EP #36

Unwinding Anxiety with Dr. Jud Brewer

alcoholic minimalist podcast

listen to



In Episode 36 of Breaking the Bottle Legacy, Molly interviews Dr. Jud Brewer, Director of Research and Innovation at the Mindfulness Center and Associate Professor at Brown University, renowned for his expertise in habit change. Dr. Brewer discusses his recent book, “Unwinding Anxiety,” exploring the science of breaking worry and fear cycles to heal the mind. The conversation touches on the parallels between anxiety and habit formation, emphasizing the power of meta-skills and mindfulness in altering behavioral patterns. Dr. Brewer introduces practical insights, such as the Bigger Better Offer (BBO) concept, emphasizing the role of awareness and curiosity in habit change. The dialogue delves into the intersections of mindfulness and meditation, challenging misconceptions and encouraging a nuanced understanding.

You’re listening to breaking the bottle legacy with Molly watts, Episode 36. Hi, I’m Molly, after a lifetime living under the influence of family alcohol abuse, spending more than 30 years worrying about alcohol and my own drinking, believing I had an unbreakable daily drinking habit, I changed my relationship with alcohol forever. If you want to change your drinking habits than breaking the bottle legacy is for you. My goal is to help you create a peaceful relationship with alcohol, past, present, and future. Each week all focus on real science and using your own brain to change your relationship with alcohol. Nothing has gone wrong, you’re not broken, you’re not sick. It’s not your genes. And creating peace is possible. I’m here to help you do it. Let’s start now. Well, hello, and welcome or welcome back to breaking the bottle legacy. With me your host, Molly watts, coming to you from a little gray and cloudy Oregon this morning. Hard to even believe it’s been so sunny, so warm for four weeks. And this morning, we’ve got a little bit of that marine layer again, cloud cover. And I think today is about the only day this week that’s supposed to be relatively cool. So I will take it as a little break in the action. And but back to my warm weather again for the end of this week. So today on the podcast, super excited to be speaking to Dr. Judd Brewer. Dr. Judd is the Director of Research and Innovation at the mindfulness center, and the Associate Professor in Behavioral and Social Sciences at the School of Public Health and Psychiatry at the School of Medicine at Brown University. And he’s also a research affiliate at MIT. He’s held research and training positions at Yale, and that the University of Massachusetts center for mindfulness. And not to mention the fact that he is a New York Times bestselling author and thought leader in the field of habit change. So to say that I was really thrilled to be able to talk to Dr. Brewer is an understatement. Again, somebody that’s talked on some big stages. So to have him share his time with me, was just very appreciated. He has just released in 2021, a book called unwinding anxiety. And I wanted to talk with him about that book. It’s called unwinding anxiety. New Science shows how to break the cycles of worry and fear to Heal your mind. This is after another book that he wrote in 2017, called the craving mind, from cigarettes to smartphone to to love, why we get hooked and how we can break bad habits. So obviously, there are a lot of things here that correspond to drinking and using alcohol as a habit, which for all of you that have listened to the show for a while know that I was a daily habit drinker. So to be able to talk to him about all of this was just super exciting. And I think you’re gonna find it very valuable because whether your habit is anxiety, which actually can become a habit for people, or is something like me, like using alcohol to unwind anxiety. Dr. Jad and I are going to talk about all of it. Here is my conversation with Dr. Judd Brewer. Good morning, Dr. Jed, thank you so much for being on breaking the bottle legacy with me, I just appreciate you taking the time. I know you are a very busy guy and certainly have talked on some bigger stages. So I appreciate you taking the time to share with me today. It’s my pleasure. And this is a passion of mine. So I’m happy to have this conversation. Awesome. So the reason I got you and wanted to talk with you because of a new book that you’ve just released this year, called unwinding anxiety. And it’s been very popular and of course coming out of not Well, I don’t know, are we coming out of COVID? I don’t know. I can technically say that. I was saying that just a couple of months ago, I felt like the you know, there was a silver lining or a light at the end of the tunnel. But right now I kind of feel like we’re going backwards again. So but tell me about the the genesis of this book. It’s a little bit different than the craving mind which you wrote earlier. And I know this is all really both books are the culmination of years and years of research on your part. So tell me more about all of that. Well, some of this was born out of my own anxiety. with helping my patients with anxiety, so I also and I also talked about my own anxiety and panic attacks in the book. So I can certainly speak to the topic personally. But as an addiction psychiatrist, I see a ton of comorbidity between anxiety and alcohol. And I write about some of that in the book as well, where anxiety triggers people to drink, and they drink, they don’t even, they’re not even necessarily aware that that’s what’s triggering them. I’ve had patients who have been referred to me for alcohol use disorder. And when I haven’t go back and start paying attention to what is what’s driving it, it turns out that anxiety is a big driver. And so whether it starts with anxiety, or whether it’s alcohol, that leads to more anxiety, and they kind of feed on each other, it doesn’t really matter, because both of these can be problematic. So I wrote the book, because I was struggling with helping my patients with anxiety, with medications, you know, prescribing medications for anxiety, the best ones out there, there’s this term called number needed to treat, which gives us a rough sense of how well a medication works. That number is 5.2, meaning I have to treat just over five patients before one of them shows a significant reduction in symptoms. So I’m basically playing the medication lottery with my anxiety patients. And so I don’t know, you know, which one is going to benefit and what I’m going to do it the other 80%. So I started looking at and I was my lab was studying habit change, you know, I’ve done work early on with alcohol use disorder, and then with smoking, and then with overeating. And somebody, one of our we created this app called Eat right now. And somebody in the program said, hey, you know, I’m realizing that anxiety is triggering me to overeat. And I was thinking, well, I prescribed medications for anxiety, but it put a bug in my ear. And I went back and looked at the literature. And it turns out, that anxiety can be driven in very much the same manner as other habits, which I didn’t learn in medical school or residency. And it was this big aha moment for me to say, Oh, let me see if that’s true. So of course, as a researcher, I, we developed this app on same name as the book on wedding anxiety, and we studied it to see how well it worked, you know, Canvas, can this methodology basically, using mindfulness training, can this help people with anxiety and we got Gangbuster results, we did a study with anxious physicians, we got 57% reduction in anxiety, we did a study with people with generalized anxiety disorder, we got a 67% reduction. And there we can calculate the number needed to treat. So for medications 5.2 for this app, an app, it was 1.6. Wow. So I just brought all of that together and seeing how this played out in my clinic and see seeing how this played out in my, you know, my research, I wanted to get it out there. So people could really do this on their own. So it’s not just you know that the unwinding anxiety book is used as anxiety is a thread, you know, where people can learn and work with their anxiety, but that can actually help them. The idea is for them to have a step by step guide to work with any type of habit. Yeah, I love that. Because that’s I talk about that a lot here on the show about the things that I talk about, which is similar in terms of the mindfulness, and I call it what I call the behavior map results cycle. And it’s really talking about thoughts and feelings and how they drive our actions. And so it’s very similar in that respect. But what I love about what you you have done is that you really talk about meta skills and habit change and how we do have the power within us in our own brains. And it’s really, it’s really our brains. I mean, the reason that that I think you that those that we can’t figure out, you know, which drug right is going to solve which problem is because the brain is pretty complex. I mean, it not pretty complex. I would say as a neuroscientist, would you agree that it’s very complex? It’s very complex, we know very little about how the brain works yet. When we look at basic behaviors and habits form, for example, it’s actually relatively simple and straightforward. Yet if we don’t know how our minds work, how can we possibly work with our minds? Right? So you know, I’m not a cellular or molecular neuroscientist, I’m more of a systems neuroscientist and a behavioral neuroscientist. And here we look at okay, what what are the necessary and sufficient components of understanding how the brain and the mind works to be able to affect habit change? Yeah. And one of the things I loved in the book that you talked about is because I get this a lot from people that I talked to and I just told you, I come from a past right a past of Being an adult child of an alcoholic. So for a long time, I held on to stories about that, that dictated how I thought and felt and behaved. And one of the things that I appreciated in your book was that, you know, you kind of say, you know, it really doesn’t matter, we don’t need to go back and look at all of the birthday parties, and how about cake. And you know, about when we decided we liked cake, that, you know, it doesn’t necessarily matter if what we’re doing right now isn’t serving us. And if the habits not serving us, we need to focus on what we’re doing right now. And creating an understanding the habit loops that are working in our lives right now to affect change. Right, right, as an SD, card carrying psychiatrist, you know, this might sound a little heretical, because, you know, we’re trained in residency to explore childhood and things like that, a lot of these stereotypes around psychiatry, when you look at the behavioral neuroscience, and you look at the math, like mathematical formulas that are very, very good predictors of behavior, for example, it has to do with reward value, how rewarding a behavior is, will determine whether we repeat it. And in that equation, I should say, nowhere in that equation is childhood. Right. And I think that’s really important, because so many of us hold on to past stories as reasons for why we cannot overcome the habits that are running in our lives right now. And the, when you understand your brain, and you understand how to work with it, to your point, you really can overcome those habits that aren’t serving you. Right, right. And this isn’t to say that childhood isn’t important. How we became who we are, isn’t important. It’s to say, you know, it’s, it can be helpful for some people to kind of see how something developed, right. But when it comes to changing what is happening right now, we can often get lost in the past, and like you’re talking about, we can get, you know, oh, this is, you know, I’ve never you know, this is who I always am, I’m never going to change No. Not at all, who you are right now determines who you will be in the future. And what you can do right now is actually changed who you’re going to be in the future. And all of that comes from really helping bring awareness to what we’re doing right now. And bringing that awareness. And so we can see, is it serving me or not? That’s really different than getting lost in you know, trying to figure out why something started in the first place. Yeah. Couldn’t agree more. And so you have spent a lot of time in your research over the years in the development of mindfulness. And so you talk about in the book, and I know that you are you practice meditation, and you talk about meditation in the book, what I appreciated it as well is because I think sometimes it gets conflated, like mindfulness and meditation, people think that they’re kind of the same thing, or they think that it means Mindfulness means getting to this zen place where we’re turning off our brains. And what I really appreciated in your book was that it’s like no, mindfulness isn’t about turning off our brains, it’s actually about just being dialed into them. Right, right. If we turned off our brain, we would stop breathing. Right? We would die, I think, yeah. Helpful brain working helpful. So you know, when I started meditating, I started meditating, actually, my first day of medical school, and I had this idea that meditation equaled mindfulness. Yeah, when, you know, 1012 years later, when I did my first study on smoking cessation, and this was a study where we got five times the quit rates of gold standard treatment. So you know, something was working. And this study was about, you know, what was what was mindfulness doing to help people quit smoking. So when we looked at our data, we actually split it up between formal meditation practices, how much people were practicing sitting meditation, walking, meditation, things like that. And these informal mindfulness practices where they were bringing awareness to their experience as they were smoking cigarettes, for example. And we found that the informal practices moderated the effects more than the formal practices. So it was really helpful for me to take a less biased approach because I was thinking, Oh, meditation, that’s what you know, that’s what does it to look at the data and follow the data. And it turns out that bringing awareness in the present moment was really critical. And now 510 years later, after that first result, we know why that’s the case. It has to do with these reward value. circumstan circumstances where our brain is going to, you know, if we pay basically, you know, when my patients pay attention as they smoke a cigarette and they realize that cigarettes tastes like crap. That’s a momentary mindfulness practice, it’s not that they have to go and sit on a cushion and meditate on cigarette smoking, they pay attention in the present moment. That’s how our brains learn best is through immediate feedback. And when they get that feedback, that burning and their lungs have the nasty taste in their mouth of the nasty smell, they start to become disenchanted with the behavior. And that’s what mindfulness is. So I think of mindfulness as this large circle. And meditation being a smaller circle within it, if you think of Venn diagrams, where meditation can help support and train mindfulness, but mindfulness is much larger than simply meditating. Yeah. I love that, like, yes, exactly that training your brain. And it’s just, you know, it’s all about that because we and I, in the book as well, I think you talk about the running around on autopilot, and it’s the now I’m not gonna build remember the name, the network behind the default mode network, defaults, I need remember it. So people run around, we, we basically run around in default mode network and for autopilot, as I call it, a lot of the percent of our lives, unfortunately, and really, for me, mindfulness is about bringing ourselves getting our brains to get out of the habit of running in default mode and running into a more, you know, cognitive state so that we’re using more of the prefrontal cortex while we’re making decisions. In the book, I know you, you separate out kind of gear one gear to gear three, that habits are the process of changing, unwinding anxiety. And I will just say that I believe that all of these changes, or the steps of change would be applicable to any habit that is negative in your life, but certainly, for a lot of people that are listening, anxiety is a big one. So with that, yeah. So I use the skiers analogy, because I like to ride bicycles. And, you know, but even if folks haven’t ridden a bicycle is like a car, you know, you have to, you have to get the car moving. So you start in first gear, and then as you gain velocity, as you gain speed, you shift into second third gear. And I think of this, as you know, if we’re not aware of our habits, we can’t work with them. So first gear is really about just mapping out these habit loops, you know, what’s the trigger? What’s the behavior? What’s the result? It’s that simple. In fact, we actually put out a free habit mapper that anybody can download link that in the show notes perfect. Yeah, it’s just, yeah, I think the websites map my habit.com. But the idea is, start by mapping out your habit loops. And we can do this throughout the day, we can, you know, take a piece of paper and map these out. We can even do this without a piece of paper and just start to notice, oh, what’s triggering me to do? Whatever this habitual behavior is? And what am I getting from this? So that’s first gear, the second gear as we start to see how our minds are habitually acting or going on along on autopilot, we’re less on autopilot, we’re aware of that, then we can shift into second gear, where I sum it up is asking this simple question, what am I getting from this? And the reason for that is that behavior doesn’t change, just simply based on seeing that we’re doing the behavior, it’d be great if we’d say, Oh, I smoke. Yeah, I’m gonna quit smoking, I’m going to stop overeating, whatever it my job would be super easy for my patients just to come into my clinic and just tell them to stop whatever they’re doing. There’s a great Bob Newhart skit actually called Just stop it. That book should check out. Yeah, it’s fantastic. It’s from the 70s. And it’s still applicable today, where he basically just tells, you know, stop it. So we can’t do that. Because that’s not how our brains work, our brains are going to do a behavior based on how rewarding the behavior is not just based on the behavior. So here, we really want to have folks focus on what am I getting from this? What’s the result of the behavior, and you can look at this, not as some newfangled thing this, this goes all the way back to ancient Buddhist psychology, where they talk about karma, cause and effect, you know, what are we doing? And what’s the effect of what we’re doing? So, as people pay attention, let’s use anxiety and worry as an example. So let’s say I see this a lot. So anxiety, actually can trigger the feeling of anxiety can trigger people to worry. So patients, they wake up in the morning, they feel anxious, there’s the trigger, they start to worry about why am I anxious? Or am I going to be anxious all day? Or am I going to you know, whatever. And that worry, as a mental behavior actually feeds back and drives more anxiety. So when they pay attention to that, and ask, What am I getting from this? Is this worrying solving a problem? Is it keeping my family member safe? Is it doing what my brain thinks it’s going to be supposed to be doing? And they see a worry isn’t actually helping anything. They start to become disenchanted with them. havior now this can be applied to any habit if somebody stress eats. And they realize, oh, stress eating isn’t fixing my stress, it’s actually just making me more stressed because I’m gaining weight or whatever, they start to become disenchanted with that smoking cigarettes when they pay attention. This is like crap, they start to become disenchanted with that. drinking too much alcohol, you know, and they look afterwards and like, what did I get from that? Well, you know, all the things that come from, from drinking too much, they can start to become disenchanted with that as well. So that’s really what second gear is all about. And we don’t need to go into all the neuroscience. But just suffice it to say, there’s a ton of neuroscience that actually explains why this is the case. And how the only way to change your behavior is to bring awareness in at this moment, and see how rewarding or unrewarding this behavior is, that’s the only way to actually change your behavior. So this second gear is critical. As an example, we my lab just did a study with our eat right now app and found that it only takes 10 or 15 times if somebody’s paying attention as they overeat, for them to shift that behavior. And for that reward value to drop below zero, that reward value of overeating, to drop below the reward value of not overeating. So it’s not like this takes years of training or years of therapy. It takes some very focused attention, Oh, what am I getting from this, but it’s relatively simple. Not easy, but simple. Right? So I love this because it’s really, like I said, You’re You’re preaching to the choir in terms of what I talk about. Because I for a long time, I avoided changing my behavior, because I convinced myself pre determinately, that it was going to be so painful that it was going to be so hard, I was going to be living with all of this on fulfill desire, right, I was going to have all these urges and cravings and not be able to to deal with them. And in reality, just as you just talked about, once I became cognizant, and created a different relationship, in my own thinking and feeling between what I associated with soy with drinking, and I mentioned this to you, before we jumped on the air, it’s like many people believe they’re drinking to take the edge off to relieve anxiety. There’s actually neuroscience there that that doesn’t support that. And alcohol can have a rebound effect in terms of releasing neurotransmitters that actually increase the feeling of anxiety after as it dissipates out of our system. So once I learned that accepted that understood that science, then the idea of drinking to take the edge off didn’t hold as much appeal to me, because I was like, Oh, that doesn’t even really make any sense anymore. Because now I know that that’s not true by drinking, am I actually going to be increasing anxiety. So therefore it that that’s exactly to that point, the reward of drinking no longer held as much, you know, it was dropping off for me because I was using my brain in a different way. Name theory. Absolutely. And I see this a lot in my clinic where my patients, you know, they wake up the next more often, it’s after a night of drinking, they wake up the next morning feeling even more anxious than they did before. And when they don’t drink, they don’t wake up anxious. And I’ve even had people describe how it’s hard to tell the difference between a hangover and just anxiety because the two anxiety are so yeah. I have not heard that. That is fabulous. Yeah, so the anxiety is a real problem. So there, you know, I, I think what I see clinically, and what we’ve seen with the research totally backs that up. All right, sorry, that was a little bit of a offshoot, but it was exactly what I like is my own experience and what I talk about here, so Alright, so gear three, let’s get to let’s, we’ve moved from awareness. And now we’re, we’re questioning things and we’re trying to understand what we’re getting out of our habits. What what do we do in the third gear? Right? So after we’ve really explored, you know, the what do I get from this and feel into our direct experience. This isn’t an intellectual process. And right here, too, it’s really, really paying attention to what’s happening in our body, in our mind in this moment. So once we start to see Oh, this isn’t really doing it for me, as much as I thought that it was, we can give our brain what I call the BBO, the bigger better offer. And the reason I highlight that is that our brains are set up based on reward hierarchies, meaning that they’re going to do a behavior if it feels better than some other behavior. So if we start to see that, you know, worrying, for example, or drinking too much, for example, isn’t rewarding. That opens up the space to find something that is more rewarding. Now It’s important here to highlight how, you know, we could just find some substitute behavior, but then we become dependent on that. And I’ve had patients with addictions, for example, that they get addicted to exercise, you know, it’s socially acceptable, you know, it’s more compatible with with a home and work life. But if they get addicted to exercise that can also be just as problematic, you know, continued use, despite adverse consequences, so they can get injured, it can affect their, you know, their social lives, their family lives, etc. So the idea here is to find something, find that bigger, better offer that is intrinsically rewarding. And here, in this is very consistent with mindfulness practices, there were two categories that my lab has studied. And we see, that worked pretty well in terms of being intrinsically motivated one category or thinking of it is two flavors, one flavor is curiosity. So if we’re worried, or we’re anxious, we can compare what’s it feel like to be caught up in anxiety versus what’s it feels like to be curious about what those sensations feel like in my body right now, curiosity wins every time. The other the other flavor is kindness. So I often see people judging themselves for not being able to control their behavior or being anxious or whatever. And so they can explore what it feels like to judge themselves versus to be kind to themselves. And again, no brainer, kindness wins every time. Well, again, I the choir singing and I’m like, Oh, this is so great, because, of course, with negative patterns are and health primitive behaviors like alcohol, right? So there are things that are that we’re doing that are negatively impacting us, and a lot of different ways. And for people who are drinking too much, or drinking more than they want to, it can be very impactful into their lives. So much like smoking, eating, right, and society tells us there’s kind of a black and white, right, good and bad, so and all or nothing approach to how we’re supposed to deal with these, these issues. So people that are overeating, you know, they’re they’re weak, they don’t have willpower, they don’t have self control. There’s a lot of dialogue that we hear, or we believe, that leads us to be self recrimination, and, and kind of beating ourselves up. And so one of the things I talked about in what was really critical for me, was, in my process was planning ahead for the times when I was going to miss step, not do what I planned to do, you know, whatever, not, not go backwards. But you know, just have a step where I wasn’t following my plan to head timeline for whatever it was for alcohol, and how I was going to show up for myself in those moments. And I talk all the time about using curiosity and compassion. Because it’s, it’s really fundamental to how if we we cannot beat ourselves into habit change, I don’t believe we can’t say, you know, that’s and you know, it doesn’t feel good. And if it doesn’t feel good, we’re not going to want to keep doing it. Right. Right. And that’s the, that’s the key element here is, you know, this is both second gear and third gear, if it doesn’t feel good, we won’t keep doing it. So if we can pay attention, and see that something doesn’t actually feel as good as expected, we’ll change we’ll be less likely to do it. Without force, right? We don’t have to force ourselves or tell ourselves, oh, that’s, I shouldn’t do that. It’s about really paying attention. And then when we pay attention to something that feels better, like being kind to ourselves, or being compassionate, like you’re talking about, we just see that, oh, I’d rather be kind to myself and beat myself up in this moment. I also have talked a lot on this show. And I’d love to hear your feedback on this just in terms of managing my own mind. I didn’t really grasp and of course, you’ve been in psychiatry and psychology for many years and done lots of research on this. But I think a lot of us wander around, feeling at the effect of our emotions, feeling like we’re run by how we feel right and not understanding that we actually can be the architect of that emotion in terms of how we think about a situation and how, and so that’s something that I talked a lot about here, those primal emotions versus the feelings that we experience and how we can direct our brains to feel differently. And, you know, it’s really sometimes just as simple as changing our own thoughts and perspectives about the circuit. stances in our lives, not that we need to change everything in our lives to feel better, but we really just need to change how we think about it. Yes. And I think curiosity is a key attitudinal component here. If we can be curious about, you know, let’s say that we, we have a habit loop of, you know, thinking worst case or worrying about the future, right? So we’re kind of stuck in that mindset of really curious, we can notice it, we can pull it out. And we can ask ourselves, What am I getting from being stuck in this mindset? Is this helping me? And then even in those moments, as we explore it, were stepping out. Right? Yeah. Well, I think that the, for anybody asking themselves better questions, is a key to just becoming a better a better version of themselves, and being able to manage their own brains. One of the things I appreciate about your work as well as you talk a lot about self mastery. And so, you know, that’s that, to me, is really at the core of all of this is that we, as humans have these beautiful, brilliant human brains, you know, the ability to be metacognitive, being able to view our own thoughts is something that is, I believe, uniquely human, you know, if I guess we don’t know for sure, with the with the, with the other species, but I mean, we believe that it’s a it’s an advanced skill in terms of the brain. And, you know, I just want to encourage people to to use their own brains to understand their lives and to become better versions of themselves. Absolutely, absolutely. Use your brain. That’s a, that’s a good. I think that’s a good way to summarize this, right? It’s, and I would say, one of the optimal ways to use our brains is to start by understanding our brains and some of the key elements here, not that we have to understand everything down to every synapse, but really just understanding these basic concepts. Oh, this is my brain trying to help me survive. You know, this is a habit loop. Oh, this is what I’m getting from this. And, oh, this feels better than my old habits. It’s really that simple. Yeah, that’s simple, that hard, whatever you you know, it’s a it’s a if it were that easy, as you said, it will, you wouldn’t, you wouldn’t have the business in the practice that you’ve had for several years. But it’s, but I appreciate you sharing all of your wisdom in both your craving mind and unwinding anxiety. I will link everything in my show notes, folks, so that you can learn more about Dr. Jett and the apps as well, which I believe are on Dr. jett.com. You can learn more about if you want more support, then Self Mastery is one thing if it’s not happening, you need to find tools that help you get there. So I appreciate you coming on the show, taking the time to do it and just sharing your work with us. Thanks for having me. Thank you for listening to breaking the bottle legacy. This podcast is dedicated to helping you change your drinking habits and to create a peaceful relationship with alcohol. Take something that you learned in today’s episode and apply it to your life this week. Transformation is possible. You have the power to change your relationship with alcohol. Now, for more information, please visit me at www dot Molly watts.com