Follow along with the transcript below for episode: Unwinding Anxiety With Dr. Jud Brewer
[INTRODUCTION]
[00:00:02] PF: Thank you for joining us for episode 436 of Live Happy Now. Anxiety is so pervasive today that more than 40 million adults in the US are living with it. But this week’s guest is trying to change that.
I’m your host, Paula Felps. This week, I am talking with Dr. Jud Brewer, a New York Times best-selling author and Director of Research and Innovation at Brown University’s Mindfulness Center. In his 2021 book, Unwinding Anxiety, Dr. Jud shared his scientific insights into how to break the cycle of worry. Now, those steps are also available through an app, and he’s here today to tell us how we all can learn to break free from anxiety. Let’s have a listen.
[INTERVIEW]
[00:00:45] PF: Dr. Jud, thank you so much for joining me today.
[00:00:48] JB: Thanks for having me.
[00:00:50] PF: You have written, researched, done so much work in the area of anxiety. This is such a huge, huge problem for people. To start it off, this has been problematic for generations. I wondered why we’re not getting better at managing it, given the amount of time we’ve had to learn about it.
[00:01:07] JB: This is way before neuroscience was even a field . Neuroscience is a very young field of study. It wasn’t even coined until like the 1970s. But if you think about this approach to changing human behavior and working with ourselves, it’s about I think, therefore, I am. I think, therefore, I could think. I can think my way out of anxiety. So that’s been a dominant paradigm for a long time. Even I love – one of my favorite comedy skits is from the 1970s. This guy, I don’t know if you remember Bob Newhart.
[00:01:41] PF: Oh, I loved him. I loved Bob Newhart.
[00:01:44] JB: So he had a skit called Stop It, basically, where this person, this woman comes into his – he’s playing a psychologist or a psychiatrist. Woman comes into his office and says, “I have this fear,” talks about this fear. I won’t give away the skit. Then he basically just says, “Stop it.” But he’s highlighting what has been this dominant paradigm back in the sixties, seventies with cognitive behavioral therapy. Still present to today as the dominant thing is just control yourself, to stop it. If only that worked, if we could find that switch in our brain that we could just flip off that anxiety switch or that worry switch or that overeating switch or that whatever switch. It just doesn’t work that way.
[00:02:28] PF: Right. It’s like growing up, my mom would be like, “Well, just calm down.” It’s like that is what I’m trying to do. Literally, I’m trying to calm down and I can’t.
[00:02:37] JB: Yes. The more somebody tells us to calm down, the more anxious we get.
[00:02:41] PF: Yes, exactly, exactly. Then we feel like we’re doing something wrong. Like, “Why can’t I get this under control?” Is that part of it too? We felt like we have to do it ourselves.
[00:02:50] JB: I think that’s a lot of it, where it’s just like, well, what’s wrong with you if you can’t control your anxiety. So we also get into loops of self-judgment and unworthiness and guilt and shame and all that stuff.
[00:03:04] PF: So is it more prevalent? Or are we just hearing more about it? Are we more willing to talk about it? Because it seems it’s everywhere I turn, I hear conversations about it. I see reading materials about it. So I don’t know if we’re just more comfortable with talking about it or it really is a bigger problem.
[00:03:22] JB: It’s hard to know whether something’s increasing, decreasing, or staying the same if you haven’t measured it. So I don’t think it’s been measured historically as much as it’s been measured today. So what I can say is we do know some of the factors that contribute to anxiety more, and we can certainly say those factors are pretty prevalent.
So for example, our brains don’t like uncertainty, and that’s actually a built-in mechanism to help us survive. If we hear some rustling in the bushes, think of our ancient ancestors. You can’t just ignore that and be like, “Yes, whatever. I’m going back to sleep.”
[00:03:55] PF: It’s probably just a tiger. I’m fine.
[00:03:57] JB: Yes, yes. It – pet tiger, pet tiger, not the dangerous non-pet tiger, right? So, yes, just a tiger. No big deal. So our brains are set up for survival in that way. In modern day, we’ve never had so much access to information, right? So it’s like our brains are like, “Oh, more information, good.” But you can’t drink from the fire hose. On top of that, there’s a lot of unintentional misinformation and then intentional disinformation.
So back in the day of our ancient ancestors, there was no such thing as the deep fake tiger or the whatever, the intentionally misleading tiger. It was like tiger or no tiger. So now, we have to become the expert on everything. When we hear something, we’re like, “Well, is that true or not,” and then – so our brains start to go into overload because not only is there a ton of information, but we don’t know what to trust, what not to trust, and we’re not the experts.
So I would say that certainly wasn’t available back, before the Internet, for example. The Internet’s really made information much more available and also mis and disinformation as well. So that’s one piece in modern day that historically hasn’t been there that is certainly contributing.
[00:05:14] PF: And we don’t get that time away from it. We used to have like you walked away from your life a little bit. Your work life, whatever it was. You had your evening. You could kind of decompress. That doesn’t happen now. So what’s that doing to give us this heightened always-on circuit in our brain?
[00:05:31] JB: Yes. Well, there’s a – it’s now coined the FOMO, fear of missing out. That fear of missing out is not just social. So that can start in someone’s teenage years or even probably earlier. But also in adulthood, it’s not only the social FOMO but also the work FOMO. So it’s like, well, I could be checking my email to see if I’m missing an email. I could be doing this or that. Or somebody can always get a hold of us via text and say, “Hey, call me immediately,” when there used to be work-life boundaries.
[00:06:02] PF: Yes. I read an article in the New York Times this past week, and it said that texting from work is starting to invade our personal space. I’m like, “That’s just starting.” Like –
[00:06:12] JB: Starting. I was going to say what.
[00:06:14] PF: That’s been going on for a little while there, NYT. So it is. It’s absolutely overloading. What is it doing to the brains of kids who are growing up in this kind of always-on environment?
[00:06:28] JB: Yes. That’s a good question. We now have a generation of digital natives, which means children that were born and don’t know what it’s like not to have smartphones, not to have social media, not to have the Internet. It is an uncontrolled experiment.
[00:06:46] PF: On your children.
[00:06:48] JB: Yes. That you didn’t sign a consent form for.
[00:06:53] PF: And you’re probably not going to like the outcome. But, yes, it is. It’s going to be – it will be interesting to see. Will the way that anxiety is addressed with that generation be different than, say, someone like myself, who actually saw the screens go off like at 2am when they’re babysitting, and there’s no more TV for hours?
[00:07:13] JB: It’s a good question. Happy to be wrong here, but my hypothesis is that, regardless of whether we’re a digital native or not, you treat it the same way. Part of that is that our brains are so adaptable that we can certainly remember what it was like to not have a cell phone or not have email or not have the Internet. But it just feels like ancient history because that’s not what’s happening right now. So whether we were born before or after, it doesn’t really matter because what we’re dealing with is the present moment, like what’s happening right now.
[00:07:52] PF: That makes perfect sense. You have done so much research in a lot of areas, but we want to talk about specifically what you’ve done with anxiety. I’m interested in learning what made you start researching anxiety.
[00:08:04] JB: Basically, I was really anxious at the end of college, and I didn’t know it to the point where my body had to give me some very clear signals through I developed irritable bowel syndrome. One of the big drivers for some people of irritable bowel syndrome is anxiety and stress. So my guts were letting me know, “Hey, pay attention. This is not good.”
Also, fast-forward eight years later, when after I had finished my MD-PhD program, I started getting panic attacks during residency. So those were kind of precursors for my personal experience with this. Then interestingly, I – my lab – so I had started studying mindfulness training when I started my career as an assistant professor because I was really interested in how people can change addictive behaviors and habits.
As a psychiatrist, I was really seeing the limitations in current treatments for addictions. So I really wanted to put – contribute there. I felt like people with addictions were my people, and so I really wanted to help there. So I started developing these programs. I developed a program for smoking. We actually got five times the quit rates of gold standard treatment, so that’s –
[00:09:16] PF: Oh, that’s amazing.
[00:09:17] JB: Yes. I was thinking, wow, this works pretty well. Then we even developed an app for eating called Eat Right Now. A study led by Ashley Mason at UCSF found a 40% reduction in craving-related eating. That’s even gone, so we’re like, “Wow, that’s pretty good.” That program is now actually CDC-recognized as a diabetes prevention program, the first one that’s based solely on mindfulness as a way to change it.
I would say mindfulness. We can talk about this in a bit, but mindfulness really targets some of these neural mechanisms which other programs don’t. But somebody in our eating program said to me, “Hey, anxiety is actually triggering me to stress-eat. Can you create a program for anxiety?” I was thinking, well, I’m a psychiatrist. I prescribe medications. But I was realizing, if you look at the data, there’s this scientific term called the number needed to treat, which basically gives you a rough and dirty of how many people actually benefit from a treatment. That number is 5.2, which means one in five people benefit from the best medications we have out there.
So I was basically playing the medication lottery when treating my patients with anxiety. One in five, I didn’t know which one of the next five was going to benefit, and I didn’t know what to do with the other four. So I was getting anxious about how to treat my patients with anxiety .So that question that somebody had asked me from our Eat Right Now program, can you create a program for anxiety, was kind of burning a hole in my ear, and I started – so I went back as a scientist and looked at the literature.
Somebody back in the 1980s, ironically back when Prozac was introduced as the first SSR that’s supposed to help anxiety, they had largely ignored the psychological research, where this guy Thomas Borkovec, had suggested that anxiety could be driven like a habit. When I read that, I was like, “Anxiety, habit. I research habits. I never thought of anxiety as a habit.” I was like mind-blown. So I developed this Unwinding Anxiety program and as a researcher wanted to study to see how well it worked.
Get this. We started as like who’s – what’s the hardest population for us to work with? Oh, yes, physicians. Like we’re a pain in the ass. We don’t take care of ourselves. We learn to armor up. We learn to be martyrs because if we’re focusing on ourselves – we could be saving patients’ lives, and so don’t waste our time on ourselves. Of course, that’s why we get burnt out.
So we did our first study with anxious physicians, and we got this whopping 57% reduction in anxiety. We also got burnout. But I was like, “Wow. Okay, this might have some legs to it.” So we got some funding from the NIH and did a randomized controlled trial in people with generalized anxiety disorder, like the worst of the worst. They wake up anxious. They feel anxious all day. Then they have trouble sleeping because they’re anxious. Rinse and repeat. Really, really challenging condition.
Here, we got a, ready for this, 67% reduction in anxiety, yes. The number needed to treat there, remember with medications, it’s 5.2. The number needed to treat here is 1.6, the smaller number.
[00:12:15] PF: Oh, my gosh.
[00:12:16] JB: Yes. So we’re like, “Wow, this is pretty good.” We went on to work out the mechanism. We did more studies showing that you could even improve sleep by treating anxiety, all this stuff. So all of that is to say work effects conjecture his hypothesis that you could treat anxiety as a habit was just so important. Here we are able to test that hypothesis in a way that’s accessible for anybody with a smartphone. Here we’re getting gangbuster results. It’s really exciting to see that the theory lines up with the practice and also that the practice can be very pragmatic. We set these programs up to be 10 minutes a day for people to incorporate them into their busy lives. Importantly, what we’re seeing from the data is that it’s really helpful for people to reduce their anxiety.
[00:13:02] PF: There’s so many aspects to anxiety, and one thing is being able to access that help when you need it. So what are some of the tools that you teach people? We’ll get to your app in just a moment. But what are some of the tools that you teach people to use so that when anxiety hits, they can start managing it then?
[00:13:22] JB: Yes. I go into all the details in the Unwinding Anxiety book, but people don’t need to read my book to get this. I think of it as a three-step process, where the first step is to map out our anxiety habit loops. Now, I didn’t even know. As I mentioned, I didn’t know that meant anxiety could be triggered like a habit. So the first thing for anybody to know is that anxiety can be a habit. The way that works is you need three elements to form a habit. You needed a trigger or a cue. Behavior is the second step. Then a result or a reward from a neuroscience standpoint is the third.
The way that works is that the feeling of anxiety can trigger the mental behavior of worrying. Yes. Mental behaviors count just as much as physical behaviors, right? Then that mental behavior of worrying makes us feel like we’re in control or at least doing something, right? Because it’s better to worry than not to worry.
[00:14:12] PF: Oh, interesting. I think most of us don’t even think of worrying as a form of control. Again, it’s just a habit. It’s just – it’s what I do.
[00:14:21] JB: Yes. Well, I think that’s accurate because worrying doesn’t actually give us control. But the research has shown that for enough people, it makes them feel like they’re in control, or it distracts them from the feeling of anxiety that it’s rewarding enough, at least initially, for it to feed back so that the next time somebody feels anxious, they worry. Then like you point out, it quickly becomes a habit.
[00:14:43] PF: Interesting. So you’ve got these three steps. Then how do they – how does that equate into being able to handle them?
[00:14:51] JB: Yes, yes. So that first step. We’ve talked about the first step is just mapping out these habit loops. So being able to identify what’s the trigger, what’s the behavior, what’s the result. We can actually even simplify that to just puts the behavior, and it tends to be worrying, like you’re highlighting. But sometimes, it can be distracting ourselves with social media, stress-eating, emotional eating, drinking alcohol, things like that.
Second step is where we really lean into the neuroscience. The way that works is our brains are going to keep doing a behavior if it’s rewarding, and they’re going to stop doing that behavior if it’s not rewarding. If we’re not paying attention, and we don’t see how rewarding or unrewarding a behavior is, we’re going to just keep doing it.
We actually did a study with our Eat Right Now program to have people where we had people specifically pay attention to what it feels like when they overeat. It only takes 10 or 15 times for somebody to overeat and pay attention to see that that reward value is not rewarding. That reward value drops below zero in their brain, and they start to shift that behavior. So it doesn’t take a lot of time. It doesn’t take any effort. Notice how none of this requires willpower. This is really all about awareness, paying attention in the present moment.
So feeling of anxiety triggers the mental behavior of worrying. If we don’t pay attention to how rewarding or unrewarding worrying is, we’re going to keep doing it because we’re going to think, “Oh, this is just what I do,” like you pointed out. If we start to ask the question, what am I getting from worrying, and we really feel into our direct experience, we start to see something pretty clearly. Worrying makes me more anxious, right? It doesn’t solve my problems. It doesn’t help me predict the future. All it does is make me feel more anxious.
That gives us a negative prediction error, where our brain says, “Hey, is this worrying thing really working for you?” No, no. It’s not. It’s not. Pay attention. Then we start to become disenchanted with the worrying. That’s step two. That step applies to any habit. When my patients come in and want to quit smoking, what do I have them do? Pay attention as they smoke. They come back. I had a guy. He’d been smoking 40 years, right? We calculated the number of times he had reinforced this process. Ready for this? It was like 293,000 times.
[00:17:04] PF: Oh, my gosh.
[00:17:06] JB: And he hadn’t been paying attention. So I said just set up a follow-up appointment and told him to go home and smoke and pay attention. He comes back and he’s like how, “How did I not notice that before,” right? Cigarettes taste like crap. So it’s much easier to quit smoking when you really see, feel, taste, smell what cigarettes are like.
[00:17:25] PF: That’s amazing. Yes, because you can’t – I can see how that works with any habit. That’s absolutely amazing.
[00:17:30] JB: Yes. Smoking, overeating, anxiety, all these things. Self-judgment, big one in western society. We’re really good at beating ourselves up. We can start to ask, “What do I get from this,” right? So that’s the second step.
Third step is actually leveraging that same process. So if our brain is going to only do things that are rewarding, and they start to become disenchanted with these other behaviors, our brains are going to look for something better. Spoiler alert, it’s not social media.
[00:18:00] PF: Yes. Dang it, I got my answer wrong.
[00:18:05] JB: Yes. Just scrolling on our social media feeds or checking our email, it might scratch that itch, but it just makes it itchier. It’s like poison ivy. So we need to find things that are intrinsically rewarding that help us step out of these old habit loops. The good news is they’re already there. We already have them. We just need to dust them off and use them a little bit more.
Two main flavors here. One is curiosity. The other is kindness. Let’s see how we can apply both of them. So if we have anxiety and we start worrying, we can worry, which tends to come into the mental flavor of, “Oh, no. This is happening,” or, “Will this happen,” or, “What’s going to happen?” We can flip that to, “Oh.” That oh awakens our curiosity, and we go, “Oh, what does this anxiety feel like in my body?” We can even ask questions like is it more on the right side or the left side, front or back? It doesn’t really matter what the answer is, but that awakens our curiosity like, “Huh, where is this? What does it feel like?”
When we go looking for the anxiety, it starts running away because what we start to notice is that these physical sensations are constantly changing. If we’re not feeding them by worrying, they tend to go away on their own. They might not go away instantly, but we can start to see, “Oh, these are physical sensations. They might be unpleasant, but I can tolerate this.” That curiosity helps us work with them.
There’s this saying attributed to Marcus Aurelius who is a Roman emperor and a stoic. He says, “What stands in the way becomes the way.” I love that because we can think of anxiety as a problem, or we can think of it as an opportunity to learn. Oh, this is what unpleasant sensations feel like. That curiosity helps us develop that distress tolerance. Instead of running to our phone to distract ourselves, we can turn toward this experience. By turning toward it, it’s like the rats that scatter when you turn on the lights, right? It’s not as powerful as we thought it was.
So that’s how curiosity can help. I think if it has flipping that, “Oh, no,” whether it’s a craving or worrying or whatever to, “Oh,” awakening that curiosity. The other flavor that I talked about was kindness, and that can be very helpful when we’re judging ourselves. So we can compare judging ourselves, what do we get from this, to kindness. What do we get from this? No-brainer, right? Which one feels better in the body, being kind to ourselves. Yes, right?
So here, this third step helps us step out of the old habit loop of judging ourselves by stepping into the new behavior of being kind to ourselves. Then because that is more rewarding, it becomes the new habit. Same for curiosity, it helps a step out of the old worrying habit loop and into the new habit of being curious.
[00:20:56] PF: Those are such incredible techniques. Obviously, they take practice. It takes one remembering to do them when it strikes, which might be the hardest part of it. Once anxiety kicks in, it kind of feels like just grab your hat and hold the hell on. You don’t really have the chance to do anything. But if you have a plan and you know, “Next time I feel anxious, this is what I’m going to do,” then you can start changing it.
[00:21:20] JB: Yes. It’s kind of like if you’re flying in an airplane, lots of people have fear of flying in an airplane. Talk about lack of control. So the pilot comes on, and she says, “Attention, there’s going to be some turbulence. Buckle up.” We can go, “Oh, no. Turbulence.” Or we can go, “Woo-hoo. Oh, no. Here we go.”
[00:21:38] PF: Am I going to be YouTube famous? Hey.
[00:21:42] JB: Yes. We have no control over that turbulence, but we certainly have control over how we respond to it.
[00:21:47] PF: That’s terrific. With your book, Unwinding Anxiety, it was widely acclaimed. It has helped so many people get through it, and that led to creating an app of the same name, which we’re going to let our listeners try out for a month for free. But talk about how the app allows them to implement these principles and kind of how that works for them.
[00:22:10] JB: So the app is set up as a – we have these core trainings where it’s 10 minutes a day for 30 days to help people get the core understanding of how their mind works and how to work with their minds. So it’s about 10 minutes a day, videos, animations that kind of teach a concept and then importantly have people start to put it into practice that day. Okay. So that’s the psychoeducational component.
The other components are we’ve got in-the-moment exercises. So when somebody feels anxious, they can buckle up, and we’ve got some great practices to help people ground, help people get back into the moment. So we can get their brains back online and working. The other piece is through those 30 core modules, it walks them through this three-step process. We use the analogy of gears, like driving a car. You shift into first gear, second gear, third gear.
On top of that, there are a bunch of theme weeks that help solidify the core concepts. Then also, and this is actually one of the favorite parts of my week, every week, I run a live group through Zoom at noon Eastern Time on Wednesdays for anybody to join and ask a question. So we can actually go through what they might be struggling with live. So there, we can reiterate the concepts of three gears. Then we can see where somebody might be struggling to shift into one of the gears.
Then, usually, in 5 to 10 minutes, kind of identify that and have them through an exploration process together. Have them see where they might already have it, and they just don’t think they do or give them a couple of things to play with, and then let us know how it goes. So those are the key elements.
We also have a very active online community where we now, over the years, have developed this very large crowdsourced knowledge base, where people ask questions. I answer the questions. Then over the years, people – there’s basically a very rich library of answered questions because 80 or 90 percent of the questions that people have are the same, and they’ve already been answered.
[00:24:06] PF: That’s terrific too because just knowing you’re not alone in your anxiety journey can be absolutely huge. Having someone else say, “I felt the exact same way, and here’s what I did,” instead of going like, “Dude, that sucks. I’m really sorry.”
[00:24:21] JB: “It sucks to be you.”
[00:24:23] PF: Exactly. “Ah, so glad I didn’t get that.” But, yes, I think that’s so helpful. That community approach is really incredible.
[00:24:31] JB: It is. Community is everything.
[00:24:33] PF: So all the work that you’ve done in this space, and you’re continuing to do more. What is it that you really want everyone to know about anxiety and, two, like really hope this accomplishes in the long run?
[00:24:44] JB: Well, I would say the most important thing is for people to know it’s not their fault, right? They think there’s something wrong with them. They’re broken. They can’t be fixed. Well, there’s nothing wrong with them. This is just their survival brains that have gone a little off track, and they can actually get them back on track in a relatively simple way, right? It’s not magic. It’s not to say one and done. But it’s also not to say, well, you’ve been anxious for 30 years. It’s going to take another 30 years to help you become unanxious. That’s the good news.
I’ve had plenty of patients, et cetera, success stories, where people come in 30 years of generalized anxiety disorder, full-blown panic attacks. Within six months, they’re like, “Wow, I don’t know what to do with all this extra time now that I’m not worrying.”
[00:25:34] PF: I love that. How freeing is that?
[00:25:36] JB: I’m like, okay, great opportunity to go help the world.
[00:25:40] PF: Yes. There you go. This is such an important conversation to have. The work that you’re doing is so incredible. I really appreciate you taking the time to sit down with me today and talk about it. I’m really eager to share your work with our listeners because I don’t want to say I think they will. I know that people will get so much out of this. So I appreciate you coming on today.
[00:26:01] JB: Well, I really appreciate you having me. This has been a great conversation.
[END OF INTERVIEW]
[00:26:06] PF: That was Dr. Jud Brewer, talking about Unwinding Anxiety. If you’d like to learn more about Dr. Jud or follow him on social media, just visit us at livehappy.com and click on the podcast tab. While you’re on this episode’s landing page, be sure to check our anxiety links and resources, including a one-month free trial of the Unwinding Anxiety app.
That is all we have time for today. We’ll meet you back here again next week for an all-new episode. Until then, this is Paula Felps, reminding you to make every day happy one.
