Dr. Judson Brewer on How to Break the Anxiety Habit

                        

  

My guest this week is Dr. Jud Brewer, New York Times best-selling author, Addiction Psychiatrist, and pioneer in the world of getting people to change their habits and enjoy life a little more. Dr. Jud is the author of the much-needed book, Unwinding Anxiety, which uses proven and science-based techniques to help the reader break the cycle of worry and find new more productive habits.

In this episode, Dr. Jud first defines what anxiety is and how we can observe it in ourselves, he shares how he got into the creation of the mindfulness-based app also called Unwinding Anxiety, and tells us the three gears to break the anxious loop and become more curious about the world around us.

Here is our interview.

Jon: Dr. Judson Brewer, welcome to the 'Right About Now' podcast.

Dr. Jud: Thanks for having me.

Jon: So thrilled to talk to you. I love your book. It's really illuminating in so many ways. I will confess that about, I don't know, 10 years ago I was diagnosed with generalized anxiety disorder GAD, a thing that I had no idea was a real thing. I just thought it was being a Jewish New Yorker. I had no idea that I actually suffered from an affliction that was not always so healthy. It was funny, I think, in kind of cute as part of my personality when I was younger. But as I got older, really handicap me in a lot of ways and made me very, very unhappy. And so I love that you shed some much needed light on this and really how to work with it. And I will confess that I've not always had the most success in battling my anxiety, although it's gotten better over the years, thank goodness. But I'd love to first talk about your own sort of journey to discovering your own battles with anxiety. You had panic attacks, right? Even when you were in medical school.

Dr. Jud: Yes, I started getting panic attacks in residency training. And I think my anxiety traces back to when I was in college. I didn't know I was anxious. You know, my GI system was trying to let me know that I was anxious. I wouldn't go into the details. But you probably guess.

Jon: My GI system is in complete agreement with your GI system. So, yeah. So that was really kind of the way it was manifesting itself, just whatever many things. Right? Worry and the physical manifestations of it. And then what brought you to sort of wanting to, you know, devote your practice to studying it and knowing more about it?

Dr. Jud: Well, as a psychiatrist, I was very interested at the beginning of my career in addictions and habits and started to develop my lab, started researching ways to develop programs that could help people with addictions because addiction is really hard to work with. That expanded actually to habits in general, like why do we form habits? How can we break them? And working with things like smoking and overeating and stress eating and things like that. And as we were developing digital therapeutics, which is just a fancy term for apps based treatments and studying them, it is interesting. We were getting like in the first study, we studied mindfulness training.

First study, we got five times the quit [] of gold, standard treatment for smoking. And then we developed this eating app called [] Right now, where we got a 40 percent reduction in craving related eating. And somebody in that program said, hey, you know, I'm mapping out my habit loops around eating and they're triggered by anxiety. Can you develop an anxiety program? And I was thinking, well, I'm a psychiatrist. I prescribe medications for anxiety, but it put a bug in my ear and made me think about, well, how well do these medications work? And in fact, their numbers. There's this thing called number needed to treat like how many patients you need to give a treatment to before one person benefits. For anxiety, best medications out there. That number needed to treat is 5.2, meaning, you know, I've got to treat five patients before one of them shows a significant reduction.

So, I started reflecting on this and I started realizing, you know, I'm getting anxious about how to treat my anxiety patients because I don't know which one of them is going to win my medication lottery. And so I started looking into the literature. And it turns out, you know, there was back in the 80s, people were talking about anxiety being driven in the same habitual manner, other behaviors, other habits. And this light bulb went off on my head because I said I never thought about anxiety this way. And, oh, I know how to help people with habits.

So, yeah. Long story short, we developed some app based mindfulness training program, a program called Unwinding Anxiety, also the same name as the book, and started studying it because I wanted to see if this could actually be true, to see if we could actually target anxiety as a habit. And a couple of studies later, like 57 percent reduction in anxiety and anxious physicians and a rate for this 67 percent reduction in anxiety in people with generalized anxiety disorder. And we can calculate, yeah, that number needed to treat 1.6.

Jon: Wow. That's amazing. And that's really the revolutionary finding of your work is that, you know, anxiety is a habit. Anxiety can become an addiction, just like smoking, just like overeating, all these different things. And I don't know if before you came along, a lot of people thought about it that way. But it certainly is very clear the way you define it. And again, it's sometimes when you know that it's half the battle, just knowing that I might be habitually. You know, I might be addicted to this this kind of thought loops that I have over and over again. I think it would be probably useful for before we even get into the way these habits is to sort of define what anxiety is because it's a fairly simple definition. Right?

And it's interesting is the word anxiety. I feel like it's been around forever, but I feel like that's the word everybody's using now. Like when I was growing up, it was like worry or you're neurotic, you know. And I know these are different things. And I guess worry is a symptom of anxiety. But what is anxiety?

Dr. Jud: Well, I think the standard definition is it's a feeling of nervousness or worry or unease or something, you know, about an imminent event or something with an uncertain outcome.

Jon: Yeah, the uncertain outcome is the key.

Dr. Jud: Yeah. Yeah, absolutely.

Jon: It's the ambiguity that makes people anxious.

Dr. Jud: Oh, yeah. Our brains hate ambiguity. They hate uncertainty. Yeah.

Jon: Right. And so you do all these things to try to control the fact that you can't control what you don't know. Right?

Dr. Jud: And even if it gives us the illusion of control, it feels better. In fact, that's how anxiety is typically driven as a habit. So, you know, any habit is formed through three basic elements that trigger a behavior and a reward from a brain standpoint. So from a survival standpoint, helped our ancient ancestors find food. You know, you see the food, you eat the food, and then your stomach sends this [] signal to your brain that says, remember what you ate and where you found it. So, our ancestors didn't have a refrigerator. So we all know where the refrigerator is, but they had to go find food. Anxiety is really interesting in the sense anxiety that feeling of worry can be a trigger for the mental behavior of worrying. And that worrying gives us this illusion of control.

It feels like, well, maybe I can control this or maybe I can keep my family members safe or maybe I can come up with a solution. But it's all that illusion because worry doesn't actually makes our brain, you know, our thinking parts of our brain go offline. We can't think and plan when we're worried, but it just gives us something to do. And so it's like, you know, our kids out the first time they're driving alone in the car, you know, and they get their driver's license and we worry our head off. Well that worrying is not going to keep our kids safe. But at least it makes us feel like we're doing something and so there is this rewarding aspects to it, which then feeds back. The next time we're anxious, we worry again. And then it starts to form this vicious cycle.

Jon: There's a familiarity also of that feeling, of that worry that is very I guess we think is soothing, right. Like, oh, this is the feeling that I'm used to having. So this is the feeling that I've had in the past when I've had these anxious feelings. And so I'm going to worry because that's what I'm used to doing. And this is a familiarity. Again, it's like you're trying to control the ambiguity, the uncertainty of an event by giving your brain something that's familiar and not answered.

Dr. Jud Yeah, yeah. It's like, well, you can think of it as our comfort zone. We're in our comfort zone because it's so funny to think of worry as our comfort zone.

Jon: That's a horrible feeling. But yeah.

Dr. Jud: A lot of people are comfortable worrying a lot.

Jon: Yeah. Hello. You've just named me. So this idea of a habit that we form these habit loops around worry and anxiety because of the reasons you said, first of all, it's in our you know, it's been around since caveman times. And in some of those it was a necessity to have worry, you know, otherwise you would be eaten by a large saber tooth tiger, whatever was around during those times. But eventually, you know, we've taken these kind of things that our brain has been wired to do and we've made them into habits that are unnecessary for our survival. Right? Is that my understanding that we've kind of like taken the original response, this original trigger behavior reward. We've taken that and kind of gone into a not always such a great places with it, with different addictions that we fall into. So what are habits? Why do we form habits? Why does the brain form habits?

Dr. Jud: Well, you can think of it as an efficiency mechanism in one sense. So you imagine having to relearn everything that we do every day. You know, walking, you get out of bed, you have to relearn how to walk. You have to relearn how to put on your clothes. You have to relearn how to make breakfast. You know, we'd all be exhausted before even making coffee because we'd have to relearn how to do that as well. So habits are formed as a way to help us learn things and then forget about the details. I think of it as a set and forget. Set the habit and forget about the details and so we can learn. But it also keeps our brain and gives our brain the the extra energy to be able to learn new things. So most habits, I would say 95, I'm making this up but 95, 99 percent of our habits are actually really helpful for us.

Jon: Yeah. Right. Like what's a good habit? A good habit would be to I don't know. What's a good habit? Because we always think of habits. Habits have a bad rep.

Dr. Jud: I know, how about? So imagine this, I don't know if you've seen a kid like an infant learning how to eat and they take the spoon and what percentage of time does it actually make it in their mouth?

Jon: Right. I take pictures of my kids with the food all over their face. Yeah.

Dr. Jud: Yeah, yeah. So eating, just being able to get a utensil in our mouth is a good habit. Tying our shoes, remembering how to speak.

Jon: Right. But it's the 10 percent of the habits that you know, such as anxiety, such as smoking, you know, being an alcoholic that are not good for us. So we're using the same sort of neural pathways to create these habits. But they're not actually benefiting us. But we think they are in some way. Otherwise they wouldn't be habits. But that's the tricky thing. So let's first talk about your book is broken down to three years. Right? And it's sort of like you approach it three ways. First gear, you said, it's just mapping out. You've talked a little bit about this already, but sort of mapping out the habit loops like becoming. Because once you become aware of habits, then you can sort of attack them more head on. And so talk to me a little bit about how one maps out. I know your app and your website offers ways to do this, but why is it important to map out a habit?

Dr. Jud Yeah, somebody the analogy that comes up is somebody says, hey, can you go deal with that thing in that room over there? And we open the door and the room is completely dark and we have no idea what we're dealing with. Hard to do it. So it's helpful if you feel around and flip on the light switch and you're like, oh.

Jon: Yeah.

Dr. Jud: There's a thing. Whatever it is, it's a mouse, it's a spider, it's a whatever. So the idea is if we don't know how our minds work, how can we possibly work with them? So we've got to flip that light switch on that illuminates how our minds work. And from an anxiety perspective, I find it really helpful from a clinical perspective to help my patients map out their habit loops around the anxiety and it really doesn't take very long to do. You know, anybody can do this. We even put out a free habit map or based on what I've been doing in my clinic, because it just seems so helpful. You put this in the show notes or whatever, but it's just the websites mapmyhabit.com. And the idea is this PDF that somebody can download. And the idea is that as they go throughout their day, there's a piece of paper that they can bring with them to reflect on at the end of the day and see, OK, what's my habitual behavior? Start their.

Worry, for example, we've already talked about that. We can map that back to what's the trigger? What triggered it. Was it a thought? Was it a something, an interaction with somebody, whatever. And we can fill that in and then we can trace it forward and see what's the result of worrying and then basically map those pieces out just so that we can start to gain familiarity with how our minds work and how these habits are at play all throughout the day.

Jon: Right. But sometimes these habits seem to work for us. I think a lot of people convince themselves that if I didn't have anxiety and worry, I would never get anything done. I would never be creative. A lot of creative people think that they need to be worried. That like their creativity comes out of that feeling of uncertainty. And I think they're the ones that become addicted to that, but also that it becomes a self-fulfilling prophecy because sometimes your worry comes true and then you're like, see, I was right to be worried about it. Because, you know, like right now I'm worried I have to book all these guests for a show that I'm doing on Thursday.

And right now, I haven't heard back from one of them. And I know the show is happening. All these people are showing up on Thursday and I'm super worried about it. And I feel like my habit, you know, is that I have to be worried about this. I have to get these guests on the show. And as soon as I get off the phone with you, I've got to get everybody on the phone and, you know, figure this all out. And I know it's not a good way of dealing with this because it's making me anxious. My blood pressure goes up. That's a good example of, like, I don't know, another way to approach that kind of high pressure situation in a way that is. You know, I'm in such a habit loop of just getting worried about it and making it happen. And then, you know, having hopefully the result, the reward be that the show goes on and everybody is booked and, you know, that kind of thing, you know what I mean? So I'm addicted to that. I'm addicted to that cycle. That would be one of my loops, I guess.

Dr. Jud: Yeah. My [] used to call this. He'd say to me when I was doing experiments, are you sure that that has a causal connection? Meaning he would say, is it true, true and unrelated or is it causally connected? So, for example, when you worry that's true. When you get your guests booked for your show. That's true. Your brain, all of our brains love to make these causal inferences where it's like, oh, I was worried and I got my guest book. So therefore the worry got them booked. So you'd have to clone yourself and do the parallel experiments where you were worried in one scenario and then you were calm and another and you check this if you actually got all of your your folks booked, my guess is that you're going to book them whether you're worried or not, you're still going to get that behavior done.

Jon: Worry, right.

Dr. Jud: Yeah. So that suggests that it's just correlated. And correlation does not equal causation as in the worry doesn't doesn't make it happen. Yeah. For a lot of folks taking that leap to saying, well, let me just try this when I'm chill.

It can be anxiety provoking itself. It's like, oh, because our brains like to do things that they're used to doing. So we're in this familiarity, we're in this comfort zone. We're in this habit loop of worrying. And it just feels uncomfortable to step out of it. You know, I've had patience. I had a guy I wrote about him in my book who had been anxious for 30 years, over 30 years, and after working together and him employing some of these practices, he was actually having worry free moments for long enough periods of time that he's like, wow, this is weird. And he was starting to worry that he wasn't worried.

Jon: Well, that I know that's happened to me. I'm like, I have to be worrying about. I wake up and I feel kind of calm and I'll be like, there's got to be something I should be worrying about today because I'm [laughter] worrying. Right? I mean, it seems ridiculous and funny and probably why a lot of comedians suffer from anxiety, because it's kind of like a funny. Of course, it's not that funny when you're in the middle of it and it feels so uncomfortable and you realize it's really not benefiting anybody. You know, people around you makes them uncomfortable. It makes you uncomfortable. I mean, the whole thing is just. So yeah. You worry about not worrying. It's incredible.

Dr. Jud: Yeah. Yeah.

Jon: But sometimes. So the loop is the trigger. What triggered behavior? The behavior, the actual behavior and then the reward. Sometimes the reward is jumping ahead a little bit because we're talking about a year or two in a second. But sometimes the reward is pleasant. For example, worry is not a good example. But let's say you were addicted to sugar. And as I am sort of somewhat and you're avoiding eating sugar, you know it's not good for, you know, but the trigger comes, you know, there's a cookie in front of you. It's late in the day. Your willpower is just you just eat it. So that's the behavior. And the reward is, God damn, does that cookie taste good? Right.

So, you know, I think the idea is and maybe I'm jumping in here, but we'll go to the gear two, which is once you've mapped out your loops, you start becoming more aware of your experiences of worry. Right. And you shift your brain's relationship to the experience of whatever it is your habit is. So that you become more mindful of what you're actually doing. And as a result, you realize this behavior isn't so pleasant anyway. Right. Like this behavior is actually not benefiting me in any way. But you have to bring your awareness to that. Otherwise it would just happened. Right. So that's kind of gear two. As far as I know. And then we'll get back to my question about what do you do with the sugary cookie? But what is second gear? And once you become aware of your habit loops and you've mapped them out and then what is second gear?

Dr. Jud: Yeah. So, this is where it gets into a little bit of neuroscience. So there's a part of the brain called the frontal cortex that kind of stores and has this hierarchy of reward value for different behaviors. And this goes back to efficiency and decision making. So it helps us if given a choice between two things, it helps us pick the one that's more rewarding. So for a classic example, would be a cookie, let's say, because you use that example versus broccoli. We're given a choice between the two late in the afternoon. Which one are you going to pick?

Jon: Right. Well, I mean, I'm always going to choose the cookie. Maybe there's one person listening to this that will choose the broccoli and those people. God bless them. What a wonderful gift.

Dr. Jud: Yeah. Yeah. So from a survival standpoint, that's our survival brain saying, dude, that cookie is packed with way more calories than that broccoli that's going to help you survive. You know, like in case there's a famine, you better eat that cookie. So our brain is set up for survival in that way. Yet the key is updating the reward value in our brain based on current situation. So, for example, if we have a refrigerator that's going to be stocked and we have reasonable certainty that there's not going to be a famine in the next couple of years, we can really focus on, you know, how rewarding is this from a health perspective, not thinking about it, but really feeling into it.

So, for example, my lab did a study with our E Right Now app where we specifically had people pay attention as they overate. And the reason for that is that the only way you're going to change your behavior is by updating the reward value. And the only way to update the reward value is by paying attention right now to how rewarding something is. Right. So often we lay down the reward value of chocolate cake or cookies when we're kids. We associate with birthday parties. All this fun and all this, and so we've got basically this reward value that's been set up and it's late, it's like cookies are good, but if we don't look at the context, we can't just have an all cookie diet. Right. Like, I'm just going to eat cookies for breakfast, lunch and dinner. It doesn't work that way because, in fact, our body lets us know, hey, this isn't actually that healthy for us and it lets us know in the way that we have a stomach ache. We can't sleep well. We get a sugar. For me I get a sugar rush and crash, and then I just crave more cookies, you know?

So it's really about updating that reward value and bringing awareness in as we do a behavior to change that reward value. I'll give you a simple example and then let's go to your cookie example. So we've done studies with people that want to quit smoking. As I mentioned, we've got five times the quit rates of gold standard treatment and helping people quit smoking. The way we did that was by having people pay attention as they smoked cigarettes. And in fact, we can study their mathematical formulas for this. We can watch the reward value change as people pay attention, because when they smoke a cigarette, people, they're like, wow, this actually doesn't taste very good. Wow. The smoke doesn't smell very good. Well, that cough just doesn't feel very good. I've never had a patient come in and say, Doc, thank you. I never realized how good a cigarette tastes. You know, this is fantastic.

Jon: That's a cigarette. Yeah, I get it. And I'm not a smoker, but I can imagine. But I'd like, you know, when I have I'm not an alcoholic either, thank goodness. But if I drink a cocktail, I'll be like, wow, that is good. I mean, I guess if I really linger, I've never really lingered on the entire experience of drinking a cocktail. Let's say maybe eventually I'm like I'm starting not to feel that. I don't know. I guess is the idea that these things that are habits, eventually you'll start to realize they're not as pleasant as you thought they were or you think they're?

Dr. Jud: Well, yeah. So you're pointing. So cigarettes, for example, are pretty straightforward because there's nothing pleasant about the taste of dismantling the burning. One thing [cross talk]. Yeah. So let's use a cookie as an example. I think of it as a pleasure plateau. And so it's not like when we pay attention a cookie is not going to taste good. Like you're pointing out, when you really pay attention, you might be good. Wow, that is a good cookie. I need to bake that one again or I need to get that one again. But when we eat the second cookie, we can ask ourselves, was this as rewarding, more rewarding or less rewarding than the first? And then we eat the third and then we eat the fourth.

And there's a thing everybody has a pleasure plateau. And now it's going to be dependent on how hungry they are, how much they like those cookies, etc. But they're all you can't just keep eating cookies indefinitely. Our stomach and our body is going to let us know, hey, you've gone. You got on that other edge. You've gone off the cliff. Well now this is really unsatisfying. So what do I have? People do is pay attention as they eat and ask basically this question, how little is enough? Like where do you maximize that pleasure but stop before you're overeating. And in fact, most people, when they really pay attention to that they stop eating much earlier than they typically would when they would just mindlessly eat the whole cookie, for example.

Jon: So when you're breaking a habit, do you have to go cold? You don't have to necessarily go cold turkey to use a drinking metaphor, because like you're saying like you might be allowed to have one cookie. Right. But then you should be aware of how does that unless that one cookie makes you feel really sick and maybe eventually you get to a point where even one cookie starts to not be appealing to you anymore. I don't know. I've heard that from people who sort of quit sugar and they look at a cookie or a piece of cake and it almost looks fake to them, like it doesn't even look like a real piece of food. [Yeah]. It becomes so unappetizing to them. But do you have to go cold turkey? I mean, first of all, I should never get where I have to worry. It's part of survival. But yeah. Tell me a little bit about that.

Dr. Jud: Yeah. So here this gets us a little bit in a third gear territory, but we'll talk about it now. So our brain is always looking for something that's more rewarding. I think of it as that bigger, better offer and so it can be helpful to compare behaviors or foods to other foods. So for example, I'll give you a personal example. I used to be addicted to eating gummy worms. I'd eat the whole bag. Right. And it was kind of like they couldn't be in the house. But I knew if I ate the whole bag, at least they wouldn't be in the house anymore.

Dr. Jud: But then I started comparing them to eating blueberries. Don't ask me why I picked that, but it happened to be blueberries at the time. So I eat gummy worm, eat blueberry. I realized, relatively speaking, gummy worms kind of have this sickly sweet, almost like petroleum product taste. [Yeah]. They were just unnaturally sweet and had this nasty aftertaste. When I ate a blueberry. Oh, man, for me, blueberries are delicious. Currently cherries are in season and I just had some cherries before we got in this conversation, they were delicious, right. But there's something about blueberries and cherries where I don't have to eat the whole bowl.

There's something, you know, maybe it's the fiber in them. Maybe it's just the natural sweetness that isn't overly sweet that gets me to crave more. It just is more rewarding. Overall, they taste great. I don't get a sugar rush and crash and I don't suddenly start craving them like I have to get them out of my house. It's different. So the rewarding quality is actually better in my body. Thanks me over and over like, oh, this is a good thing, you know, I feel better.

Jon: So is that like replacing one habit for another? Like a healthy habit for a non healthy habit? So eating a lot of blueberries, unless you're on the keto diet, which apparently even eating a lot of blueberries on keto is like off limits. I was just reading about this recently, like it's nature's candy, you know, which is like, can you let me have something sweet, you know, like my body wants something sweet. But anyway, so is the idea to replace maybe a healthy habit, an unhealthy habit with a healthy habit?

Dr. Jud: Yes and no. OK, so we can for example, we can over consume just about anything. So I think the key really is bringing awareness in so that we can see, for example, blueberries, they taste better. But if we are stressed out, for example, we eat candy when we're stressed, we say, well, I'm going to replace eating candy with eating blueberries when I'm stressed, we might mindlessly eat those blueberries just like we mindlessly eat the candy and we're still stuck in the same habit loop. So really, it's about learning to step out of the habit loop. Certainly that often encompasses stepping into healthier habits. But it's not just doing it mindlessly where we're just literally replacing one habit or another. We're still stuck in the habit loop in those moments.

Jon: So, OK, given that example worry, I'm going to come back to worry again, since that's one of my habits. I mean, so is the cookie. But we'll talk about worry. I'm trying to think of if you were working with somebody like me. A little free therapy here. Thank you. What would you replace maybe the feeling of worry with? Because again, it's so familiar to me and blueberries is such a tangible thing, a blueberry versus a cookie, gummy worm. But what's the replacement for worry? Like I'm excited that I have a ton of work to do today and I'm got to book all these [] like, yeah, you know, it's not that bad. I know it's not, but maybe it is.

Dr. Jud: So one thing that my lab has looked at and is also actually related to this mindfulness training that we've been studying is this attitude of curiosity. So let me ask you, which one feels better worrying or being curious?

Jon: No, I'd much rather be curious. Right. Yeah, right. So curiosity is a good one.

Dr. Jud: Yeah. So I think of curiosity kind of as a superpower. And in fact, in moments when we're worried, we can get curious or moments when we're anxious, we can get curious like, oh, what is this anxiety feel like in my body instead of oh no, I'm anxious again. You know, that attitude can literally flip it from oh no. To oh, what does this feel like? Right.

Jon: So I ask myself, what does this feel like? And I'm like, this feels pretty crappy, right? Because nobody likes that feeling of worrying. But then of course there's going to be a little voice in the back of my head that's going to be like, yeah, but you've got to get this shit done anyway. It's nice to sort of sit there and be mindful in a kind of meditative state and reflecting on it. But if things got to get done but I have to figure out another way to get it done without worrying about getting it done, I guess.

Dr. Jud: Yeah. So you can look at the worry and the getting it done probably as orthogonal. Right. You can worry and get it done or you can not worry and get it done. So they get it done is actually not directly causally connected to the work. So the voice in the back of your head is probably right on. Just got to get this done. You can explore even and take a moment. Right? And say, OK, I'm worrying. Can I just take a moment? You know ground myself, calm down and then see how much more efficiently or how much better it feels to be getting this task done when I'm not worrying versus when I'm worrying.

So you could even just compare. OK, I'm going to worry while I do this task. Let me see if I can just calm down a little bit and not worry when I do this task and compare the two and see which one is that bigger, better offer.

Jon: So that brings us to third gear for [] out there to review, first gear is mapping, second gear is paying attention, and I'm simplifying this tremendously. You have to buy the book. That's really, really good. And the third gear is the practice, like a continual practice of mindfulness and kind of being always like, what is the third? What is third gear?

Dr. Jud: So overall, I think of it as finding that bigger, better offer. But as you pointed out earlier, it's not just substituting one have it for another. It's about finding behaviors or attitudes that help us move from a contracted quality of experience or for example, anxiety feels contracted and craving for a cookie feels contracted, self judgment feels contracted. So are there categories of things that help us move from contraction to expansion? Because you can't be contracted and expanded at the same time. And what I mean by that, literally, we feel contracted. We can feel more open as compared to feeling closed. So I think of the two flavors or the two general categories of curiosity as we talked about, curiosity helps us open up and kindness helps us open up. So, for example, if we're judging ourselves, if we're in a habit loop of self judgment, we can compare that to what's it like when we give ourselves a break? Which one feels better? Right. Kindness tends to feel better. It also feels more open. And all of these even give us the bonus of putting us in more of a growth mindset. So instead of kind of being in a fixed mindset, we're like, oh, this is terrible and this is the way it's always going to be and I'm never going to change. And all that stuff which feels very close down, we can oh no, this is happening. We go, oh, this is happening. We can open to what's happening and see. OK, well, this might be a little uncomfortable right now, but what can I learn in the process? How can I grow? This is where Carol Dweck, who talked about growth mindset versus fixed mindset. And I think we can really apply that pragmatically by bringing in curiosity and kindness and both of those being that third gear or those bigger, better offers.

Jon: Now, one could read your book and get all these answers, but to make it a regular practice in their lives, what would you recommend? I mean, if people can afford it, should people have regular therapy? Like, does it help to check in with somebody once a week or whatever every two weeks? You know, not everybody can afford therapy, but let's say you could. Is that what you would recommend? It certainly is certain. We also want to recommend people get your app, and that's important. And not to be like sort of mercenary, but that you know, your app actually has a lot of these. It takes you through a lot of this process, right?

Dr. Jud: Yeah, it does. And again, not to try to say, hey, buy my book, buy my app. [Yeah]. As a therapist myself, for some people therapy can be helpful, and especially if the therapist is good. I mean, that probably goes without saying. But there's a range of quality of all professions. It's not just therapists. [Exactly]. All lawyers are good. You know, you've got to find [cross talk] are good. So if somebody is inclined to therapy and they've got a therapist, that is good. And I would say especially if the therapist is oriented toward helping people understand how their mind works, because sometimes their therapy can become this codependent relationship. Somebody goes into a therapist's office and they want to talk and the therapist is like, oh, I'm getting paid to listen. You know, then it feels good to talk and hear, especially these days where it seems like nobody's listening because we've got this attention economy. Some is like, wow, somebody is actually listening to me. And the therapist is like, wow, somebody is actually paying me to listen.

Jon: Yeah. I can see how that could become a habit that just keeps going. That process of just going and dumping your stuff and having for both people. But, you know, talking about the patient first, just, you know, that's like that's the work, just going and dumping my problems on this person and feeling a little bit better for it's like when I go to a chiropractor, no offense to chiropractors, I like it, but I feel really good like the first day afterwards. But it doesn't kind of goes back to not feeling so great the next day. Right, unless I get my training. And so I feel like it's the same with a therapist like you could keep going back. And I know that feeling as I've experienced. You come out, you walk out of therapist's office and you feel really great, but it doesn't last.

Dr. Jud: Absolutely. Yeah, yeah. So this is where therapists are oriented toward helping people truly gain insight. And it's not just, oh, what happened in my childhood that caused this? Knowing about our childhood can be helpful, but it generally isn't what changes habits.

Jon: Maybe an expiration date on your therapy.

Dr. Jud: Yeah. Yeah. And if there's ideally if therapies are really good, they're going to be helping somebody to the point where they're not going to need their therapist anymore, right? And the better the therapist is, often the shorter the length of therapy because somebody gained the insight and they had actualized it and they've internalized their therapist and they're good to go. So long story short, therapy can be helpful. It depends on the therapist, depends on the person. And I would say it also it's really important for people to be looking for pragmatic progress. Are they truly making progress? Are they not only gaining insight in that session, but as you're pointing out? Are they taking that into their everyday life as compared to saying, wow, that felt good and then they come back next week and something felt good? I don't remember what it was. Let's do that right.

Jon: Right. You have to do the practice. It is a practice. It's really like it's been explained to me, like it's like training your muscles. You know, you're going to get the first time and it might be sore the first time. You got to keep doing it until your brain starts remembering what you're doing and takes it in the right direction. All right. Let's talk about your app for a minute, though, and the different resources that you offer people. So aside from buying your book, which, again, I recommend really highly, what can they do and what will they discover when they do this?

Dr. Jud: Well, we developed this app as kind of like, you know, it dawned on me that my patients don't learn to smoke in my office. They don't learn to [] my office. Hopefully they don't learn to worry in my office. And so our brains are set up to learn things in a particular context. So we're actually pulling them out of context, trying to get them to learn something and then putting them back in context. The ideal would be to have their kind of therapist in their pocket where they can actually learn skills and learn how their minds work in context. So this is where we started this over about ten years ago now.

Way before Digital Therapeutics that term was coined in 2017, the idea of delivering a treatment through an app. Yeah, but we started testing this idea where we could just take a manualized evidence based treatment, cut it into bite size pieces, give people, say, ten minutes of training a day where they learn a concept. But importantly, we say, OK, you learn, you listen, you watch the app in the morning, videos, it's animations. It's ways to learn. And then we say, OK, now take this into your everyday life, because the only way to form a new habit or breaking old habit is [] moments many times like as you see something, you've got to work with it many times throughout the day. That's how you form a new habit.

So we created this program to help people. It's like progressive training, 30 core modules in our unwinding anxiety app. I think it's twenty eight core modules in our E right now app. And the idea is somebody is progressively getting mind training. They understanding how their mind works and then they're learning how to start working with their mind. So they get these core modules. They also get in the moment exercises. So with the on running anxiety app they've got, if they're anxious, we've got some tools that they can go to right in that moment to help them ground. We've got some checking exercises that help them kind of learn or remember to take a moment to. It might sound cliché, but take a moment to be mindful throughout the day.

What that does is it starts helping them form the habit of being mindful and then importantly, seeing how rewarding it feels when they are starting to instill and actually that attitude of curiosity as compared to worry. So that's the nuts and bolts. We have an online community. We've got some other bells and whistles that can help people. We've got a weekly group that I run through Zoom that anybody in any of the apps can join just so that people can access an expert and ask questions. But the core of the training is really this 10 minutes a day of learning how your mind works.

Jon: If people want an actual human expert and again, can afford to have a private session to do you guys offer that opportunity? Like you put people in touch with people, real people?

Dr. Jud: We are training some facilitators to be able to coach people. I'm only licensed to practice medicine in Rhode Island, for example. So it's not a large state. So people have to come to my office to do that. But that's why we're training people to be able to coach folks through this. If they want that extra help.

Jon: I would be it because I'm out here in L.A. and unfortunately not in Rhode Island. So that would be something that I'd be super interested in personally. We'll talk. So you wrote this book. Did you write this book on your own? Did you have some help with a ghostwriter or anything? Did you do it all on your own? It's really well written. I'm wondering you. It's not easy to write a book. How did you do it?

Dr. Jud: Oh, well, thank you. I read it myself. Yeah I've never really you know, in my first book I had engaged an editor and let's just say it didn't work out so, well. It just seemed like it was much easier just to try to work with my own voice, and I have to say it's the writing process with a lot of trial and error. After I wrote this book, I actually worked with an excellent editor who basically did more coaching than editing because I was trying to get this balance between trying to bring some levity to the writing and then also really approach a serious topic seriously. And I'd been impressed with the way that some people have been able to bring levity into their books. And so he would basically ask me questions like, what are you trying to say with this? Or OK, you took this a little far. Can you rephrase this? That way. And in that sense, I actually learned I felt like I got great coaching in learning how to find that voice, to be able to write in a way that was hopefully accessible, hopefully engaging enough for people to want to read the whole book, et cetera.

But I have to say, it's been a wonderful journey just to learn how to write, because I really don't consider myself a writer. [Yeah], but I do. I'm a scientist. I'm a psychiatrist. I love to try to express complex scientific concepts in a way that everybody can understand. I feel like that's a responsibility of scientists to be able to do that. And for me, when I'm thinking, well, metaphors come up and images come up more, this is why this gear's analogy, I use that throughout the book. And so that's also a very rewarding process just to like get in that zone of like, well, what am I really trying to say and see what metaphors come up and then try to get those down on paper.

Jon: That's interesting because it seems like you almost went through your own habit loop initially doing it of like maybe you trigger behavior reward and then you adjusted it as you were writing it, like you said, with your coach editor, to find the reward being that it's in your own voice and it feels honest and true to you and to what you're saying. I think a lot of writers fall into []. And I'm sure you worked with a lot of writers in your practice, but they fall into this imposter syndrome where they're sort of don't feel like. They don't know who they're writing for. And they're kind of like they're not writing for themselves or writing for somebody else. And they don't know who that person is and those people are. And I feel like that becomes a kind of a loop in a way for them of not procrastinating. And a lot of things. It seems like when you work with writers or have worked with writers or even yourself in the initial stages, what are some of the loops that you find they fall into? That hopefully can be broken?

Dr. Jud: Well, I think you're naming one of the big ones. And I have to say, one thing that I also fell into was that impostor syndrome. And what am I trying to say? What am I trying to write about? And actually it turned it kind of flipped it on its head in the sense of like, yeah, I stopped trying to think about writing and I just kind of lived my life. Yeah. And I found it that with my first book, I've been approached by editors to write about addiction, etc. for years. And I was like, no, I'm not ready, I'm not ready, I'm not ready.

And then I actually went on a self meditation retreat and I was like, OK, I think I'm ready to write a book because I gathered enough personal experience, life experience and had enough conversations with people and given talks and whatnot. Where I just felt like the material was all there and it needed to come out. And in fact, the second book came out very much the same way. I wasn't expecting to write a book, but I went on a self retreat and it was just like, you know, the water spigot open. And I was like, Oh, it's time to write this book. So the thing I would say to people is really see if there's enough life experience, if there's enough research or enough whatever you kind of supersaturated that solution rather than trying to add more secrets, more what is it, sugar, that you put into water and then you heat it up and you can make the rock candy right. You've got to heat up the water and be putting that sugar in while you're heating the water. If the water is cold, you can't just add sugar and magically you're going to get rock candy.

So it's about finding the right conditions. And so here I, myself, personally and others might feel differently. I see this as like supersaturate that solution. Have those experiences, do the research, do all of this stuff, give yourself plenty of leeway in terms of like not writing. And you feel like you want to write, see if you can actually hold back from that and get that saturation set so that you can just drop that seed crystal in and then the writing just flows from that. That, to me is the best.

Jon: I love the silent meditation. Seem to have helped. I don't know if you said silent [] you did say a week of meditation or you went on a meditation retreat and silent meditations is a very specific thing. Do you meditate every day?

Dr. Jud: Yes, yeah.

Jon: Like how many, like a half an hour. Like how long or do you do it in a kind of more mindful way where it's or do you actually have a set time during the day when you meditate?

Dr. Jud: Yeah, it's some of each. So I used to have very formal meditation practices. There was a point where I was practicing several hours a day just because it just seems so helpful where I was doing the formal, like said, eyes closed, that type of thing. I found now that, you know, it's nice to start in the morning with a certain period of time, but especially to bring it just like any habit, bring it throughout the day as many moments a day as possible when I can notice. Just take a moment. Notice am I contracted? Am I expanded? What were the conditions? And kind of taking those as mindful moments throughout the day. That combination seems really, really useful for me.

Jon: All right. Well, that's wonderful advice to end with. Dr. Judd. You like Dr. Judd is what seems to be your cool nickname. I like that. But Dr. Judson Brewer, thank you so much for joining me and for writing all the work you do. It's really just so helpful. And I really appreciate it. Certainly personally very helpful for me. So thank you so much for all your work.

Dr. Jud: My pleasure. It's great to meet you.

Jon: Thank you.