of field of love that you’re bringing to the topic. And I so appreciate that, and it makes me feel really welcomed into the conversation and optimistically curious about what will come from practicing your approach. So thank you so much.
JB: Well, thank you.
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