Ease Anxiety: Your Path To Calm

Introduction to Dr. Jud Brewer 0:00

Welcome. And today, I'm really excited to welcome Dr. Jud Brewer, who is a psychiatrist who practices at Brown University, who's a wonderful expert on anxiety and mindfulness in a host of things. And I learned so much with Jud through the years. And so welcome to the summit. Thanks for having me. Yes, I'm really excited to just kind of dive into your expertise regarding mindfulness and maybe the effects of mindfulness practice on our physical well-being. You know, for example, that it affects our physiology, lowering blood pressure and such.

Could you give us a little understanding what mindfulness mindfulness is and maybe how we've seen some more recent data on how it can affect our well-being? Yes. So there are a lot of different definitions around mindfulness. I like to keep it very pragmatic. So I think of two components. One is awareness, where we're aware of what's happening right now, and then also bringing this curious attitude in where we're we're not judging what's happening. We're just we're just really curious and bringing that open mindedness to what's happening.

And what that has can help with. You know, there are a lot of

What Mindfulness Is and How It Affects Physiology 1:22

mindfulness has been studied for the last 30 or 40 years now. So still relatively young in the grand scheme of things. But certainly developing an evidence base. And when it comes to physiology, you know, it's been shown when people are provoked with stress tests, for example, there's this trigger social stress test. When people get mindfulness training, it's been shown to help reduce, you know, were they have less of a of a kind of a physiologic response to stress. So, for example, their blood pressure doesn't go up as much.

Some of these stress hormones, some of the even some of the inflammatory markers are more regulated. When somebody has gotten mindfulness training versus when they haven't. Some of this great work has been done by Liz Hughey and others, and there's even work by Eric Loucks at Brown University, where he's designed a program specifically for mindfulness training, for blood pressure reduction. And he's found that it can really help people lower their their blood pressure if people have high blood pressure or borderline hypertensive and also keep it down.

One of his studies that he recently published was shown to keep blood pressure reduction gains for two years after after this a week training from a from a neurobiologic standpoint where we're learning more about how that works. So, for example, there are things like anxiety that affect blood pressure for anybody that has white or white coat hypertension where they go to see their doctor and suddenly you have high blood pressure. You know, it's not exactly the most pleasant thing to go to the doctor.

And you're generally not going because of, you know, it's like, hey, let's just hang out. You know, it's often because there's something wrong or you're getting a check up or you're not sure how your health is. Hopefully all as well, but it's often not the case. So I there was somebody actually in our unwinding anxiety program that specifically he told me how he went to the doctor, sat down and got his blood pressure taken. And I think it was something in like 170, 180 range of around 100 diastolic and the office started to kind of vocalize like, oh no, oh, no, no.

He's fine. Hey, guys, give me a second. And just sat down. It did some I think it was some breath awareness meditation or some curiosity meditation. And they could just, you know, the next reading was almost normal. And, you know, they're all running around going, what? What did you just do? You know, because they wanted to give him some medications and do this and that. And really, he was he was just demonstrating in real time how much our mind can both increase our blood pressure, but also how it can help help regulate our blood pressure.

And we you know, we've even done studies, neuroimaging studies, where we look at people's brains when they're meditating and we can see there's this default mode network, this network that gets activated when we're anxious, for example, when we worry, that gets really quiet when somebody is meditating. So I have a high level, I think, of mindfulness as helping us be with our experience without reacting to it. And that reaction can often kind of make that blood pressure go up. Mm hmm. Could you give an example of maybe one practice that your patients or the person in your group might have been using in the doctor's office that someone could utilize in a really quick manner on their own?

One of my favorite practices and this is, you know, people can find it I have a YouTube channel where I walk people through it is is called the five finger breathing practice. So it's very simple where somebody is paying attention to the physical sensations of their breath and they're also tracing their fingers as their breathing says they pretty then they're tracing up their pinky as they breathe out, they're tracing them down. You get the idea. So over the course of five breaths or ten breaths, they're just tracing their fingers.

And that's a really helpful practice in helping

A Quick Breathing Practice for Anxiety 5:21

somebody ground in the present moment. Our dorsolateral prefrontal cortex, this working memory part of our brain, only has the capacity to hold about four or a few more pieces of information at one time. And so that's that's that working memory piece. And so for focusing on physical sensations on two hands, that's two things. The physical sensations of breathing, that's three things. And then looking at our hands as four things that can really kind of clear out that cachet so that our or that cash or how we say that word is so that our brain kind of reboots.

And for anybody that's taken five mindful or ten mindful breaths, they might already notice, there's a calming down to the physiology. And that's really helpful because then when they stop it, these worried thoughts come back in. They might not be the same emotional intensity or same level as the physiology, and the two needed to be about the same. Think of it on the same wavelength for them to feed off of each other. So if we're thinking, we're worried and we're feeling worried, those two are going to say, Oh, yeah, I'm worried now.

I'm feeling worried now I'm really worried. Whereas if we're feeling calm and a worry thought comes in this is where mindfulness can come in. We can notice, Oh, that's a thought, that's a worry. Thoughts, I'm not really feeling it. And so we can notice those thoughts as thoughts and let them come and go, which is really that's one of the mindfulness practices, is to just kind of note thoughts as thoughts, and that can help us not get caught up in the drama of our thinking mind. That's fantastic.

And I love also how you kind of build or explain anxiety as a habit loop. Could you just kind of walk us through what that means or what a habit loop is and how anxiety is actually a habit, because I think that might help people as well. I'd be happy to. So this is something that I never learned in medical school or residency. I'm guessing you never learned it in medical school or residency either. So I learned it from you. So when I discovered this and it wasn't that I came up with the concept, but I was struggling to help my own patients with anxiety and went back and looked at the literature.

And it turns out that back in the 1980s, a researcher named Thomas Berkovitz suggested that exactly could be driven like a habit. So any habit needs three key elements that trigger a behavior and a result. So the feeling of anxiety can trigger the mental behavior of worrying. I generally think of worrying or behaviors as, you know, like eating or scrolling on social media, something that we can see somebody do. But it turns out the mental behaviors aren't a whole lot when it comes to driving, you know, driving habits.

So worrying is a bona fide mental behavior. You know, we worry about things and that at times, or at least when this habit gets set up, can feel like it's rewarding enough because it feels like we're in control when we're worrying.

Anxiety as a Habit Loop 8:14

Or truthfully, it probably feels better to do something than not to anything when we're feeling anxious. And so that worrying gets reinforced where it says, Oh, when you feel anxious, there's the trigger. You should worry, there's the behavior. Because the result is, you know, you're you've got this feeling of control, this false sense of control, really, but that feeds back so that we learn, Oh, next time I feel anxious, I should worry some more when we get stuck in these worry anxiety habit loops that ironically just drive us to be more anxious.

They don't. It doesn't actually help. Yeah. And then you kind of get well, I think you get the trust pressures and tightness in you call it constriction and the palpitations, which obviously we definitely could see higher blood pressure and things like that. So you have an excellent book all about this. You want to share a little bit about your book and then your you have an upcoming book as well. But I want to I have another question, but can you just speak to the Anxiety loop book and all that?

Because I think that's really important. Yeah, this turned out to be such a big deal because so we had, you know, I found out about this hypothesis, my lab at Brown and before that at Yale had been doing habit change research for years. And so we had done some really good work with finding ways to help people break bad habits. Like we had a study where we had, you know, help people quit smoking at five times the rates of gold standard treatment. And then we had started doing work with eating, helping people with habitual eating, which then led to somebody asking, hey, you know, my eating is triggering me to strategy.

I'm sorry, my anxiety is leading me to stress eat. Can you, you know, create a program for anxiety? So we had we had actually developed this app called Unwinding Anxiety and started testing it in randomized controlled trials. Did a bunch of research to figure out what was going on. We're getting these huge results, like 67% reduction in clinically validated anxiety, scores in people with generalized anxiety disorder. And so that there was enough there and enough where people really haven't thought of anxiety as a habit that I wrote the Unwinding Anxiety book and ended up doing all right.

From there I went back to this eating work and, you know, my publisher was very happy with the anxiety, anxiety book and said, hey, you know, can you put can you write a book about, you know, eating? Because this is something that we really need? And I was thinking, well, lots of books written about eating, but she's like, well, nobody's really written it from the neuro biologic side. So really focused that it's called the hunger habit and the hunger habits really about helping people identify these habits around eating, whether it's overeating, stress eating, eating out of boredom, eating out of comfort, all of these things.

So where that comes from, from a neurobiological and physiologic standpoint, you know, there are a lot of things where, you know, hunger is kind of important. Help us survive. Yet somehow wires got crossed in our brains and we've learned, ironically, to eat when we're not hungry, which is an anti survival mechanism not so helpful, including I'm a big risk for, you know, obesity is a big risk for increased or increased risk for hypertension. Right.

Books, Research, and the Anxiety App 11:24

And I think many of the things that you related to or done research on is smoking. That's definitely will increase your blood pressure, the mental health side, the anxiety, the stress, the worry. And then also, of course, like you said, obesity, which can drive heart disease and hypertension and lots of other things. So any of your books, any of your groups, your websites, DrJud.com, right? Yes. D R J U D dot com Yeah, perfect. So any information there, we'll put links here as well, but really amazing stuff.

And I want you to utilize it a lot with my own patients and send them your way for sure, obviously still to this day. But I do want to speak to a maybe if we can talk a little bit also about the smoking piece of that, because I think someone who is smoking or maybe even the hunger cues, if you want to go into that a little bit more. But just really speaking to how lifestyle in how you're utilizing these practices and mindfulness and habits, how people can literally change their lifestyle. And of course, obviously that will help blood pressure.

Can we speak to that at least a little bit? I'd be happy to, yes. So there are a number of lifestyle factors that have direct impact on blood pressure. For example, smoking, you know, big the big driver of hypertension. We've approached smoking in a slightly unorthodox way, which is now a hopefully will start to become more mainstream as people see that it actually can work pretty well. And the unorthodox way is, you know, when I have a patient come into my office, they want to quit smoking. I tell them to smoke, you know.

So typically somebody's doctor doesn't tell them to smoke. But I add something to that. I said, well, you're going to you're probably go smoke anyway, right? That's why you're coming to me to try to quit smoking. So pay attention as you smoke. Pay careful attention. And what we've found so not just in my clinic, but we've even done studies on this, is that the really the best way and some would argue the only way to break a bad habit is to change the reward value of that behavior in our brain. And simply put, you know, our brains are going to keep doing things that are rewarding and they're going to stop doing things that aren't rewarding.

And so typically people start smoking in their teenage years where there's been there was enough of a reward to fit in, to Rebelde, to whatever, that they actually overcame all of their body signals that said, hey, this is you're putting toxin in here. You know, all the nausea, all that stuff. And so now they smoke as they're not paying attention to the cigarets as they smoke them. For example, I had somebody who came in who had been smoking 40 years and we calculated the number of times he had reinforced this habit loop.

It was roughly 300,000 times. While not exaggerating, it was roughly it was like in the 290 thousands because if you smoke new 20 cigarets a day for 40 years, that adds up pretty quickly. So I had him pay attention. I said, Go home, pay attention. As you smoke. And he comes back and he says, How did I not notice this? You know, these things taste like crap. And what he was highlighting was that shift in how rewarding that behavior was in his brain.

Mindfulness, Smoking, and Changing Reward Value 14:32

He hadn't noticed it. He was actually not paying attention. Most people, when they smoke, they'll pay attention to something else because cigarets don't taste very good. So we can actually leverage that really strong learning mechanism in our brain to help us change behavior without willpower. Right. This isn't about, Oh, I should stop smoking. Everybody already knows that. It's really about what am I getting from this? So asking this simple question, what am I getting from this? So we even did a study with our Eat right Now app to help people pay attention as they overeat.

So we can see that this isn't just smoking, but this applies to any habitual behavior. So as somebody over eats, we have them pay attention as they overeat. It only takes 10 to 15 times of somebody's paying attention as they overeat for that reward value to drop below zero and they start to shift that behavior. So it's not a matter of how many times we've reinforced a behavior. It could be 300,000 times. It's really a matter of remembering, one, that our brain is really adaptable. It's going to it's going to adapt quickly to changing environments and that awareness.

That's number two. That awareness helps us really see, oh, this is there's a change here. If we're not paying attention, we're just going to keep doing the old behavior habitually. But if we pay attention, we'll see. Is it rewarding? Is it not rewarding? And we describe this as becoming disenchanted with the behavior. If we're overeating, it doesn't take very long to see that. It just doesn't feel very good to overeat if we're eating crappy food. Right. This also directly applies to hypertension when when somebody is eating food, that's just not good for them.

It feels very different. The results feel very different than when they're eating healthy food. You know, and this is something I think you've really helped people see very clearly with, you know, just the benefits of eating a healthy diet, you know, especially big fan of the, you know, the whole food plant based diet because people can see real changes in their lives that they never noticed because it was such a habit to eat crappy food their entire life. And then they they shift and they say, wow, how did I not notice this?

Well, what do they need for that awareness? So that awareness is the key for all of these habits. And really else it is about curiosity. What you said is your superpower, which I've stolen that phrase multiple times, but I just want to highlight a story in my own experience as a physician regarding the smoking, because nicotine is a very difficult chemical to kind of overcome by sheer willpower to quit. But at a patient who had also smoked multiple packs a day for 40 plus years and did not change his habits, regardless of what I told him, there was no fear of anything.

It didn't matter. The cost, the fear of lung cancer, nothing. He's like, I enjoy it. I'm like, okay. So he came back one day and he had said, Dr. Marbas, I quit smoking. It's like, What did you do? Because it was nothing I did. And he said, Well, my granddaughter came up to me and said that she had learned in school that basically this is a story. So he's sitting in his chair. I get a little more drama because I'll pretend like I'm the little girl, but she came up to him and he's smoking a cigaret and she came up to him.

I think she's about eight and she was really quiet. Is like, pop up, you're going to die. And he's like, Sweetie, I'm not going to die. He's like, Yes, you are. Because I learned in school people who smoke are going to die and you smoke, that means you're going to die. And he literally said that had such an impact on her, on him having seen her cry, that he literally stopped that day and had no desire, simply in one fell swoop. For me, the rewards I thought that was such a wonderful example of what you're describing.

Can we just go back to the eating piece of that? Because when you say when people are over eating and becoming aware, where are they aware? Like, what does that look like? Just can you make that a little bit more practical? And so people can understand how maybe they can even just start using that today? It's a really good question. So this is an important shift for a lot of people. So a lot of people are stuck in their heads. They're not really paying attention to their body sensations. And so they'll say, Oh, I shouldn't overeat, or they'll go on some calorie restriction diet at work for a little while and then they regain the weight, you know, that whole yo yo dieting thing.

So the key here is really bringing that awareness into our body, our stomach, our body. It's very wise. It knows when we've eaten too much. So really bringing that into into our body and keeping in mind things like, you know, it takes about 15 minutes for our body to register satiety. So if we can not just shove a bunch of food down quickly, you know, but but you know, take our we don't have to eat extremely slowly, but just remember, it's going to it may take a few minutes to register satiety, but at the same time, we can also start paying attention.

You know, as we've eaten a little bit with each bite, we can ask ourselves, you know, is this more or less pleasurable than the last one? Because our bodies already sending our signals was saying, hey, you know, you're starting to fill up. I think of this as hitting the pleasure plateau. And so that can help us bring a curiosity to each bite and, you know, really see.

Eating Habits, Awareness, and the Raisin Exercise 19:48

Oh, am I starting to hit that hit the top here before we go over that cliff of overindulgence. So just really paying attention. Oh, do I am I for or am I close to full? Right. And then, of course, if we overeat, we can pay attention to what that feels like because that can also feed us feedback so that the next time we're eating a meal, we can remember what that was like so that we're less likely to do that in the future. So it's really about just being curious, you know, like, oh, you know, how much does my body need right now listening to our body as compared to trying to think our way through something, you know, my mantra is that our feeling body is much stronger than our thinking brain because that's really where behavior change comes from.

And it also tells us, you know, if we've had enough. So I'm assuming slowing down eating, setting down your utensil, not being distracted by screens or the phone or something. Is there a eating hygiene protocol that you might suggest for someone kind of like a sleeping protocol or sleeping hiding that might be helpful to help people engage in that mindfulness awareness practice here? I would say keep it simple. So removing distractor and I will say many of us feel most or all of us eat a lot of meals in some type of a social setting.

So just keep in mind that this can be more challenging if we're out to dinner with friends or even at the dinner table with our family so we can start practicing by, you know, when we have an opportunity to email by ourselves. And so here instead, you know, putting away the book, the television, the phone, the tablets, you know, all the things that we tend to do, you know, to distract ourselves from life, putting those away and then bringing curiosity to the dinner table with us. Right. And just getting really curious.

So a simple thing, putting down our fork between each bite and really paying attention as we chew until we swallow that next bite, we can even notice. Is there an urge to get in that bite before we finish chewing and and we're not even actually paying attention or enjoying the food that's in our mouth right now. So simple things put away that distractor and put it put down the fork or the spoon between each bite and just pay attention, you know, what's this taste like? What's this feel like in my mouth, really?

You know, if we're going to eat, we might as well pay attention to what we're eating. And ideally it might be something that's pleasant, so will enjoy it even more when we do pay attention. So keeping it simple like that. I love keeping it simple. Absolutely. And I just want to ask a few more questions of Dr. Brewer and really regarding the eating component of that, could you talk to us a little bit about what the raisin experiment is? Because I think that is really cool because it really becomes highlights different parts of the body and how to kind of connect back the mind body connection.

Can you speak to that and where it came from and how is it helpful or maybe some other exercises that you find is helpful? Sure. So the raisin exercise is this now famous or infamous practice that is typically offered on the first day of a mindfulness based stress reduction program. And I write I wrote almost an entire chapter, I think, in the hunger habit about this, because it's so iconic, so helpful, and also has so many misconceptions around it. And the idea is and it doesn't have to be a raisin, but, you know, raisins tend not to you know, you can you can keep them in a box for a while.

You can hand out a bunch of them to a bunch of people. And it's in raisins or something that almost all of us have had experience with to one degree or another. So, you know, some of us love raisin, some of us hate raisin, some of us are indifferent to raisins and most of us aren't allergic to raisins. But we can take something like a raisin and we can really. The odds start to bring what's described in mindfulness practices as this beginner's mind to the raisin. So instead of, you know, the way that we typically eat raisins, which is like by the mouthful and absentmindedly, you know, we just take one of those little boxes and just pour it into our mouth.

It's like, you know, gone, you know, we don't even notice what they tasted like. We can take a single raisin and again, we can do this with anything. But raisins are nice because they're small. We can start paying attention to what they look like and really look at them carefully. We can even notice what they sound like if we kind of roll them between our fingers and listen to that little crinkly sound, we can bring them out to our nose and really notice. What does a raisin smell like? You know, I'm remembering last time I did this, there's like an earthy tone that I hadn't really noticed.

And then we can. We can deposit them in our mouth and really pay attention to what it feels like before we even bite into it. And then as we bite into it and remember, it's like it releases all this, you know, this, you know, explosion of flavor. But after we bite into the raisin, it tends not to be, you know, until we've broken through the skin of it. And the What's our raisin exercises highlights is a couple of things. One is that, you know, we tend to eat mindlessly. We don't pay attention to our food And two that when we and it's not like we have to do this slowly.

That's one of the misconceptions is like, oh, this means I have to eat slowly all the time and this is an example of when we slow down for a moment, we can start to notice all of our conceptions around eating. So for some people that are like, I hate raisins, you know, and we can notice other thought, or for some people it's like, I love raisins for some people. And they're like, Oh, whatever, raisins, you know, I care that much. One way or the other. So we can notice all of our conceptions around these things as well.

And we can also notice that if we pay attention, you know, life is much richer even, you know, no matter what's happening, it's not like life is always going to be wonderful. But when we when we really pay attention, we start to see all the the thing that we are missing. And the raisin exercise is a great example that highlights all of it, all of the parts of life every day that we're just going through habitually. I'm kind of zombie mode. No, I think that's a great thing is can translate not only from food but to other parts of your life and things that you just ignore.

Right. I agree. That's part of living this life is paying attention now. That's fantastic. So just one more question. As far as when you're saying being curious and being mindful while you're eating, are there any other things that they can do as well? Are there support groups or other therapeutic interventions that might help people

Community Support and Recovery Resources 26:38

that you might suggest besides just the mindfulness piece to help, you know, one, engage maybe in healthier lifestyle practices or becoming aware of their mental challenges like any good resources or anything else you would suggest? It's a really good question. So most people are social creatures. And one thing that I think research is starting to highlight more and more is that loneliness is really not good for our health. So finding a community that supportive for us, you know, for some people this is church or a religious group.

For other people it's volunteering for other people, it's finding individuals that like to be out, you know, go hike like a hiking group or an exercise group or you know, there are all sorts of community activities that are out there that are available because that's what we tend to do is as humans and often we're not aware of these because we just haven't thought about it. Oh, I could, you know, I could go check out to see what's what's available in my community. On top of that, there are now online communities where people can get together and support each other.

So as an example, in our digital therapeutics, we have an online community for each of these, whether it's a smoking community eating them, a depression program that's that's now launched so people can come together and support each other in that way. And so online communities can be really helpful. And those are examples where folks can find online communities where, you know, there might be a pain point that they rally around, whether it's anxiety or overeating or whatever, where they can come together and really support each other.

And I really think that that's that's a wonderful thing. I'll mention one other example. We just started this nonprofit for addiction treatment called Mind Shift Recovery. And one of the core components of that is really training peer specialists to be, you know, help each other. You know, where somebody that has struggled with addiction, whatever their addiction is, can be trained, actually support somebody else with another addiction. I've seen this in my clinic way too much where, you know, somebody in AAA or the support group, there's like they're like, oh, got to get a sponsor and fortunately there's not a lot of training in a lot of these grassroots movements.

So sometimes sponsors are wonderful and sometimes sponsors aren't so wonderful and sometimes, you know, they cause more harm than help. So another example of providing community and support where there are people that are really drawn to give back where they've been helped. Hmm. I think that's a beautiful way to end our discussion. But again, I wanted to say thank you so much for joining us on the summit. And I'm certain people are going to truly appreciate and benefit from your resources.