Dr. Judson Brewer is a psychiatrist and neuroscientist, and the author of Unwinding Anxiety: New Science Shows How to Break the Cycles of Worry and Fear to Heal Your Mind. Dr. Brewer explains how to hack the anxiety habit loop by mapping it out, disenchanting your anxiety-driven behaviors, and giving your brain a bigger, better offer by getting curious about your anxiety. We also talk about why asking why you re anxious is not part of the process, and how this habit-based approach to behavior change can also work for things like depression and anger.
00:01:47.500You know, it was kind of serendipitous, so I used to get panic attacks when I was in residency,
00:01:53.700and then I actually got anxiety trying to help my own patients with anxiety.
00:01:59.020And I say that because with the best medications out there, it takes about, you know, for every five patients,
00:02:06.920only one of them shows a significant reduction in symptoms.
00:02:09.740There's this term called number needed to treat, which is basically what that means.
00:02:14.860And so I'm placing the, I'm playing the medication lottery.
00:02:18.240I don't know which of the next five patients I'm going to treat is going to benefit.
00:02:22.780And also, I don't know what to do with the other four.
00:02:25.740So serendipitously, I was doing a lot of research.
00:02:29.660You know, I'm just really interested in addictions.
00:02:31.980It's a tough field to work in, and I like challenges.
00:02:37.100So I'd been doing a lot of research with addictions and habit change, and we'd gotten some good results with, you know,
00:02:43.720we'd developed a program for smoking cessation.
00:02:45.900We'd gotten five times the quit rates of gold senior treatment, so that was nice.
00:02:49.260And we'd developed this eating program called Eat Right Now that we had developed through an app so we could deliver it as a digital therapeutic.
00:02:58.360And somebody in that program said, hey, you know, it looks like anxiety is driving my eating habits.
00:03:05.360Could you create a program for anxiety?
00:03:07.620And I was thinking, well, I generally prescribe medications for this, but it put a bug in my ear.
00:03:12.600And I went back and looked at the literature, and it turns out way back in the 1980s, people had been talking about anxiety being driven like other habits.
00:03:21.980And when I saw that connection, I was thinking, well, you know, I know how to work with habits.
00:03:55.700So much, you know, much better effect than I had seen with medications.
00:04:01.420Well, so I want to go back to this idea of anxiety being a habit, because that's the big thrust of your book is looking at anxiety as a habit that you have.
00:04:08.940But before we do, what is anxiety exactly?
00:04:11.680Because we see this word thrown around a lot.
00:04:14.240People, you know, I even hear like kids, like, I'm anxious.
00:04:17.540So as a clinician, how do you define anxiety?
00:04:21.340One of the definitions that I like is that it's a feeling of nervousness or unease about an imminent event or something with an uncertain outcome.
00:04:34.460And I summarize it as fear of the future, you know, because we start to worry about something in the future, not something that's happening right now.
00:05:08.640So that feeling of nervousness, that feeling of unease can lead to the mental behavior of worrying, which then feeds back and drives more anxiety.
00:05:21.420That's how these two can get connected in a loop.
00:05:24.520You know, to form any habit, you need three elements, a trigger, a behavior, and a result.
00:05:29.700And from a neuroscience perspective, that result has to be rewarding in some way.
00:05:33.720So the feeling of anxiety can then trigger the mental behavior of worrying.
00:05:39.360And that mental behavior of worrying gives us the reward of feeling like we're in control, or at least that we're doing something, which feels better than doing nothing.
00:05:48.340And then that feeds back so that the next time we feel anxious, our brain says, oh, last time you worried, you should do that again.
00:07:10.560And in fact, I've had patients who've worried so much in their lives that it's, you know, been such a habit.
00:07:16.960But as they start to worry less and have moments where they're not worrying, they start to worry that they're not worried because they feel like there's something wrong that they're not worrying.
00:07:28.220Based on your work with patients and your research, why does it seem like there's an uptick in anxiety amongst Americans and Westerners in general?
00:07:37.020Like, what's going on that's encouraging more people to get on this anxious habit loop?
00:07:44.680And it really, you know, the pandemic was a great, well, I should say unfortunate but amazing natural experiment in anxiety.
00:07:54.340So the hypothesis is that our brains don't like uncertainty.
00:07:58.320Uncertainty prompts us into action to get information to try to reduce that uncertainty.
00:08:03.640So we've had waves and waves of uncertainty over the last couple of years where, you know, anybody can think of a gazillion different things, whether it's, you know, how dangerous the original coronavirus or the COVID-19 was to, you know, economics, to schools, to whatnot.
00:08:23.960Anytime there's a new wave of uncertainty, our brains start to, well, they're supposed to be thinking and planning.
00:08:30.920But if there isn't accurate information, our thinking and planning brains spin out into fear and dread where they worry about this or that or this or that or this or that.
00:08:40.440So, you know, we've seen that come into play where anxiety levels have spiked.
00:08:46.320They've stayed pretty high because there's pretty constant uncertainty, a lot more uncertainty than there has been in the past.
00:08:53.420And we're also, as a world, getting more in the habit of worrying.
00:08:58.800And you also make this point that the digital world that we live in through our devices also contribute to this anxiety habit loop.
00:09:27.680In modern day, not only do we have a deluge of information, you know, thanks to the internet, we can get more information than we could ever digest.
00:09:35.420But we also have layered on top of that misinformation where people are inadvertently saying things that are inaccurate.
00:09:42.560And then disinformation, where people are overtly, where on purpose, they are saying things that are not true.
00:09:49.440And we have to sort through all of that.
00:09:51.200Suddenly, we have to become, you know, an expert in every one of these fields to really try to figure out whether what somebody is saying or posting online is true.
00:10:01.380And that, in itself, adds to those layers of uncertainty and all of that builds anxiety.
00:11:09.180I've even seen it, you know, where they call it the COVID-20, you know, where somebody's gained 20 pounds during COVID because they're anxious and they are working from home and they go to their refrigerator and they eat.
00:11:21.980And so the other ways besides worrying, it could be eating, shopping online, surfing the internet, smoking.
00:11:29.260It could be like anything that just soothes the anxiety is going to be a potential action you take because you experience that anxiety.
00:11:37.680And we get that brief relief, whether it's drinking alcohol or doing any of these other things.
00:11:42.480And that brief relief feeds back and says, oh, next time you're anxious, you should do this again.
00:11:46.760Okay, so knowing that anxiety is the trigger for worrying or drinking or surfing the web or whatever, I can see someone getting the idea that, okay, you can change the anxiety habit loop just the way you change any other habit loop, you know, by substituting the behavior of worrying for something more adaptive, you know, or something that will give you more positive results.
00:12:08.520So, you know, someone might think, when I experience anxiety, instead of doing my typical response of worrying, I'll just replace worrying with, you know, something like, I'm going to do 10 push-ups instead.
00:12:20.460But you make the case that hacking the habit loop like that for anxiety doesn't work.
00:13:00.660They don't actually feel less anxious, you know, by that much.
00:13:04.560So they do 10 more and, you know, suddenly they just can't do any more push-ups, but they're still anxious.
00:13:10.000So here it's helpful to really go to the root cause and really understand how any habits formed, anxiety or otherwise, and then really tap into that system.
00:13:20.240Once you can, you can really work with it, you know, it's kind of like understanding how your mind works is the first step in working with your mind.
00:13:29.340And with anxiety, that's absolutely true.
00:13:32.300And so, yeah, you say the first step in getting a handle on your anxiety, unwinding anxiety is you call map out your, your anxiety habit loops.
00:13:39.920Yes, and that's as simple as, you know, just finding what the trigger is, what the behavior is, and what the result is.
00:13:47.680So the trigger typically is the feeling of anxiety.
00:13:54.700That's one of the typical ones, but you've named some of the others as well.
00:13:58.420We might eat some food, drink alcohol, smoke a cigarette, go on the internet, procrastinate, or whatever, and then map out what the result is.
00:14:05.940You know, is it an avoidance behavior, do I feel a little bit better because I'm avoiding it, do I feel like I'm in control because I'm worrying, or whatever the result is.
00:14:15.800And once we can map those three things out, that starts to give us a picture of what our mind is doing.
00:14:22.880And that mapping process is really critical, is that critical first step for working with the behavior.
00:14:28.880And you, you highlight, you give some case studies of patients you've worked with, where just doing this mapping process that goes a long way.
00:14:36.740They, they suddenly, like it decreases their anxiety, not significantly, but some, for some people significantly.
00:14:41.880What is it about mapping out your anxiety habit loops that can immediately, before you even start doing anything, decrease anxiety?
00:14:50.480Well, this goes back to the uncertainty and how our brains don't like uncertainty.
00:14:54.300And if we don't know, you know, if our brain is like a black box, suddenly if you, you know, or it's like a dark room, you don't know what's in there and you go in there, what could it be?
00:15:04.560And you flip on the light switch and you're like, oh, this is what's in the room.
00:15:32.400And then I just drew arrows between those three.
00:15:35.180And importantly, so that first arrow from the trigger to the behavior, that second arrow from the behavior to the not having panic attacks.
00:15:42.720And then the third arrow, not having panic attacks feeds back to those thoughts.
00:15:48.840So the next time he has a thought, he says, I can't drive.
00:15:50.880And then suddenly, you know, he's really limiting himself and having, you know, meeting all the criteria for panic disorder.
00:15:57.220Just seeing that, I pulled, literally pulled out a piece of paper, mapped it out with him for 30 seconds after taking his history.
00:16:04.540And I could see the light bulb go off in his head because he just didn't know how that process worked.
00:16:10.940As simple as it is, most of us just don't see these things.
00:16:15.440And so that reduces the uncertainty because he can see how his brain works.
00:16:19.880And I can explain to him, well, this is a normal process.
00:16:22.600Your brain is, you know, adopting this old system that helps you survive.
00:16:26.540That's just ironically making you more anxious.
00:16:30.420And that in itself can reduce the anxiety because the uncertainty is lowered.
00:16:35.900And one thing to keep in mind when you're mapping out these habit loops, you're trying to, you're supposed to take like a mindful approach to it.
00:16:41.080You're not supposed to beat yourself up.
00:16:43.080It's like, man, why am I such a dummy that I have this dumb anxiety habit loop?
00:16:46.280You're just supposed to be as objective and distance from it as possible so you can get a grasp.
00:16:52.080Because if you do that, beat yourself up, you're just putting yourself in another anxiety habit loop.
00:17:00.800And then that habit loop distracts us from working with the original habit loop as well.
00:17:05.700So yes, this is about, I think of it as approaching it like a scientist or a physician or a lawyer or somebody that's just trying to get the facts, you know, so they can really understand what's happening.
00:17:17.260We're going to take a quick break for your words from our sponsors.
00:18:09.200You know, our brains are set up to try to maximize calorie intake because back in the day, you know, our ancestors didn't have refrigerators.
00:18:17.620And so, you know, when you've got a good calorie source, the idea was to pack them in.
00:18:22.100So we prefer cake to broccoli because our brains are set up to say, hey, cake has more calories.
00:19:25.000That's how the learning process happens.
00:19:26.520We can apply that process to any behavior so that we can update the reward value to how rewarding it is right now.
00:19:34.580So if I learned the reward value of cake when I was five and I'm just mindlessly eating cake when I'm 45, that's probably not so helpful.
00:19:43.900If I pay attention and I notice, oh, when I just eat a ton of cake, I get a sugar rush and I crash and I gain weight and I get cavities and I get diabetes, I can start to see that's actually not that rewarding.
00:20:01.200We have this app called Eat Right Now that helps people pay attention as they overeat.
00:20:04.760It only takes about 10 or 15 times of somebody really paying attention as they overeat for that reward value to drop below zero where they start to shift their behavior.
00:20:14.440So we can do the same thing with worrying.
00:20:16.740And I have people ask a simple question.
00:20:19.320As they're worrying, I ask them to ask themselves, what am I getting from this?
00:20:24.540And feel into their direct experience.
00:20:27.200And what people typically report is that worrying doesn't feel very good itself.
00:20:31.720It doesn't keep their family member safe or solve a problem or do whatever their brain thinks it's going to do beyond distracting them.
00:20:41.260And when they can start to see that really clearly, they start to become disenchanted with it.
00:21:29.500So there's a great example of becoming disenchanted with our behavior simply by paying attention to the results, what it gives us when we do it.
00:22:21.240It'd be great if I could just, you know, I'd have one visit with every patient where they come in and they say, I want to stop social media.
00:22:27.180And I would, you know, dub them, I'd say, stop doing that.
00:22:30.180And they would just leave and stop doing it.
00:22:31.780So the, the critical piece here is that the reflection on the previous action helps us load that reward value into our brain.
00:22:40.720So we can ask ourselves, do I really want to do this again?
00:22:43.560And we can feel into the experience of last time.
00:22:46.780And like you described with social media, we're like, this doesn't feel so good.
00:22:50.780And so we naturally are disenchanted so that we're not pulled to do it again without having to force ourselves not to do it again.
00:23:06.920So after you disenchanted the maladaptive behavior, whether it's worrying or eating or smoking, whatever, the third part is creating what you call a bigger, better offer for your brain.
00:23:21.000So this is an homage to, to myself and all of us that, you know, back in high school, when we had a date set up for Friday night and then, you know, Friday afternoon, our dates lets us know that they have, you know, their parents are requiring them to power wash the car or some, something that's ridiculous and clearly an excuse.
00:23:40.780Where, where clearly somebody else called them and wanted to go out on a date and that was, that person was the bigger, better offer.
00:23:46.900You know, and so, so I think of it this way, cause that's how our brains work.
00:23:52.560You know, our brains are, you know, given a choice between A and B, they're going to pick the one that's more rewarding.
00:23:57.740So if we become disenchanted with these old behaviors, why not give our brains something better to do?
00:24:04.420And not in the case of, you know, if you're anxious, just go scroll on social media or drink alcohol, because we can start to see that those things aren't that rewarding themselves and don't fix the root problem.
00:24:14.960But instead we can tap into things that are intrinsically rewarding.
00:24:19.640So if we're anxious, we can get curious about what that anxiety feels like instead of worrying.
00:26:18.080Really sticking with our direct experience, not the concept or worrying about why am I anxious and trying to figure that out.
00:26:25.780Really just dropping in and seeing what's going on.
00:26:29.820And then you have that, you had that section about like using like some little hacks, I guess you can call them about widening your eyes to maybe encourage or nudge yourself into the curious.
00:26:41.780So this, again, goes back to evolutionary neuroscience and psychology.
00:26:46.780There's some great experiments where people looked at, you know, what, what do our eyes naturally do when we are, let's say, let's start with something different, like angry.
00:26:58.400So when we're angry, so just think of a time when you are angry and anybody listening in can do this themselves and see what your eyes naturally do.
00:27:07.760So would you say that your eyes narrow or do they widen when you're angry?
00:27:47.400So again, it's when we're trying to gather more information.
00:27:50.900So both with curiosity and interestingly, also with fear, which makes sense, our eyes get really wide, you know, because they have to take in information.
00:28:00.260And so here, if we aren't curious, we can simply use this trick.
00:28:06.520So somatic memory basically just means that our bodies will hold certain postures or positions or feelings that are associated with, with emotions.
00:28:16.560So for anxious, you know, for example, my shoulders tend to be more contracted or hunched or, you know, kind of closed in than when I'm not anxious.
00:28:26.540So if we're not curious, we can simply open our eyes really wide and see if that can help induce the feeling of curiosity itself.
00:28:38.340That's kind of why it's a hack because we simply open our eyes really wide and anybody can do this right now.
00:28:44.340It's like when you open your eyes really wide, does that actually help you become a little more curious in that moment?
00:28:51.580Well, you also have, you tell people to like say, hmm, like, hmm, like verbally say, like, I'm interested in that.
00:28:58.660And you might feel silly, but I did it.
00:29:01.580I was taking a walk the other day and I did it and I think it works.
00:29:06.840The thing I like about, hmm, I think of it as a curiosity mantra is that it takes us out of our thinking brain and really into our feeling body because that's where all the action is.
00:29:18.060And so if we're anxious, for example, we can go, hmm, where am I anxious right now?
00:29:25.700Like, is it more on the right side or the left side of my body?
00:29:28.960And that, hmm, can really open us to our experience.
00:29:33.340It's another way that I like to play with this is, you know, it's kind of like if we feel anxious and we start to worry and we go, oh, no, I'm anxious.
00:30:35.720And so just doing that naturally, your body or your mind and your body, I guess you'd say, would kind of extinguish that behavior because you're not getting any value out of it.
00:30:45.100And then the third part is offer a bigger, better offer to your brain through curiosity.
00:31:08.740So as a card-carrying, board-certified psychiatrist, this might sound heretical that we're not trying to go back to someone's childhood or figure out why they're anxious.
00:31:20.180And the reason for that is that here my neuroscience hat wins out.
00:31:24.140When I think about and I look at the equations that have to do with behavior change, none of them have to do with childhood or past experience.
00:31:34.680It's not that that experience isn't important or meaningful.
00:31:42.120And like you're pointing out, we can get stuck in these why habit loops, trying to figure out why am I anxious, thinking that suddenly if we figure out why we're anxious, it's going to fix it.
00:31:50.280Well, that why is generally in the past.
00:31:52.720So it certainly can be insightful, it can reduce uncertainty, but it's not going to fix the habit itself.
00:32:35.900You know, this is, I think of the serenity prayer.
00:32:38.880It's like, let me, you know, accept things that I can't change and have the strength or courage to change that which I can.
00:32:46.300If we can see very clearly what we can't change, we can stop banging our head against that wall so that that frees up the energy to look for the doors.
00:32:56.460Sometimes, you know, we do need to find the door.
00:32:58.940We're like, wow, this job really isn't a good fit for me and we can walk out it as compared to being too exhausted to even notice.
00:33:06.080So you mentioned some other issues that, you know, hacking the anxiety loop or unwinding anxiety, addiction, overeating, smoking, it works for this.
00:33:15.580Does it work for other things like depression?
00:33:17.100There's a lot of good evidence showing programs like mindfulness-based cognitive therapy can really help people with depression.
00:33:25.920And what that highlights is that this habit loop, you know, whether I think of worry and anxiety as, you know, future-oriented habits, this story of me in the future worrying and trying to protect myself against the future or what might happen in the future.
00:33:40.080Depression is more about beating ourselves up over what happened in the past.
00:33:44.580And so when we ruminate, we can get stuck in those habit loops around, you know, this is terrible, I'm terrible, the world's terrible or whatever.
00:33:53.640And bringing awareness to this and using these same processes can really help us not reinforce those habits.
00:34:00.700And, you know, these programs have been shown to be really, really helpful for depression.
00:34:06.060Yeah, there's another, Richard O'Connor is a psychologist.
00:34:10.760And he kind of makes the case that you do with anxiety that depression is just a series of habits that you have and you have to undo those habits.
00:34:32.180The term may not be perfect, but they're just, you know, they have such low energy that they can't even think.
00:34:38.760Like thinking feels like they're going through sludge or through some bog.
00:34:43.680And so here, you know, it certainly can help with the thinking elements, but it's not necessarily, you know, I just want to emphasize how it can be very helpful for some people where some medications can be really helpful for those biological components.
00:34:57.180As we were talking, another problem I can see, this habit approach could help is anger.
00:35:17.500And so you sort of start disenchanting that anger response.
00:35:20.460Yes, and I think here, and I've certainly, this has been helpful for me in terms of working with my own frustration and anger, is looking at how we're directing our energy.
00:35:34.200You know, it can often make us feel like we're self-righteous, like, I'm doing, you know, I'm doing this for the right reasons or whatever.
00:35:41.420But we have to look to see what our anger is getting us.
00:35:46.220And is it the most skillful or helpful way to change something?
00:35:51.180You know, if there's some injustice in the world, is getting angry going to be the best way to solve that problem?
00:35:57.440Or is it just going to make other people push back and make it harder to solve a problem?
00:36:01.860Is it going to be an inefficient use of our energy?
00:36:04.920So here, even, you know, for myself, I ask myself, what am I getting from the anger?
00:36:11.140And that opens up the space when I become disenchanted with it.
00:36:15.020It opens the space and frees up the energy to ask, well, is there another way to go about changing things?
00:36:22.220Well, Judson, this has been a great conversation.
00:36:23.860Where can people go to learn more about the book and your work?
00:36:26.180I have a website, drjudd, D-R-J-U-D dot com, that has a bunch of free resources, links to my books, to the apps that we talked about, and other various and sundry things.
00:36:48.040It's available on Amazon.com and bookstores everywhere.
00:36:50.200You can find more information about his work at his website, drjudd.com.
00:36:53.640Also, check out our show notes at awim.is slash anxietyhabit, where you can find links to resources, where you can delve deeper into this topic.
00:37:06.640Well, that wraps up another edition of the AOM Podcast.
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