“How do we resist anxiety? We can hold it with kindness.”
In this episode of the Numinus podcast, Dr. Joe speaks with Dr. Judson Brewer. Jud is a psychiatrist, an Associate Professor of Psychiatry at the School of Medicine at Brown University and the Director of Research and Innovation at Brown’s Mindfulness Center. He has become an authority on the application of mindfulness in the treatment of anxiety, addictions, and eating disorders and his work has been featured in some of the top medical and neuroscience journals as well as in the popular media. His 2019 TED talk is ranked the 4th most popular of the year.
Jud’s research and clinical work are highly innovative, partly because of his integration of traditional Buddhist psychology with modern neuroscience and psychology. In recent years he has focused on making his work accessible to the general public and has produced online programs for helping people reduce anxiety (Unwinding Anxiety), overeating (Eat Right Now), and smoking (Craving to Quit). He is also the author of The Craving Mind: from Cigarettes to Smartphones to Love – Why We Get Hooked and How We Can Break Bad Habits.
Joe and Jud discussed:
- Jud’s theory that anxiety is actually an addiction to worry
- The reward-based learning model that underlies the development of all habits, including anxiety, addictions and eating disorders
- How mindfulness can help “unwind” anxiety and other unhelpful habits
- The role of the brain’s Default Mode Network in getting us caught in unhelpful habit loops
- Why episodes of mental illness often recur
If you’d like to learn how to practice mindfulness to help with your anxiety or any other unhelpful habits, please reach out to Numinus: numinus.com
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Here are some highlights from the interview:
How Does Mindfulness Help with Anxiety?
“The Buddha said that ‘it wasn’t until I explored gratification to its end, that knowledge and vision arose.’”
So you’ve got this model for understanding anxiety as it is driven by reward based learning. And you bring mindfulness into the mix to help people, as you say unwind. So how does that work exactly?
So it goes back to these elements that we’ve been talking about. The first piece is really helping people understand how their mind works because if they can understand that, then they can work with their minds. And in that sense they can start by really just understanding how the process gets perpetuated. So if they have a feeling of anxiety, they can start to map out how it triggers a worry response and how they get caught up in worry thinking. And then what the result of that is–which tends to not be like, ‘Oh. This is great. I want to do it more.’ [Laughs]
So they can just start to see how the elements that they’re actually adding to it are leading to negative outcomes. And what that does is help their brain kind of recalibrate how rewarding the worry behaviour is itself.
Because that’s what drives future behaviour. Reward based learning is based on reward not on the behaviour itself. So if it were just based on behaviour we’d say, ‘Oh. Stop worrying.’ Which I’m sure many of our parents or spouses or whatever have told us to do. ‘Hey. You worry too much. Stop worrying.’ ‘Oh. Thank you!’ [Laughs] It doesn’t work that way because we end up worrying that we’re worrying, and it spirals out of control. [Laughs]
But if we focus on the results or the reward and say, ‘That’s not very rewarding,’ and see that very clearly. That’s mindfulness can then help us do. Once we’ve mapped this out, we can see, ‘Oh. This is not very rewarding.’ Which then drives disenchantment with the process itself.
And this is actually super clear in the early Buddhist teachings, where the Buddha said, ‘It wasn’t until I explored gratification to its end, that knowledge and vision arose.’ And the way I interpret that is he was really exploring reward based learning. How rewarding is this behaviour? And it’s only when we see that there is no juice left in this fruit that we become disenchanted with the behaviour. And that then starts to have us look for other things. I think of this is looking for the BBO: the bigger, better offer.
So we first have to see how this isn’t serving us. And we’ve learned that by seeing how our minds work. Then our brain starts looking for something better and this is where we can bring in mindfulness practices themselves. And I love that if you think of the second factor of awakening as interest or curiosity. What feels better: Fear, anxiety, panic or curiosity? It’s a no brainer to our brains.
And I see this in my patients with addictions as well. You know curiosity feels much better than craving. So when we can then train them to just be curious about what the feelings of anxiety feel like in their direct experience. They can start to realize a number of things:
1) These are just feelings. These are just thoughts as compared to being identified with these things.
2) They can see that these don’t last forever.
And this is challenging because a lot of folks with anxiety really feel it all throughout the day. And they say, ‘Well, my anxiety does last forever.’ And I say, ‘Well let’s explore that. Does it get stronger? Does it get weaker? Is there worry that feeds it?’ There are lots of ways to explore the impermanent nature of the feelings.
And also ways to explore how we resist the feelings of anxiety itself. How we can change our relationship to it and just hold the feelings, this physical feeling, these emotions in our awareness. We can hold them with kindness and curiosity. And that holding where we’re providing that holding environment rather than pushing away or trying to do something helps us move into a completely different relationship.
And I’ve had a number of folks report back–I remember one person who said that she was really blown away by the curiosity because when she really trained herself to bring curiosity to the fore. When she was having panic, curiosity just felt better and she could notice that these were just feelings, rather than something that she was so identified with. And it really helped her just be with panic attacks and really unwind from that. Which helped that whole process itself unwind.
The Default Mode Network
If I’m understanding correctly, self reflection is sort of mediated by or driven by the default mode network. We sort of construct the sense of self by this ongoing story about who we see ourselves as each moment.
So I’d love to hear you talk about how mindfulness helps decommission the default mode network, at least temporarily and maybe makes us a little less dependent on it on a day to day basis.
So let’s just start with a clarification to make sure we’re on the same page with the default mode network. There are two main hubs. One is the medial prefrontal cortex and the other is the posterior cingulate cortex. They talk to each other all of the time.
The hypothesis is that the medial prefrontal cortex is more of a conceptual sense of self and a conceptual sense of self is not a problem. It’s taking that conceptual sense of self too personally.
So where mindfulness comes in is it helps with two things. So if we bring in the reinforcement learning process we can say, ‘Well, does it feel to take something personally?’ ‘I love fuming and plotting revenge.’ It’s a painful process. We can bring awareness in by asking ourselves, ‘how’s that going for you taking things personally?’ Not in a ‘I told you so’ way, but with curiosity. So we can start to see the lack of reward in taking things personally.
Which then helps us bring awareness to the next piece, which is that awareness itself can feel better than being identified with ourselves. That kind of curious awareness itself feels better. And so when we’re caught up in anxiety we just bring in that awareness and curiosity. ‘Oh, so that’s what anxiety feels like.’
For example, in our ‘Unwinding Anxiety’ program, on day one, we walk people through the idea that they have this inherent capability of being curious, by saying, “Okay. You’re anxious. Let’s go there. Check in your body to see where you feel anxiety most strongly. And now tell me is it stronger on the right side or the left side? And they have to explore, ‘Is it on the right side more than the left side?’ Now what does this do?
It opens us to curiosity. The answer is that it doesn’t matter what side it’s on. What matters is they just touched into their inherent capacity to be curious. This is on day one. And then they can just go from there.
We can bring this kind curious awareness even to the worst of things and start to crack that a little bit. With this inherent capacity that we have, it feels better. It’s not like anxiety vanishes, but it helps us see, ‘Oh. I can actually be with this.’ Which is better than running away from it.
