Do you find yourself overeating during this stressful time? Maybe drinking or smoking more than you would like? What about shopping or gambling? And how's your relationship to your phone these days? Our guest this episode, Dr. Judson Brewer, is an addiction psychiatrist - with a special interest in how mindfulness can help. He says we all sit somewhere on the spectrum of addiction. And when you add stress into the system- in this time of pandemic, recession and racial strife- many of us move the wrong way along the spectrum, toward hardcore addiction. And of course, for people who already have full blown addictions, the current conditions can be an utter disaster. But again, Jud has good news. He's used mindfulness and meditation to treat people with addictions to cigarettes, food, and opioids. He is the Director of Research and Innovation at the Mindfulness Center at the School of Medicine at Brown University. He has written a book, called The Craving Mind, and founded three apps to help people with eating, smoking cessation, and anxiety. Before we dive in, I want to mention that we recorded this episode a few weeks ago - right before the recent protests. As you will hear, though, this conversation is still fully relevant. With that said, here we go with Jud Brewer. Where to find Jud Brewer online: Website: https://drjud.com/ Twitter: https://twitter.com/judbrewer Facebook: https://www.facebook.com/judson.brewer.9 YouTube: https://www.youtube.com/channel/UCi6bQu-Df7Wh2x3gFT5a8aw Other Resources Mentioned: Borkovec's model of GAD - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3073849/#:~:text=Borkovec's%20model%20of%20GAD%20 Mindfulness-Based Relapse Prevention for Addictive Behaviors: A Clinician's Guide - https://www.amazon.com/Mindfulness-Based-Relapse-Prevention-Addictive-Behaviors/dp/1606239872 New Research Shows Results for Smartphone Intervention for Obesity - https://osher.ucsf.edu/news/new-research-shows-results-smartphone-intervention-obesity Eat Right Now - https://goeatrightnow.com/ Craving to Quit - https://www.cravingtoquit.com/ Unwinding Anxiety - https://www.unwindinganxiety.com/ Additional Resources: Ten Percent Happier Live: https://tenpercent.com/live Coronavirus Sanity Guide: https://www.tenpercent.com/coronavirussanityguide Free App access for Frontline Workers: https://tenpercent.com/care Full Shownotes: https://www.tenpercent.com/podcast-episode/jud-brewer-258
This is an unofficial transcript meant for reference. Accuracy is not guaranteed.
For maybe see this is the ten percent happier podcast Harris. Do you find yourself overriding at all during this stressful time may be drinking or smoking more than you would like what about shopping, gambling and how's your relationship to your phone, I find myself checking compulsively are guess this week doktor judging brewer? Is an addiction psychiatry with especial interest in how mindfulness can help? He says we all it somewhere on the spectrum of addiction and when you stress into this system? In this time of pandemic recession and racial strife? Many Let us move the wrong way along the spectrum toward hard core addiction and, of course, for people who are they have full blown addictions. The current conditions can be an utter disaster, but
and judge has good news here. He has used my fulness and meditation to treat people with addiction to cigarettes. Food opium toys and more he's. The director of research and innovation at the mindfulness centre the school of medicine at Brown University has written a book called craving mind unfounded three acts to help people with eating smoking, cessation and anxiety. before we dive in. I do want to mention that we recorded this episode a few weeks ago right before the recent protests, but as You will hear this. Conversation is still fully relevant, So here we go with Jabber nice to see you thanks for do this my pleasure, so I'd like to start just to get a sense of your philosophy, as as it pertains to
Addiction, I'm I have this memory of when you are writing your book. The craving mind you briefly played with the title, were all addicted and and to decide. to get Europe. Can I really like that at all, and I thought it says this isn't a profound about human nature, so you just talk about what you meant by that yeah. I had forgotten about that. Thank you for reminding me. It's really based on what I had been learning more and more both for my own personal perspective, what I've been learning in my psychiatric training, as well as working with my patience and also even the science. The research that I've been doing, which is their addiction, seems too
Yet this for end of the spectrum of a habit formation. You know, there's there's this survival mechanism that helps it set up habits. They help us not have to remember everything from learning at a walk to talk to make our food in all that stuff. So that's actually really helpful. Yet on that, if you take that to an extreme, you know, my favorite definition of addiction is continued use despite adverse consequences, and so continued use could be a habit and helpful adverse consequences. Well that You know that says word slipped into the addiction room, so I think that title comes from this peace, where you are back in the really set up in this way- and everybody shares this right. So it's interesting
thinking about like framing this episode for people. I think most of us. I may be wrong about this, but I think most of us don't think of ourselves as as attics per say, although there are many walking around and I fed periods of addiction Many people my family suffer, and so there are tens of millions of attics and but better by probably more people don't consider themselves to be addicted, but what you are saying is: actually you need to think about addiction on spectrum? Yes, yes, I really as a spectrum. So what given? What you ve, given the foregoing, what kind of impact do you think the exaggerated stress of this pandemic is put it on all of us. No matter where we stand on this spectrum yeah. Well,
the number I think it's the number one, if not the top one of the top three predictors of relapse, is stressed. and I would include in that anxiety and and I certainly see this clinically my patient are most likely to relapse when they have had a major strasser. They ve lost a job, they ve gone through a relationship break up or even had a fight with a partner patient like that recently, who relapsed after doing really really well. So if you think of it, as you know, on a population level. We all probably have a certain amount of anxiety. and once you ve over some threshold, Their anxiety can lead to somebody in using a substance. sir relapsing or starting to learn to drink more when they hadn't been drinking MA much before so there's this buffer and that buffer has actually been done.
finished because I think the societal level of anxiety has increased its like that tied has risen, so it takes so the wave to go over there, the proverbial whatever it is, the wall that protects the town from the flood right. Oh, if stresses the number one predictor of either relapse or, as you just indicated, the sort of thing formation of a new bad habit or a new addiction. We ve just added a massive universal stress here and there four we're gonna, see people at every point in this spectrum, moving toward the more extreme end of the spectrum. Yes, yes, whether its people who have been suffering with addictions, their dixons getting worse or people who have been suffered with addictions, starting to form
it's her dixons! You know everything from things did seemingly are benign, like the you ve, probably heard of the quarantine fifteen. You know, People gain Euro gain weight because their stress eating to people not even knowing that there you know they they looked back to its later in there been drinkin several drinks every day. You know in hadn't done that before it, but that's just their new habit. It. You know because they don't know how else to deal with the stress this seems like you can have and we believe we started talking about people who went into this pandemic with profound active addictions, but just for those who were in the middle or the the far end of the spectrum away from addiction, as we most often think of it. This seems like a profound issue that is not being talked about enough. Perhaps the men
the health impact, I mean there are many mental health impacts of this pandemic, but the fact that we're gonna see people having even more complex relationships to food drinking more so looking more gambling more on line being addicted to view oh games or or tv as sorry, my employer ABC News and Disney. I love TV, it's good for you but you don't have saying this seems like a big big deal I think there are a number of things that play in here. One is you know it's hard to think of ourselves. Ass, developing problems, you know said there can be denial. I love her. You know that there are so many things dead player in here, but the EU? Some of these other aspects include where it's just a word work. We can imagine
that we would suddenly start we knew something word where we'd never had that before them articulate that a little better one thing is one of my patients who works. It is families liquor store in in Rhode Island, and he said that a liquor There is a considered, an essential business based ahead of him and his family's bit, This has never been busier. He is working has been working his tail off, because, many people are coming in as a way to to work with this, and I think I do a peace here is in a way we hear about the physical elements, so You know and there's a lot of uncertainty around the physical elements, we're learning more, but we still don't know a whole lot. You know we're getting a better sense for it, so that something where people they give me something that I can work, would give me something that's reassuring
and they learn a little bit about. You know a new symptom cluster or you knew this or that the gives comfort, but with the the mental health aspect as you're talking about. Nobody is talking about this, and I think some of this is nobody knows what to do. You know that I'm a psychiatrist, they prescribe medication you know, the gold standard treatment for anxiety is not particularly great theirs its number. It's called a number needed to treat where anti depressants or the goldsmith. entered for anxiety, you have to treat just over five people for one person to benefit from that. You know if you're playing the mental health watery. That's not, you know, that's not great odds, so I dont know if people do let's talk about it? They don't know what to talk about. Besides, I guess this is really going to suck. What do you hearing from your patience they are all saying that there are struggling, I shouldn't they all of them. I would say eighty percent of them.
saying that their struggling more than they have previously there's a subset of them, and, ironically, maybe not ironically thing a couple of them. That is actually feared be well almost to the point where there feeling guilty that their doing so well, but they ve actually incorporated some really solid mindfulness practices, kind of pre pandemic BC before Corona Virus, and I it's it's like this litmus test for their product this in any really showing him how resilient they can be. So I think it really depends on individual and white, what resilience doctors they ve developed, would you say that having a robust Michael, this practice is what separates those of your patients who are doing well from those who are not. in a nutshell. Yes, I'm not sure if there's anything else that separates them big
as a lot of them have actually struggled with drinking marred or struggling more with their anxiety and the ones that have been resilient to it have been beyond they ve been practicing mine, France, I would say: that's probably the big differentiate her and in your patient group. As I understand You treat a lot of people with anxiety and addiction both to opium alcohol, and smoking so was that it was an accurate description of your patient pool. I see patients with also of addiction. So I have a deep, an orphan clinic vitriol lot effects without produce disorder treat folks will stimulate. This disorder I'd. So I treat a whole range, I would say, Almost ninety nine percent, if not all of them, have co morbid anxiety, but the idea that if there is a better sense,
I can only imagine for those of your patients who are not doing well, which I imagine is the majority now and not because of your tree, meaning depict because because of the current situation. You're, the amazing doctor, as that was not what I meant, but for the host for those you are not doing well in this situation because it went in with real issues. They, contending with and are now living through? What we're all living through the pain must be intense. Yeah. I think the psychological pain is the intense and a lot of them are dealing with the same she's that everybody else's dealing with you know they ve got kids it that are trying to do school work from home, while they're trying to hold down their jobs eyes. So in some I patients laid off. Some of them are really struggling with just being able to time manage where there
trying to hold down a job and I've got one patient has got three kids who are all trying to do schoolwork at huh. Well, while this patients trying to work, you know it's really, it's really challenging and then on you know that increases her anxiety, which then you know just sets things off. What do you advise people in these situations there dealing with the things that all of us are dealing with a maybe the law? so the job or had a job and then having a bunch of children or having a job. and having no children so having no stress neither of those areas but worrying about the overall being locked down and lonely or whatever it is an anti above all of that and addiction yeah. So I don't have it a blanket prescription for them I approached them each individually, based on you, know what they are struggling with, but here I look see where their strengths are and what they do unable to rely on often I would for the vast majority of them. We have
I'd conversations around my fulness, if not have had them start mine from this practice, is themselves and oh here I have them- I you know I asked them what what's been helpful for you in terms of a mind from his practice. Even if it's just a short breath awareness exercise or just bring your awareness into your feet. I think of our feet is an anxiety, free zone, That's a great place to anchor our awareness, especially in times of a pandemic when it tends to factor respiratory system answer her. You know the breathing might I'd be that guide com inducing
As so simple practices, I think, are really helpful. Our research shows this and I think my patients can really access these more then you know, go, go and sit for forty five minutes or something like that were that's just not mean they can't do that with three kids in a job in it. You know, espousing all this so in a simple breathing practices and we need some of the ones that that you describe just very, very simple breath awareness practices very, very simple, oh, you know feel your feet. Are they wore mother called? Is that one warmer than the other ways to just bring in some curious awareness to anchoring of our body that that dont tend to be associated with anxiety that that's a really good place to start. and then, when somebody can kind of Ankara their awareness in the present moment, Condor Physiology, the time to help them kind of get another mind a little bit more because everybody wants than they could behind x. You know, even if it's not
I teaching them something, you know what the word mindfulness in it simply helping them bout habit. Leave surrender anxiety is really helpful for a lot of them, a kind of illuminates this black box of their mind. That was yanking them around. I think you use that before you in our Yanks us around, and it helps us kind of turn that light on, so that we can see our actually yanking ourself around, and we can stop doing it. I want to talk more about how meditation helps, but let me just add I I suspect that another thing that helps your patience and could help other people struggling in this way is simply to have somebody really smart to talk to about it to have a good, therapist, absolutely yes, unbiased summit. Yes, having somebody that can even discuss of some basic answers and help reassure people that they not alone in I'd for a couple of weeks. At the You need a pandemic. I was just holding open,
office hours online, for anybody in other, wanted to join I just so. I could answer basic questions as a psychiatrist, because that wasn't something that people had access to and what so I think, having access to somebody. they can answer some questions is, is really reassuring in itself. Do you think I mean just thinking of other people listening to this, given the nature of our health care system and given the magnitude of the addiction issues in this country, which I suspect will only get worse, our? Sadly? Are there enough therapists out there to treat people, oh I haven't done the research to know how many therapists there are based on. You know how many people need treatment, but what I do know is access to mental health care has been woefully lacking even BC before Corona virus. So I think it is safe to say that they're probably aren't enough out there to help them
everybody, I think one thing that's helping is the kind of we ve all been posted the telemedicine. I see all my patients now, virtually anything that increases. The accessibility for folks they haven't previous they ve been near you of care facilities where they might be over geographically remote or just not have transportation, or things like that. So, hopefully, that's can actually increase access where people you know her underserved in general, but it's a general. I we do not have enough mental health treatment specialists out there, especially with the the coming away. I don't want a free people out more, but it's real, I think, we're only Seymour Mental Health issues come from this as we go. so we know from the treatment of of addictions dad being in a group and working these things through, like a can, be read
Billy healing, but were now under these social. Distancing orders many of us and for some people the dixons either they camps. the people with whom they are short of co healing in a or they're just totally isolated. So what can people do and have? How dangerous is that dynamic yeah? So you touch on something really important, which is support in connection is really healing really rewarding right. It feels good to be supported. It feels good, connected with others that kid that we really feel can relate to us. So I seen with a number of my patients where they have their life has been abandoned. where they can't go to their are twelve step meetings. You know they go daily or sometimes multiple times a day. What they found is the
they're moving on mine. So a lot of these groups are forming zoom meetings or some other type of web based platform where they can connect. They can see each other I can support each other. That way, I think, there's there's nothing like being in the same room is somebody, but the next best thing is you will see each other here, each other and support each other. That way, so, fortunately, technology has helped here where even more people can access these web based platforms, because you don't have to be in a certain geographic area to be able to attend eating. So that's what I'm saying primarily is people using. This is a measure I haven't heard anybody say they like it better or more, but I have heard them say you know this is point the new normal right now and it's better than not having it. The other I've seen in. I think people should do visitor. You know really think of. This carefully make sure it's safe, though also though meat
in smaller meeting, so I'm in eroded For example, some of my patients are meeting in groups of forty five as compared to larger a groups at individuals, homes where they ve either they can kind of screen and make sure the circles are small in and taking the proper social distancing precautions as they do that so, for example, with people with social anxiety, I, where they ate their door, is one of the biggest barriers, as in walking out the door is really challenging for them. This is where a phone call or a screen based intervention can help reduce is that barrier to entry. So here they might feel more embolden. Ok, I can. I can do a phone call I can do a video chat with somebody where for the only option was walking out the door going on public transportation are getting in a car and going to therapists office. So hopefully this can help folks,
I respect the other thing I would say, as I'm seeing that people are really starting See, finally, that how stigmatize mental health is and everybody for who hates the anxiety for Asia. I dont know anybody that said man, I'm so much more chill. So here I have that people can empathize with folks who really struggle with anxiety and other mental health issues, much more because there actually feeling it themselves, and my hope is that this will help at a population level where everybody can start to relate to the folks who I struggled with this and I felt nobody can understand what I'm coming from. Why many many more people. If not, everybody can understand this more now. Would you think of of serve technological solutions like talks base and other companies that allow you to
connect to a therapist online. Sometimes we a text yeah. I we ve been play with this ourselves, but I think the text so that I'm not going to speak to the technology peace because that's I'm not an expert there just giving people access in other many ways to do that there may be some are probably better than others, but I think the ability now to connect with a therapist is tremendously health. I I was surprised by how much I actually like telemedicine in virtual medicine. You know I've only ever seen, patients in person and then I'll have to see patients through telemedicine and even through our phone, I've done much taxpayers treatment, but that that that it's actually you can connect. Of people really really well, you don't get all the queues their seeing somebody, but I think it certainly better than nothing, and especially as more and more people become comfortable with texting,
sometimes there more comfortable texting. Somebody then actually talking to them. You know here again and goes to we'd have what, where they comfortable, whether their strong suits So I know you know. I actually learn from you all with the ten percent happier app. I think you are probably some of the first, if not the first, to actually be doing text based What would you call it coaching through four meditation is fair to say, and that type of thing you know you so that sector is going through meditation, but I think the same thing applies to treatment. You ve probably found that really effective. I was really impressed with what you are doing and I've heard nothing but great things from people who have used it
So I would imagine that that could actually applied to getting a hold of a therapist are working with the therapies, especially compared to not having that absolutely. I think it's going to be much better than not having anything, and probably people are finding that it is better than they imagined when their forced to use it. As your so so, let's go back to bed occasions. I think this is worth a lot of discussion here. How is that meditation can help with addiction from a basic perspective, I think meditation really help people understand other minds, work. You know I mention earlier. I have to say one thing I didn't learn in medical school and thing. I did learning residency one thing I didn't even learn from my colleagues was their anxiety.
and actually be set up as a habit. You know- and I think you and I've talked about this a little bit before, but this idea vets anxiety can be perpetuated. Is a habit was a black box for me until it out. I was illuminated toward them. And seeing how that work. Just understanding the mind in that respect was really helpful for helping me my helping my patients were way with. This is to send me to stop me for a second. I apologize. I hated drafting people but anxiety as a habit. That's people are going to want to know what you mean by that. So can you just a thousand. You brought it up, let's, let's unpack that sir Heavy do so to form a habit. You need three core elements: a trigger a bit saviour and reward, and so I a simple way to think of this. Is this what helps to survive? You know you see food, the food and then your stomach senses dopamine signal to your brain. That tells you to remember what you ate, where you found it seem is true for a vote. endanger see this or to Tiger run away, that's the behaviour and then survival the reward.
so in the same way. Negative emotion, such as fear or anxiety, can trigger a mental behaviour right so these physical behaviors, like eating running away our survival mechanisms, our brain use the same mechanism, but it can and turns it internal. So we worry as a mental behaviour, which I really thought about is a behavior. Until I learned this, there is a guide. Bork evacuees studied this back in the eighties, and his literature had been kind of buried. I've. Never really, learn much about it, so that mental baby of worry makes us feel like worrying control or distract us from that negative feeling. Emotion such as exemplary or fear. Okay. So in that sense, worry can be perpetuated in the same way that smoking a cigarette can zahm accent, yeah so of receiving restated yeah
few routine reward, so the queue might be. see something on the news about the pandemic. Routine is start planning for home when I get through this with six pack absent my side, hustle, becoming a venture back business and rule Lord, is that anxiety, loop of plan. planning planning planning gives The feeling of I got this I'm in control, yeah, yeah and you see you fallacy and now, because worrying doesn't actually help us think our plan ended stream. obviously I taxing energetically, so maybe We had helps us sweat off some extra thoughts, but that's not the way I reckon using what they get started. Ok, so what does that have to do with meditation? So understanding the mechanism of how this works. Then we can look to see what is a targeted solution.
And meditation is the only targeted, I should say only one of the only targeted solutions that I know of that actually gets right it that core mechanism, so I think of meditation as this small circle inside a larger circle of mindfulness, so meditation can train Us mindful, but meditation isn't the only way that we learn to be mindful right. We can be mindful when we're eating Oreo cookies, for example, getting triggered ray. We can notice so levies. Cookies is an example, so one could meditate. Let's say you have an urge to eat Oreos at speaking, you could sit down meditate in wide standards come up. You could notice, it is sensations. You can notice it his thoughts and you can watch them go go by right
so you learn o this earth to eat. Orioles is just a thought: its combined with emotions and physical sensations. It comes and goes. Oh, I dont have to act on this every time I have an urge to eat and Oreo right, so there's a place where meditation can actually help us see the habit leave for what it is so the trigger, maybe a stress, their behave there is that urged the Orioles in that that urge steed Orioles then leads us to eat areas, and then we get that Briefer Lee for the distraction or the dope emanate from the sugar whatever. So we can, we can meditate on that and weakens we can move about the loop through meditation. We can also be with those urges as they come and go and watch them in a watch them failed We don't clinical studies with smoking where formal meditation practice is correlated with the likelihood that somebody's gonna quit we done stays with eating, etc. So that's that's me
attention. Even within that larger circle, we can even bring that meditation into a mindful moment right. So Bernard Orioles, and that moment you can actually pay attention as you eat that Oreo and noticed what's his taste, What's this feel like and what the result of so how rewarding is eating this Oreo or, as you ve described me previously, a sleeve of Orioles right? That was just hypothetical right. That's that doesn't actually happen in reality, I was asking for France. They offer a right, ok, so to help friend out? You could tell your friend, hey patron as you eat that sleeve of Oreo. What's the result do you wake up in the middle of the night and end with your stomach so sick, the huge actually throw up I'm just saying, hypothetically speaking, that may or may not have happened debate. So here we go bring awareness in and unjust track of that process, even the moment where we
the AU, when I need a bunch Orioles. This is the result, and we see that it's not that rewarding. We ve actually built what we call a craving all right into our eat right now up and we can study how how that we're value changes and we can get out on this if you want, but there's this whole mathematical model developed in the seventies, where you can actually our model out how rewarding behaviour is and then drops out close to zero. Laughter somebody just bringing awareness as they do this mindful eating exercise ten to twelve times so doesn't even take a lot of practice for somebody to do this so that, May I give you a sense for how meditation can actually work with this? You know when we see how these habits are formed. We can specifically, the mindful is jumps in their entire gets those mechanisms, both through formal mindfulness practice unit through meditation and also through informal mindfulness practice. So in that moment, paying attention
ok, so bunch of things to say just to build on, then I ll build to a question. First, you mentioned one of your apps, which is called eat right now, which is an app designed to help you oh, where who are struggling with their eating of you, to have an app for people struggling with smokey cessation called craving to quit. Add you have an app for people with anxiety disorders, which is called on winning good idea on winding anxieties, and you want to get that out there. I will have said that I hope in the introduction, but it's worth just doubling down on that for folks, looking for extra help and I recommend all three of those unreservedly so just to walk through this cycle. Again, it is you We may be sitting there watching tv anxiety hits and we get this urge to bite the same, watching the news or or Oh, I don't know we're surfing the web and and were somebody were reading, tweets, upsetting us for some reason and the desire to eat.
Sleeve of warriors ordered TAT. Chug a brew can arise, and you can who's that, as in the moment, meditation too, to stop and just examine. What is this urge feel like in my body right now? What does it feel like lets? You stop and look at it. It's my it's my chest. buzzing it's this kind of desire to get out of my seat. Under. That is a lot of fear or anxiety or anger, and you get to be with it, which is of our habitual reactions to strong emotions, either fight it or feed it were or deny it and in that, Inter in that moment of turning it into a meditation, you can see that the urge will arise and pass away on its own and so that
is one way to do. That is the way you teach your patients or one of the ways you teach your patients to deal with anxiety. Have I article eight it correctly the beautiful beautifully, and it's not just transitive it's enough for an urge to smoke foreigners to either the Oreo all. you know, that's the beauty of a vital that can help us with any habit formed in any urge to make something and pleasant, go away like a craving or anxiety. So you talk about informal meditation. What I just described was an informal free rein in the moment, meditation something happens and instead of just acting on the urge blindly, you turn it into a meditation I am of the view, but I wonder whether you agree here that having a formal, a consistent, formal a daily ish, formal meditation practice can up the odds that you will
be able to muster the mindfulness in the moments when you most need it. Do you support that view nice, a liberation? yes, and I would say these complement each other. So if you think we are talking about the exciting tied right, is it when its low? You need a big swell for it to go over the sea wall and inhabited hid. The town, our collective anxiety, has risen the tide, and you know the polar icecaps of a UN com, have melted in so you know that level has gone up. What formal meditation can help us do is keep those levels low. You know like that pomp that keeps were the analogy die here, but basically it helps how's that sea level drop a bit, so they were less likely. You know it takes a bigger, some something bigger to drive that wave over the wall. So that's where the formal meditation pray
This can be helpful and then the informal practices as that wave is starting to come up and go up. Can you help us right in that moment, so I think the two com, Men other really well and are our research suggests that both are helpful. You took me exactly where I wanted to go, which is I want to hear more about the research, because I suspect there may be sceptics listening either. They struggle with addiction personally, or they know somebody who struggle with addiction. You can see how ugly it is and how hard it is. How can this sitting watching your breath thing actually help yeah? It's a great question. I did my first recent study on this and the mid two thousands I they were look. I wanted to know if this stuff could actually help with hard core dixons, and I did my first study when I was a resident physician in hours it owes at Yale and in our in our substance, Bees Truman unit.
look to see if my fullest training could be as good as gold standard treatment in helping people not relapse here I was working with people with our colleague, disorder and cocaine. Yes, disorder, long story, short there is good, is gold standard treatment, and so I looked at, there was a signal there and there was a signal and then we started looking to see. Ok, what are the active elements? Can we? You know we had studied a modified version of mindfulness base, relapse prevention, so it kind of combines mindfulness training with evidence, base relapse prevention developed by Ireland, Alan Marla, so we gonna stripped out the real observation opponents and just Todd people mindfulness here we I did a study with with smoking can smoke is actually the hardest addiction to quit. We can talk about why had his later, I doesn't gets memorialize in movies. Siena like leaving LAS Vegas, isn't about
quitting smoking trains, botting, isn't about quickening worth struggling with smoking and in fact I unfortunately I'm seeing smoking our five more and more in television and movies, which is unfortunate. So I dont know if some reg, relation changed or what night, but I'm sure that doesn't help in the marble man held glorify its, you know whether its people smoking on you know homo and or other types of television shows in aid did it clarifies its. But anyway, so with me and we studied smoking cessation and found that we can get five times equal rights of gold standard treatment and with those studies we could I they look mechanistically to see them? Iphones was decoupling that art, the smoke with the action of smoking We then look to see how we could broaden their still look at other behaviors. You know we talk about addiction being on a spectrum you don't have to smoke, does
five, but you do have to eat, and so could my for our people. or with overeating stress eating. You know we noticed but what they re now up. We got a forty percent reduction in craving related eating. that was a stay led by actually Mason at you see us Recently we just finished. Do studies with young anxiety up where we found a fifty seven percent reduction in clinically value to anxiety scores in anxious physicians. and then another we have sixty three percent reduction in anxiety and people in general is anxiety, disorder. So, looking across the spectrum that continuum of continued use, despite address com you Quences, whether its smoking are eating or even that mental behaviour. My voice seems to be able to help people in a notice. The. his habit lips and then be able to ride out those does urges to act. For ten percent happier after this.
by the way was aren't you may notice it there's a slightly different audio quality right now as compared to before earlier in this interview in that's because in the middle of the interview my computer died and instead of recording, think the power for it would not run all the way into my wife's closet so now sitting outside my wife closet on the floor next to my cat Toby, as I asked these questions so that that context provided, let me get to the question: if I'm You know finding myself in a mist emitted a pandemic drinking more than I want to or we're having. Vilified, my mice old, you know college smoking habit or putting on the the covert fifteen or whatever the movies
boot up meditation practice and then apply it to whenever the urges are arising? I would say yes, and I would start that booting up with just a basic mapping of the habit loop, so one can do that mapping weather. They're doing sitting formal sitting meditation where they can notice that urge to check their phone. You notice what the behaviour is no What the result is are they can even do it in the moments whether there in a reaching for the refrigerator, handle or white, not, and I would say, that mapping peace can then help us start to learn to explore what cravings and urges actually feel like an important Lee. as part of the practice, we can also look to see you know. What's the result of the behaviour, because our brains, don't change behaviour based I'm just you know you can't think you're way out of the habit can think your way.
eleven addiction. Otherwise, I would just tell my patients: ok, stop smoking and they go home and they quit. Wouldn't it be great if it were that easy, so we can think our way, into into a better behavior, but we can hack this same learning process and our brain. So here it's all based I'm reward value, so we can people see. We know how rewarding it is to smoke a cigarette or to have that third drink verses, just one drink or to eat. six Orianas verses, one Oreo. The reward value tangibly changes in if we pay attention are bodies will actually tell us hey. That was That was enough, for that was too much. So if we really focus on the results, that's what mindfulness helps us do see that cause and effect relationship. Oh, I ate one verses. Six, the Orioles and and really notice how different that experiences that
sat reward value drop, so it opens up the door for that bigger, better offer rate and the beauty of my illness is the marvelous itself. Is that bigger, better offer? Ok pop quiz hot shot in your own experience? What feels better, a craving or being curious about that craving itself? Definitely curiosity that just to put some meat on the bone there, if I'm sitting watching you no end of the day. I am unwinding, I'm tired, do you know? Maybe a little restless been understan whining I've had it. I've had enough, eating day. As many of us do, these days and warm watch in a little Disney plus at the end of the day, shudder to Disney and I get the urge to you know like a zombie walked to the kitchen and open up a bag of pretzels. What feels better doing that? Just
automatically or actually having the wherewithal to sail What's goin on here, what's billion press paws on the show work? What does this feel like to have this urge? That that popping into the mindful awareness for me, in my experience, feels better than just doing the thing and I know you you talk about. Would you talk about? Mindfulness is a superpower? What what? How do you there's something that you talk about as being a superpower? I've heard you say the superpower of not being. By every urgent emotion that flits through your consciousness yeah. So I would think curious, in their as that as that Cape Furthest help hours, because the curiosity is what helps us not get own right, it's not some magic or some Harry Duster, some magic wave of the one anybody Bobby Boo and you're, not you know, you're not addicted. It's really
thou bringing that curiosity and in saying that it is that bigger, better offer? It feels good to be curious, but But to say you know, I've been meditating for all a little while, and there are times when I stood I'll do the thing you last night, I was really tired. I had more I've been workings, it was Sunday I've been up do early doing good morning. America was an and end of the day. My wife and I had some cookies, and I just over did it I don't actually by bit I've gotten much better it not we're doing it, I've got their village where wasn't even sugar at all, and then I decide to eat soon. Sugar and I've been able to moderate reasonably successfully, but I just you know I got it. Like a feeding frenzy began, the waters were charmed and I just ate a bunch more, not like a verdict. this map and more than I wanted to hear and didn't feel that good about it. So I guess what I'm saying is it's not
I have not found that meditation or mindfulness is some sort of panacea in the face of all of my urges in its and if we look at them mechanisms of how it works? That's not our brains, work in or Brent. You can flip your flip, a switch in the brain. This is all based on our brains, trying to survive in learning through that. So here I would say if you think back to what you did was it just last night you said what's it feel I can you bring up the feeling of what your stomach felt like her or Europe. since we're after you ate a bunch of cookies, yeah the great I felt certain belly distended self laceration heavy in their head were actually kind of like jacked up feeling from all the sugar late in the day. Yes, I didn't filled it so if you just sit with those what you just described, that you are not a thinking, but just really in your embodied experience,
Does that make you more excited to do that behaviour again or less excited less so I see that it, but that's gonna like this is what my foes about. If I kindly rub it in your face, you know You can learn even now from what you did yesterday, where you can. You can just reflect back on your behaviour and the even in the bank ancient buddhist psychology here, the Buddhist the Buddha apparently was talking to his son and he said reflect on your behavior before you do it. You can reflect on it before reflect during if you can reflect on it during reflect. After because of you reflect on sending after where'd, you can learn from it. That's what mindfulness helps to see is that cause and effect relationship? Oh, I ain't a bunch of cookies. Oh what you just described! Oh I be, I'm disenchanted, especially by, can bring that memory forward. The next time I ve been urged to over indulge right. It's not about four
Sir willpower regret it simply about learning. Oh, that didn't work so well ass time and if you do it again you can doubt it was a teacher again and say: what can we learn from you as compared to beating yourself up for having done it right and you're gonna kick in a second habit. Loop of self regulation or self judgment have often described your approach as kind of co. Opting the pleasure centres of the brain, even in not feeding the pleasure. What we think of us beating the pleasure centers of the brain by you know, snorting a bunch of cocaine or take it. You know taking out a ton of appeals or whatever it is that actually there is this, as you said, be a bigger, better offer that, if we're tune to envy unmindfulness, we can't go up the pleasure centres in the brain in ways that bring us not through grit
to the healthier behaviour. Yeah grit is takes work. If I get sweaty But here we can just simply let the process unfold, no effort necessary just simply out of kindness in a awareness and curiosity right. Oh, what did I do yesterday? Oh, what can I learned from that? But there is some work here because, as I often say in the show, the nervous with something you know. Obviously, the one of the the original translations of the ancient indian war, saw tee mindfulness, We translated that society into my on this, but what are the original meaning? That word is recollection, and so we do remember to do this thing, and that is not nothing here, and so I think I'm not a bit a scholar, city Buddha scholars can throw rotten bidders to me,
Does that me or whatever for saying this? But here I would say one way to x remembering a recollection is ok Dan recall what you did last night right. And when you recall what you did last night, how much effort does that? Take Norma but it also remembering to do that Yasser of making this a practice of because you? U one, I can recall what I did last night as just a culture, It's a beat myself with, or I can recall it as a way to say hey that to really some men, the felt sense of awfulness not again to be myself up with it, but to to hell me remember next time, I'm tempted to do it not to do it again it, but but this is a practice that really
he needs to be learned, and that is, I think, it's better than grid. Obviously I think it's better than grit, but it's not no work at all. So, let's on factors love him. Are you ready? Yes, okay, so, yes, we could try to force ourselves to develop. This is applied. This right and I'm not saying you're, saying force it buddy. I hear what you're saying in terms that it can take effort and a lot of teachers talk about taking effort so here Here I would say: is there another way to explore? This can we, you know when I think about my patient, who really I'd, are ready for change. When they ve really struggle with an addiction. It's when they ve hit rock bottom so when they really noticed how much their suffering they they don't have to force them so
ass to be motivated to seek out changed their naturally seeking it out, because that suffering motivates them to change. So here I would suggest- and let's explore this- I'm not saying this is this? Is it? But what do you think of this? If we can recall so recollect how you know our own suffer? bring from the last time we did. A behavior does died kind of engender a motivation to want to practice more as compared to thinking. Oh, I should practise more or, however else we might think of it. No question. In my experience, no question about it that a crew they create, positive feedback loops in the mind to see over and over again that it feels better to be curious and mindful about what going on internally, and
the over and over that it leads you to doing the things that feel better for your body. So I wonder, if tapping into our own suffering is a way to kind of unleash motivational energy that helps us be inspired to practice as compared to feeling like we need to crack the whip in practice. I throw that out of the question that anybody can explore themselves yet die. I actually, I agree with what you're pointing out here. I just think of my on life, as somebody is a committed meditated, probably. doing more than most people will do even once their committed just because it's a huge part of my life. It's my career now in many ways an yet. I especially now with a endemic, I'm checking the phone. My my phone addiction is worse than it used to be my
relationship to food, is gotten trickier, my relationship, the sort of numbing out, probably more than I want to with entertainment, etc Et Cetera, various of my bubbling addictions again, not hard core addictions, but the sort of run of the mill addictions have been exacerbated, and so can we can any of us really get too. I know you're, I figure say perfection isn't what's on offer here, but but when you're dealing with a hard core addiction, actually any imperfection is could be a profound relapse. It could be. Yes, I and if we re lapse, we're there, we are right and so we're gonna hold line. I carry loves, carry loves, carry labs in that actually uses our energy in a way that using it up as compared to opening to the possibility
and then remembering in what was Like last time. I realized in having that open up the energy in a way that that is motive. Sitting, but I don't know, I'm getting your question or your your bill. I think so. I think what I'm hearing from you is. I what I was going out is, I think, one. Hearing from you is we're not gonna, be perfect, we're still. owing to at times eat or drink or smoke, or so medicate, more them We want to and weak and use those core unquote failures, as learning that counts super power. Are the of our own urges going forward by I then then I started to think well for some people with hard core addictions and he falling off. The wagon could actually have much more profound.
occasions than my eating more chocolate chip cookies. Last night and I wanted to it, could and it doesn't change the circumstances for them. I, but I would say for anybody you know with a who has profound addiction, orb new cell phone addiction. I think the more we build up our resilience, factors the less likely. We are too relapse whether it's hard core addiction are accordingly, not hard core addiction. So you brought the example of of news and maybe we can explode as a tangible example that anybody can work with, especially with some like a pandemic where we don't have a lot of information. I think it's helpful for people to understand that our brains, information is like food for our brains, bright. It helps us survive and it helps us plan for the few
sorry, our minds are naturally going to seek out information. This is something that we are. We could try to force ourselves not to do it by think. It's helpful just to acknowledge. Oh I'm, looking for information, that's what my brains doing to try to help me survive so just letting ourselves giving ourselves some grace around that But then looking at the new cycle is fascinating, because you know you if you check the news and there's like a big news story that tells our brain hey news is here, go check than is so we checked the news again, no bids, I know big story, no big story and then some time later in the future, it could be late, that day or the next year. Whatever big news heads again, does that sound familiar, hence kiss he knows right, you pull the lever, you pull the waiver and then suddenly the jackpot, so I think especially and there's something brand new out there in. There are big stories that are hitting it's really important for us to see
how we are especially vulnerable to becoming more addicted to checking our news feeds are given an account, example. There was a resident physician that I was training back in two thousand. Sixteen She was just learning, mindfulness I'll shoot, whereas actually training into work with people, addictions and she fell She was starting to learn the practice and she told the story about this was in January, two thousand, sixteen. So right after the two other sixteen election, she it was one evening. She had two young kids and she woke up one evening. Her kids were sitting in the dining room table eating dinner. She was standing back from the table, checking her news feed and she woke up to the fact that she was so addicted to checking the news either so much uncertainty in January. Doesn't sixteen that she hadn't realise that she was that disconnected from her family and so that
suffering where she said. Oh, my god, what am I doing was like a big wake up call for her, where she was sitting of this little thing. That didn't seem like a big thing had progressed to the point where she was an inner. She was having dinner with her kids, and that was that really really helped her learn this is what my fullest dies. This is how I can work with it and was able to really unwind that behaviour and I use It is an example because I'm guessing that many many more, many of us are much more addicted to the news now because our brain say hey this pandemic thing. This is where we have a very uncertain future right now our brains hate uncertainty. So we can learn to work with something like that. So if we have of course go more hard core addiction, just knowing that can help us develop the resilience to work with not only
our news addiction, but some of these other things as well. Do you ever struggle with any of these things? Are you perfect? I I struggle with with always and that's why I wrote my book. I realize I chapters upon chapters of my own experience to write about and I have to say the pull for the news. I noticed that that is new stronger now than it was a b c. You know before corona virus and do you have times when you? You know further than you want with either the news or having than they do Ankara eat or whatever and and the ever find it applying your own advice is even hard for you. Then the news in particular. I notice that I am pulled to my news, feed more than I've ever been, and yes absolutely. I find that there are times when, like what am I doing,
You know that the news deeds are set up like slot machine, you scroll, you know, and then there's a little balanced. They set him up perfectly to make it see, you know, did to pull in all these tricks of the casinos, so yeah than minutiae, absolutely he has been something that I've noticed that I've over indulged in and here so I tried to also take my own advice. Words like oh, what am I getting from this instead of trying to hide its or beat my golf up over it? I bringing some some kindnesses himself compassion and say: what can we learn from this any time I can remember what it's like, though indulge in the news where it actually makes me feel kind of restless in and dissatisfied, especially because you know, There'S- there's not
a lot of new news out there right now. You know that helps me be able to step back so certainly not perfect, but it's kind of taking you doing my own training in that respect, right in and so you you may have an occasion where you go too far with the news, but then learn you use the negative or the difficult physical and psychological sensations in a way that the next time you have the urge to do the same thing you bring the last experience to mind, and maybe it goes differently for you, yeah, the buzzer last experience and the current experience. It's like. Oh I've been scrolling for five minutes. Ok, and when I can just wake up to that its much easier to let go because like an immediately drop into my direct experiencing like and then I put it away, doesn't take it. It doesn't take effort to do that when I just drop right into what it feels like right in that moment,
last question for me is when I think about, in particular, hardcore d but we can really apply to any any of the additions along the spectrum. You do you do cry bad enough in this kind of mechanistic way? That's my were probably not yours if you know Q routine reward, but I think that assumption that many of us myself included, have is that often its deep psychological stuff? That's driving a lot of this
we you know maybe had abuse and or background, or were you name it and at that too needs to be tended yes, so I'm a card carrying psychotherapist might be about, say something heretical so card carrying psychotherapist, get your rotten tomatoes ready. I here I would say I love this. There's a quote and I haven't been able to find who actually said it. It's a true debated, often I think, to Lily Tomlin, but I'm not sure that that's accurate. The deaf forgiveness is giving up huh of a better past. Have you heard that one no forgiveness is giving up hope of a better passed, so what I've seen a lot of my patients really struggle with the Y know. Why is this happening? Why am I doing this again and they think if they can go back and figure out what it was in their past, the dough magically b better or something like that, you know. Oh, are you I saw that it was because of this or that these
to minimize trauma abuse. The people have had a ton of my patients come in were trauma histories, that's what led them to addictions and the first is so. This isn't a minimize died, but is to say ok So what if you learn? What happened in your past it? What? What does that actually help you now? Can we actually focus on what is happening right now? So, instead of why is this happening? Let's focus on what is happening right now, oh because they can do something about what's happening right now there, if they're getting caught up in a habit, lived triggered by an emotional memory. Ok, will you can't fix the past? You maybe be able to give yourself a bit of grace and forgive yourself for you know, or forgive do a little bit of forgiveness around let's let let go of the hope of a better past
let's focus on what's happening right now, what's it feel like to get caught up in that urged to do something? What's it feel like to get caught up in worry? What's it feel like to get caught up in self judgment, blaming yourself, maybe for something for your role in something that happened in the past the olive add is workable in the moment, but we can't change the past so here weaken it I'd. Think of it as let's it's not about forgetting about the pastor or in a mere minimizing it, but it's about from in a given up hope of a better pass. That's where a lot of folks get stock. Ok, can we focus on what's happening right now, rather than why has this happened, or why is this happening again? That's workable! Is it possible that there are a couple of things that need to happen? That way, yes, everything that ever happens happens right now and so all of our past the issues from our past. manifesting now, and so we,
it's a learn, coping mechanisms that we can apply in the moment and It might also be useful to talk through the issues from the past so that we can stop having. Kind of rear their heads in unpredictable half I'm gonna be able to talk about this correctly, but that sometimes where We living just like half of the memory from some traumatic event, but not living it all the way through in a way that would allow us to metabolizing put in context and that that can really be a big part of talk therapy that these two tracks to be pursued. Yes,
think they can be complementary and so really depends on how we're doing this. I could there be so if it's enough, if we're being encouraged to talk about our past and then it's just re traumatized us, that's obviously not help one another or any their business is meaningful. Universe is purposely doing something like that, but if, if you know, I think good their best are there to help people you knew if, if they want to understand what happened in the past, help that not contribute and get laid down more of an emotionally charged memory in the present. So memory can consolidation from a scientific standpoint. Where the memories can actually againe emotional charge. you know we bring up a memory and then there's that emotional element, that's with it and then
Right now are like oh yeah. That was really terrible in that you know that peace adds actual emotional charge. To answer can actually make it worse. As that rigour, three consolidated we bring it up later and it happens over and over and over so here. I think it really dependent on how we're, our working with these things. You know if, before thinking not a story or bring it up in therapy in talking through it are we able to cut back in an awareness of again. My phones can be really helpful here so that we can notice these things as thought. So we can notice these things as body sensations. and noticed these things as memories. Oh, here's a memory, I'm safe. Now right is this trying to
oh me, I'm not safe, and then I get laid in a gets laid down is owed, not save, don't go there or in. If I'm, if some reason in working with good therapist, they can help them in the hold that stuff in a way the dozen actually perpetuated or potentially make it worse. So here I would say view both of these can be. They can be very complimentary. This has been incredibly interesting and really helpful. I'm u help people for a living one on one, but now you're helping a lot of people one too many. So I really appreciate a jet. Thank you. It's always find a geek out with you. Damn big thanks to judge and if you want to check out his apps, they are called eat right now craving to, it and unwinding anxiety also. He has, of course, on the ten percent happier app about two mindful eating so go check that out as well.
Before we go. I want to thank everybody who worked so hard to to produce. This shows I'm real Johns, runs point on go or sound. Designers are met boys and on your sheikh of ultraviolet, audio Maria were tell us our production coordinator. We get an enormous amount of guidance oversight and more from our Tpa colleagues, Jen Plant, they Toby been rumen and, of course, big thanks to our guys from a b c Ryan Kessler and Josh co him. What's your on Wednesday, with another episode,