#179 — The Unquiet Mind
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Summary
In this episode, I speak with Dr. Judson Brewer, an addiction psychiatrist and neuroscientist. Dr. Brewer is the Director of Research and Innovation at Brown University's mindfulness Center and the founder of MindSciences, which makes app-based mindfulness training programs for habit change. He is also the author of the book The Cravings Mind: From cigarettes to smartphones, to love, why we get hooked and how we can break bad habits. In this episode we talk about mindfulness and addiction, the nature of reward-based learning, the neuroscience of craving, real-time neuroimaging of smoking cessation through mindfulness, the difference between dopamine-driven reward and real happiness, and other topics related to anxiety and other addictions. This episode was originally published in 2018, but is now available as a podcast episode on the Making Sense App, which is available to download until the end of the year! If you're interested in trying the app, or if you're already using it, or you want to recommend it to others, you'll need to subscribe to the app. If you can't afford a subscription, there's an option at Samharris.org to request a free account, and we'll only be hearing partial episodes of the podcast until the new year's end-of-year deadline on January 31st, so you can get access to the full-length episodes of Making Sense. . Thanks for listening, and as always remember that all of the content is available until New Year's Day! Make sense! -Sam harris -Jonas J. Jonas -- Jonathon Sam Harris -- Jonasparadigm -- The Making Sense --Jonas -- John Rocha -- J.J. -- Dan Brown -- Dr. Phil -- MD -- Daniel Brown Dr. John Ralden -- PhD John Hall -- Sr. , PhD -- D.S. -- John Condon J.D. -- John F. ...and so much more? and so much so that you can help make sense of it all? , ? Jonathan & so on and so that he can be a better than you can make sense ... What's the future officially begins officially begins? Jonos , and is it possible?
Transcript
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welcome to the making sense podcast this is sam harris just a note to say that if you're hearing
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so if you can't afford a subscription there's an option at sam harris.org to request a free account
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and we grant 100 of those requests no questions asked okay well 2020 is upon us where are the
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flying cars surely the future officially begins now okay just brief housekeeping here the waking up app
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is now unlocked until the end of the year so if you're interested in trying it or you're already
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using it and you want to recommend it to others now's a very good time because all of the content
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is available until new year's day and i hope you enjoy it as always if you have any issues with the
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app please contact support at waking up.com and they will sort you out and today's conversation is
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appearing both on the app and the podcast that doesn't usually happen but sometimes there's a
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conversation that seems relevant to both audiences and this is one of those times today i'm speaking
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with judson brewer judd is the director of research and innovation at the mindfulness center an associate
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professor in psychiatry at the school of medicine at brown university he's also a research affiliate at
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MIT and before that he held research and teaching positions at yale university and at the university
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of massachusetts center for mindfulness judd is also the founder of a digital therapeutics platform
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mind sciences and the author of the book the craving mind from cigarettes to smartphones to love
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why we get hooked and how we can break bad habits and in this episode we talk about mindfulness
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and addiction and the nature of reward-based learning the neuroscience of craving real-time neuroimaging
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smoking cessation through mindfulness the difference between dopamine driven reward and real happiness
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working with anxiety and other topics and now without further delay i bring you judson brewer
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i am here with judd brewer judd thanks for joining me thanks for having me so uh give us uh the
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potted biography of your intellectual interests and what you're doing professionally now before we dive in
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i'm an addiction psychiatrist and a neuroscientist i'm the director of research and innovation at
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brown university's mindfulness center and the founder of mind sciences which makes
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app-based mindfulness training programs for habit change so what is your background in meditation how
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did you get interested in it and what sort of training have you done i started meditating my first day of
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medical school through the background of suffering you know with that 10 000 hours rule i certainly
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achieved that early on in my life with regard to 10 000 hours of suffering so i can say i'm a i'm an expert
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there but started meditating yeah i was really struggling at the beginning of medical school
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figured it was a you know starting something new in my life and i started meditating to see what that
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would be like and to see if it could help with some of the stress and started practicing i didn't know
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that there were different traditions so right i joined a local sangha in st louis where i was going to
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medical school which turned out to be led by first by a zen practitioner and then a theravadan practitioner
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and then i found a teacher in you know in the midwest and started practicing the theravadan you know
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the theravadan tradition and have largely focused there over the last 20 plus years most recently i've been
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studying with joseph goldstein who has you know an eclectic style has studied with a bunch of different
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teachers and i've also been doing some collaboration with dan brown who's more in the
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terror and the tibetan lineage so i've been learning a fair amount of zogchen both for you know from a
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practice perspective but also to help make sure that the research that we do is accurate nice and when you
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went into medical school did you know immediately that you wanted to go into psychiatry or was that a
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later epiphany uh let's say later as in it was the last thing that i thought i was going to do
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when you i was in this md phd program where you do a couple of years of medical school and then you do
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your phd for long enough to forget everything that you've learned in medical school and then you go
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back into the wards and so when i went back into the wards for the you know my third year of medical
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school i i figured i would do psychiatry as a way to remember how to interview patients
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right and then i realized that these you know what my patients were talking about was was really using
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the same language as the as the buddhists and also that psychiatry was in tremendous need of good
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treatments especially for addictions and that was that seems to be a a sweet spot of the buddha you
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know craving and clinging yeah the the the lens through which the buddha looked at the whole
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problem of unenlightenment is really one of craving and its consequences and and there's a very helpful
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analogy drawn here between addiction and these ancient methods of practice and you do this in your
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book the craving mind so let's talk about that maybe that's the the right way in before we get
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to the the esoterica of how mindfulness can help what is addiction and how should we be thinking about
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it i like the simple definition of continued use despite adverse consequences i learned that in
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residency training and the american society of addiction medicine just came out with a definition
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that very much parallels that you know continued use despite adverse consequences which not only
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points out that we can be addicted to chemicals but we can be addicted to behaviors ranging from
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you know our cell phones these weapons of mass distraction to thinking we can be addicted to
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our own thoughts or our own views right i sense that many people will balk at that definition it seems
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somehow or can seem somehow too capacious are we really saying or do we want to say that addiction to
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something like cigarettes is precisely on the same continuum as addiction to smartphones or thinking or
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shopping or gambling i mean isn't there some significance to the fact that in one case someone could be
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using a chemical the cessation of which would lead to withdrawal or is there a biochemistry that kind
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of holds people hostage in a way that behavioral addictions don't quite or is it really just you know
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once you get in there it's just neurophysiology whether you have exogenous compounds on board or not and
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really it's the same mechanism i think there are two aspects here one is that we can look at
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physical dependence where we you know certain you know if you jack the brain with dopamine which every
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known drug of abuse has been shown to do you know it's going to lead to receptor modulation and that
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for example with alcohol or nicotine or you know opioids or whatever you're going to see you know
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receptor up and down regulation and that take can take a while to normalize so i think that piece
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hasn't been you know it's that that physical dependence piece is it can be separated from
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the continued use despite adverse consequences and so i think that's where the playing field gets
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leveled somebody can be drinking alcohol and not have consequences somebody else can be drinking alcohol
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and can be having severe consequences somebody can be using their smartphone same thing you know
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they could be texting while driving and getting into an accident while somebody else
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uses their smartphone responsibly let's say right right i guess there's a little wiggle room in the
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definition or in the who is defining the adverse consequences right i mean they're probably people
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who by any outside estimation are addicted to whatever their smartphones or gambling and yet they have
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a problem admitting that they have a problem yeah and i think we see this in psychiatry where it's helpful to
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get information not only from the person who might be referred to us or come in to see me as a psychiatrist
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but also from you know collateral where you know it's family friends co-workers whatnot and
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like you're pointing out somebody might not think they have a problem no matter what whatever the substance or the
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behavior is but it might be causing significant adverse consequences to all the people around them and so i think of
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that's despite adverse consequences meaning not just what somebody thinks is happening but really having
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as much much of an objective perspective as possible and that includes many points of view yeah and perhaps the most
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subtle addiction here and and many people again will find it strange to be conjoining these
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concepts addiction and thinking but you mentioned one being addicted to thinking and this is really
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something that you encounter when you you when you try to meditate especially intensively on silent retreat you
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just the automaticity of being lost in discursive thought the fact that it's it's our default state
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despite our most heroic efforts to pay attention in this case we've you know deranged our lives and
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gone into silence with the goal of paying attention moment to moment and yet the thoughts don't stop how do you
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think about thinking in light of this sort of addiction framing and and just i guess the underlying
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mechanics of reward-based learning and processing well i guess i should say hi my name is judd i'm a thinkaholic
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how many days sober do you have none i'm on day one my you know i remember my first seven days silent
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meditation retreat this is when i was in medical school and by day three i was crying uncontrollably on
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the shoulder of the treat man the retreat manager because i didn't think i could do this i could
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pay attention to my breath you know because that's always encouraging a psychiatrist to weep openly on
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the shoulder of a stranger yes so i think in terms of you know what i've seen from my own experience and
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also what i've now begun to understand scientifically you know and this is also is how mindfulness comes in
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you know there's this idea that we can just just control ourselves and thinking is a great example
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of really not having any control because we can't just stop our thoughts we might be able to create
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conditions where the mind is quiet but if we just get up there and you know hold up the stop sign and
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say okay okay thoughts you know take a break they come at us you know like zombies you know yeah and it
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becomes the thought apocalypse so you know that's one i think in terms of addiction i i also remember
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being on you know i was on a month on retreat and it took me a full day or so to realize that i would
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be having these thoughts and they'd be saying oh this is this is a great experiment if you do not write
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this down you know you will forget it and then it'll be lost and and i would you know get up from the
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cushion and then write it down and then you know sit down again and then the next you know world's
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greatest thought came up and then do the same thing and i was like wait a minute this is this is my mind
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not just not wanting to meditate yeah so i think in terms of the looking at this from an addictive
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perspective it might be helpful just to even think about what the general framework of reward-based
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learning is because that can also explain where addiction can move you know not just from alcohol
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and the typical ones but to even to thinking and views and things like this so there's a you know
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there's a very simple framework that has three components a trigger a behavior and a reward and this
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framework is set up to help us remember where food is and how to avoid danger so basically if you see
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food that's the trigger you eat the food that's the behavior and then your stomach sends this
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dopamine signal to your brain that says remember what you ate where you found it there's the reward
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or quote-unquote reward it's from a brain perspective it's basically it lays down context-dependent memory
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same for avoiding danger you see the danger you run away and then the reward is that you're you're
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alive to tell your buddies don't go over there that's kind of dangerous so that's the basic framework
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for reward-based learning now there are a couple of important components that really explain a lot of
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modern-day maladies that we don't quite understand with this reward-based learning is based on rewards
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not on the behavior itself and i mention that because in modern day we try everything from dieting to
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trying to make our minds silent when we're meditating but we use the brute force brute force method
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where it's like okay just stop that's what i was trying to do i used to sweat through t-shirts
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in the middle of winter at this center at the insight meditation society up in massachusetts you know
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where it's cold i'd sweat through t-shirts trying to force myself not to think and to just stay
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concentrated on my breath well this is the same thing that people do when they're trying to lose weight
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and they use a traditional diet which just says you know make sure you eat salad instead of cake well
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you know it makes sense it's a the formula is correct but that's not how our minds work
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so the reward-based learning reminds us that it's not the behavior it's the reward how rewarding a behavior
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is and that's what's going to drive future behavior and understanding this was really key not only for
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my lab in developing you know app-based mindfulness training programs for example but also understanding
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the the underlying neural mechanisms of what was going on and also personally it really helped me
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be able to pay attention to my breath or pay attention to an object of meditation rather than trying to force
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it and it's also more the anticipation of reward than it is the actual landing on the object of
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desire right it's both actually so the dopamine fire is the first time we get a reward and if it happens
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repeatedly that dopamine firing and that's that anticipation piece that that feels like the dopamine
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firing shifts from receipt of reward to anticipation of reward so it actually starts firing when we have a
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trigger trigger or when we have a thought can be a trigger where we start thinking about getting that
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thing it it motivates us to get off the couch and go do that behavior because remember this is all set up
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to motivate us to eat and to motivate us to run away from danger so that anticipation piece is go do something
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so you're saying that it's initially encoded by the actual reward but if in future instances it starts
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prior to the reward just when when we're actually engaging the routine that would reliably deliver
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the reward yes so for example you know the first if i and usually this has to do with unanticipated
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rewards so if i'm you know walking down the street and suddenly i find you know a chocolate bar
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that you know it's my favorite chocolate bar my brain says oh wow that was a surprise and that oh wow
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surprise says oh you just you just won the chocolate lottery and so then the next time i walk down that
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street my brain will say oh i wonder if there's another chocolate bar there and so the trigger of the
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context that walking down that street says oh go look for chocolate in your book you draw an analogy between
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the cycle of learning which is in the behaviorist literature going back to skinner what was called operant
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conditioning there's an analogy to draw there between that mechanism and the buddhist framing of
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dependent origination i don't know if you want to unpack that for us yeah i'd be happy to so
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dependent origination is reportedly what the buddha was contemplating on the night of his enlightenment
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now that sounds kind of important this this is what the dude was was contemplating and then he became
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awakened then he became enlightened so i worked with a poly scholar jake davis because as i was
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studying dependent origination personally i was studying behavior change you know professionally
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as an addiction psychiatrist and was starting to see the importance of operant conditioning which is
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basically that reward-based learning cycle that i talked about and we looked at the parallels and it was
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striking how similar these two frameworks were there were slight differences in terminology in terms of
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you know some language that the buddhists were using and some language that the behaviors were using but
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basically it was the same process and what it suggested was that you know the buddha basically
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discovered what we now think of in modern day as you know reward-based learning before paper had even been
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invented you know and this discovery in modern day science just to put it in perspective was so huge
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that eric kendel won the nobel prize in the year 2000 showing that this process is can evolutionarily
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conserved all the way back to the sea slug so a critically important concept whether it was the buddha
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becoming awakened or eric kendel getting his nobel prize showing that this is a very very fundamental learning process
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so in the buddhist framework there's this capacity of the mind to notice
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the feeling valence of a stimulus so you you can notice whether something's pleasant or unpleasant
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and craving follows from that there's craving and identification with it and you know i think we
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now know something about the neural correlates of these processes what does your work tell you about
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what the brain is doing when we're feeling desire for a stimulus and that desire is made actionable
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because there's no distance between you know attention and the desire itself yes so we why don't we
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start at the the the vedana the pleasant and unpleasant aspect in buddhist terms uh vedana pleasant unpleasant
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or sometimes neutral in operant conditioning or modern day psychology terms you know pretty similar
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terms are used you know something feels pleasant something feels unpleasant and what the what both
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frameworks show is that whether it's pleasant or unpleasant both of them lead to a craving so we want more of the
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pleasant and we want less of the unpleasant so you can think of an anti-craving or a aversion you
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have a craving and aversion and then that leads in in the buddhist terminology to clinging or upadana which can be
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also suggest a translation can be sustenance where we're we're fueling that fire of craving and by behaving we
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start to become identified with that behavior so if it's eating chocolate i can start to become
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identified with eating certain types of chocolate like dark chocolate versus milk chocolate or if i have
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a certain political propensity i could start becoming identified with a certain type of view or set of
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views where you know i am this versus not that and the more we perform the behavior whether it's eating
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chocolate or thinking you know this is the right view the more we become identified with that now
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interestingly in ancient buddhist terms they called they said that the cycle is perpetuated through
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ignorance and then in modern day i think of this as that cycle is perpetuated through i i'll i use the
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term subjective bias and so the term ignorance and subjective bias i would suggest are basically the same thing
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meaning meaning that we become biased based on our previous behavior so we're not seeing the world
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clearly we're seeing it through these lenses of our previous behavior so if i see chocolate i'm going
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to see it through the lenses of oh i like or i don't like that type of chocolate based on my previous
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behavior so the subjective bias the buddhist would suggest is ignorance because we're not actually seeing
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clearly you know and i and i like the interpretation of the term vipassana which literally means seeing
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clearly it's as though we're taking off those subjective bias glasses yeah there's an interesting connection
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here between the more creaturely levels of craving and wanting and identification and something that seems
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you know far more recent in acquisition in evolutionary terms you're talking about political views right
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so that the fact that one's sense of identification the sense of self can be an emergent property of
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kind of contracting within the domain of either of these things whether it's the taste of chocolate
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the wanting of the wanting of it the preference for one form or another and just holding to an opinion
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that one has entertained and become attached to this can sound surprising but just in evolutionary terms
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we didn't add entirely new modules to the ape brain to become human right i mean the only way we acquire
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new abilities is by extending the processing reach of structures that you know we're already there and so
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the same circuitry that's encoding you know disgust over being confronted by something toxic that you don't
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want to get into your mouth it's that same processing that is underwriting moral intuitions and even
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judgments of you know the truth or falsity of ideas from the side of experience in meditation
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this really isn't surprising i mean you can feel in yourself the difference between identification
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attachment the sort of cramp of self around any of these things you know wanting another bite of cake
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we've all had this experience of you're eating some dessert which you're you're very happy to be eating
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and someone usually your spouse will ask for a bite of it when you're down to the last bite right and
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you you know you feel viscerally that something in you some homunculus in you has not budgeted for the
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possibility of having to give up that last bite your pleasure extended to the remaining bite you would
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have happily perhaps given an earlier bite but surely not the last one that feeling of kind of emotional
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impediment you know that is tied in the middle of virtually everything that feels like me do we know
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much at this point about the underlying neuroanatomy of of these processes i'm glad you brought in these
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terms around you know contraction and and you know basically clinging the the the closed down quality of
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experience because that's something that my lab has kind of serendipitously fallen into studying and if you think
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about it from a from an evolutionary perspective you know fear for example feels contracting right and the idea
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is to make ourselves as small an object as possible protect our vital organs from whatever it is that's about to eat us
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now that's very different than the feeling of say joy or connection which feels much more expansive or even
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curiosity so just just anchoring us on that on that framework and that feeling of contraction versus
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expansion my lab was studying experienced meditators this is back in 2009 10 11 yeah almost a decade ago
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where we were just trying to understand what the basic brain activity looked like in experience versus
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novice meditators and we were actually looking for convergence so we studied a bunch of different
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types of practices so we had people practice like a concentration practice like breath awareness a
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loving kindness practice you know more of a connection practice and then a choiceless awareness practice where
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they were you they were not focused on any particular object but just whatever came into their awareness was the
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objective of their awareness in that moment and we looked to see what was common amongst those
00:27:04.760
three meditation practices what we found was very striking one was we didn't find a single brain region
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that was increased in activity in experience versus novice meditators which was a little shocking to me
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and i think went against my primary hypothesis was that there must be some brain region activating because
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i'm sure working my ass off this is back before i really you know i was only 10 years into practice
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and still didn't have quite a clue about what force was like but the other thing that we found was that
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there were particular brain regions that were deactivated in experience versus novice meditators
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and these had to do with this network called the default mode network that has to do with self-referential
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processing so when we take something personally basically this network of brain regions gets
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activated so for example when you know let's use your example of the cake you know it's like oh i i
00:28:04.680
want that like last piece of cake and we're kind of holding on to it we're we're uh clinging to it so
00:28:10.440
to speak also happens when we ruminate when we're depressed it happens when we perseverate when we're
00:28:15.960
anxious when we're worried about the future so there are a bunch of different things that when
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we take them personally when we're worried about the future when we regret things in the past when
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we want that piece of cake they all activate the default mode network and lo and behold this same
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network was deactivated in experienced meditators now is this you know i've spoken about the default mode
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network before in this context is the finding the same for the medial prefrontal cortex as the
00:28:47.880
posterior cingulate or are we mostly talking about the posterior cingulate for these deactivations
00:28:53.320
yeah it's a great question we've most we've done most of our experiments in the posterior cingulate
00:28:58.600
cortex and that's because that was the strong the brain region that had the most deactivation
00:29:06.200
and experienced versus novice meditators and also pragmatically when we started doing real-time
00:29:13.800
neurofeedback experiments we didn't have the techniques to be able to give feedback from
00:29:18.520
multiple brain regions at once the two are pretty highly correlated but with most of the work that
00:29:25.000
we've done has been with the posterior cingulate and there's also a theoretical reason for that which
00:29:29.640
is the medial prefrontal cortex part of the prefrontal cortex which is a younger part of the brain
00:29:35.240
has been more linked to the conceptual sense of self whereas the posterior cingulate cortex
00:29:42.920
and this was actually through some work that we'd done and others had done seems to be more linked
00:29:47.240
to an experiential sense of self and is also directly anatomically connected to brain regions
00:29:55.160
involved in memory like the hippocampus so the posterior cingulate is what we've been focused on
00:30:00.920
primarily but a fair number of the studies have shown that the both are pretty intimately correlated
00:30:07.240
so we wanted to actually understand what this deactivation meant because there's a big issue in
00:30:13.240
neuroimaging and neuroscience around reverse inference where if you see a brain region activated you assume
00:30:19.480
that something is happening based on what other people have done in other experiments but you can't make
00:30:25.000
that assumption accurately because it could be doing something else and we just don't know it
00:30:29.320
so the best way to reduce that likelihood is to do real-time experiments where you can measure brain
00:30:36.280
activity and show people their brain activity in real time while they're doing a particular task in
00:30:42.040
our case we were having people meditate and that way you can link up the subjective experience their
00:30:48.280
first-person subjective experience with their brain activity in real time and really know what's going on
00:30:52.520
so we did a bunch of these experiments with novice and experienced meditators and we found something
00:30:59.240
that was really striking which was that this act this activation in the posterior cingulate cortex was
00:31:07.400
correlated not just with things like mind wandering or craving but it's the degree to which people get
00:31:14.280
caught up in that experience and we found this because not only were things like craving or mind wandering
00:31:21.000
activating these brain regions which other people had found before but we found that other experiences
00:31:26.120
were also activating it such as when people were trying to meditate harder as one person put it you
00:31:33.480
know so i tried to look at the they were looking at the graph as an object of meditation they said
00:31:38.200
i tried to be more aware of it or or force it basically and that actually induced an active increased
00:31:47.160
activity or an increased activation of the posterior cingulate cortex whereas other people were
00:31:52.680
reporting that the more they let go and stopped trying to do anything the less their posterior cingulate was
00:32:01.240
activated so you mentioned that you you gave people three different practices to do and two of them
00:32:09.800
were essentially mindfulness but you know one was to focus exclusively on the breath and the other was
00:32:14.600
choiceless awareness which is to say you just leave your attention wide open and notice whatever you
00:32:20.600
notice were those different in terms of the activity of the posterior cingulate they both showed deactivation
00:32:29.960
in experience versus novice meditators as in when people were focusing on that object whether it's the
00:32:37.400
breath or just anything coming into their awareness the less they tried the less they got caught
00:32:44.280
up in in doing and we're just resting in awareness the more deactivated their posterior cingulate gone
00:32:53.240
right right you can feel this subjectively i mean this is the difference between feeling like the
00:33:03.720
meditator right where you're strongly identified with the aiming of your attention you're the locus of
00:33:10.760
attention in the head and you're now pointing attention strategically at the breath and trying
00:33:17.160
to get closer to it and noticing the competition between doing that
00:33:24.360
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