How Curiosity Quiets Anxiety with Dr. Judson Brewer

Summary

Podcast Summary: "How Curiosity Quiets Anxiety with Dr. Judson Brewer"

Podcast Information:

• Title: Science of Perception Box
• Hosts: Dr. Heather Berlin and Dr. Christoph Koch
• Guest: Dr. Judson Brewer
• Release Date: January 16, 2025

---

Introduction

In this insightful episode of the Science of Perception Box, hosts Dr. Heather Berlin and Dr. Christoph Koch welcome Dr. Judson Brewer, a leading expert in the neuroscience of mindfulness and anxiety. Dr. Brewer, director of research and innovation at Brown University's Mindfulness Center and author of Unwinding Anxiety, delves deep into understanding anxiety's neural mechanisms and how curiosity can serve as a powerful tool to mitigate it.

---

Understanding Anxiety in the Brain

Dr. Judson Brewer begins by elucidating the nature of anxiety, describing it as a "ramping up of fear of the future" ([03:33]). He explains that anxiety arises from the interplay between two fundamental survival mechanisms:

1. Fear of the Present: Immediate responses to potential threats, such as hearing an unusual noise in a hotel room ([03:33]).
2. Planning for the Future: Anticipating and preparing for future events.

However, when these mechanisms combine—specifically, fear about future uncertainties—it leads to anxiety. This constant worrying "makes our prefrontal cortex go offline", ironically impairing our ability to think and plan effectively ([03:33]).

---

The Habit Loop of Anxiety

Dr. Brewer introduces the concept of habit loops consisting of three components: Trigger, Behavior, and Reward ([05:46]). In the context of anxiety:

• Trigger: Thoughts like, "Oh no, I'm going to have a panic attack."
• Behavior: Engaging in worrying or avoidance behaviors, such as not driving on the highway to prevent a panic attack ([05:55]).
• Reward: The temporary relief from anxiety, giving a false sense of control ([06:58]).

This loop reinforces anxiety because the behavior (worrying) feels rewarding, even though it ultimately exacerbates the anxiety.

Notable Quote:

“Worrying doesn't actually give us control. It just makes us feel like we're in control because we're doing something as compared to doing nothing.” — Dr. Judson Brewer ([07:34])

---

Breaking the Anxiety Cycle

Traditional approaches often emphasize willpower, urging individuals to "just stop worrying." However, Dr. Brewer argues that willpower is more myth than muscle, especially since pushing against worrying can intensify it ([09:01]).

Instead, he advocates for mapping out habit loops to recognize the triggers and rewards associated with anxiety ([10:16]). By understanding these loops, individuals can identify how their anxiety-driven behaviors are reinforced.

Example: Dr. Brewer shares a patient story where a man struggling with panic disorder mapped his habit loop:

• Trigger: Thoughts of a potential car accident.
• Behavior: Avoiding driving on highways.
• Reward: Preventing a panic attack.

By visualizing this loop on a sticky note ([16:17]), the patient realized the pattern and began to disrupt it, leading to significant weight loss and long-term anxiety reduction.

---

Mindfulness: Curiosity and Compassion as Tools

Central to Dr. Brewer's approach is mindfulness, which involves:

1. Awareness: Being conscious of one's thoughts and feelings without judgment ([10:16]).
2. Curiosity: Approaching anxiety with an inquisitive mindset rather than resistance.
3. Compassion: Cultivating kindness towards oneself and others.

Notable Quote:

“Mindfulness is really about being aware of what's happening and bringing a curious, nonjudgmental, compassionate attitude to that.” — Dr. Judson Brewer ([27:24])

Dr. Brewer emphasizes that by paying close attention to anxious thoughts and bodily sensations, individuals can shift their perception from being overwhelmed by worry to exploring their feelings with curiosity. This shift reduces the reward value of worrying, making it less appealing over time.

---

Practical Applications and Personal Stories

The conversation highlights several practical strategies:

• Mapping Habit Loops: Identifying triggers, behaviors, and rewards to understand and disrupt anxiety patterns ([16:17]).
• Mindful Observation: Paying attention to sensations and thoughts without attempting to change them, allowing them to pass naturally ([20:00]).
• Acceptance: Embracing anxiety rather than resisting it, which diminishes its control over one's life ([29:46]).

Dr. Koch shares his personal experience of achieving a state of non-dual self—a profound sense of connection beyond the ego—which significantly reduced his anxiety around death ([39:15]).

---

Transformative Insights and Conclusions

Dr. Brewer's research, including a randomized controlled trial of the Unwinding Anxiety app, demonstrated a 67% reduction in clinically validated anxiety measures by training individuals to be curious and attentive to their anxious states ([29:34]).

He underscores the importance of:

• Leveraging Intrinsic Rewards: Shifting from dopamine-driven behaviors to naturally rewarding practices like curiosity and compassion.
• Expanding the Perception Box: Gradually widening one's mental boundaries by embracing mindfulness practices ([22:54]).

Notable Quote:

“We create these habit loops, we blame ourselves, and that gets in the way of us being able to see them as boxes and then open those doors.” — Dr. Judson Brewer ([37:23])

---

Final Thoughts and Encouragement

The episode concludes with a heartfelt exchange between the hosts and Dr. Brewer, emphasizing the transformative power of mindfulness in overcoming anxiety. Listeners are encouraged to engage with their own perception boxes, map their anxiety loops, and practice curiosity and acceptance to foster greater mental well-being.

Call to Action:

“If you'd like to learn more about your own perception box, spend time this week answering the same Perception Box questions that we asked Dr. Brewer.” — Dr. Heather Berlin ([41:21])

Listeners are invited to subscribe to the Science of Perception Box on YouTube, Spotify, Apple Podcasts, Amazon Music, or their preferred platform to continue exploring ways to redefine their reality through scientific insights.

---

Key Takeaways:

• Anxiety stems from worry about the future, creating harmful habit loops.
• Traditional willpower methods are less effective; understanding and mapping these loops is crucial.
• Mindfulness, characterized by curiosity and compassion, can significantly reduce anxiety by altering the reward value of worrying.
• Practical strategies include mapping habit loops, mindful observation, and acceptance of anxious feelings.
• Personal transformation is achievable through consistent mindfulness practice and self-awareness.

---

Resources Mentioned:

• Dr. Judson Brewer's Books: Unwinding Anxiety, The Craving Mind, The Hunger Habit
• Unwinding Anxiety App: A tool to help manage anxiety through mindfulness techniques.

---

Stay Connected: Subscribe to the Science of Perception Box on unlikelycollaborators.com or your favorite podcast platform to access more episodes and deepen your understanding of how beliefs and neural wiring shape your reality.

Transcript

[Dr. Judson Brewer]

This is actually key for mindfulness in general is. I think of it this way, the feeling body is much stronger than the thinking brain.

[Dr. Heather Berlin]

Hi, I'm Elizabeth Koch. We all live inside our own personal, private perception box built by our genes and the physical, social and cultural environment in which we were born and raised. In this podcast, we explore how although the walls of this mental box are always present, they can exp states like awe, wonder and curiosity, or contract in response to anxiety, fear and anger. I'd like to introduce our esteemed hosts, two incredible and distinguished minds, Dr. Heather Berlin, professor of psychiatry and neuroscience at the Icahn School of medicine at Mount Sinai in New York City. And Dr. Christoph Koch, chief scientist for the Tiny Blue Dot foundation and the current meritorious investigator and former president of the Allen Institute for Brain Science. Welcome to the Science of Perception Box. Hi, everyone, and welcome to Science of Perception Box. I'm your co host, Dr. Heather Berlin.

[Dr. Christoph Koch]

And I'm Dr. Christoph Koch.

[Dr. Heather Berlin]

Welcome to the show. Every week we feature an aspect of the Science of Perception Box, highlighting the latest research together with our expert guests. This week on Science of Perception Box, we're going to explore mindfulness, anxiety and how that works in the brain. But before we bring on our esteemed guest, I wanted to ask you, Christophe, how do you manage your anxiety?

[Dr. Christoph Koch]

I go running, I talk to my dog a lot. I take a hot bath.

[Dr. Heather Berlin]

What does your dog say to you?

[Dr. Christoph Koch]

He communicates a lot to me. Whenever you know there's something upsetting happening, I can just talk to him and he calms me down. He's a burnished mountain dog.

[Dr. Heather Berlin]

Is there something about that particular breed that's anxiety reducing?

[Dr. Christoph Koch]

They're big, they're fuzzy, they're gigantic teddy bears.

[Dr. Heather Berlin]

So oxytocin is released.

[Dr. Christoph Koch]

Oxytocin is released, yes.

[Dr. Heather Berlin]

There's people, too. You can also hug people.

[Dr. Christoph Koch]

You can also hug people, but dogs are different. Okay, Heather, so are you anxiety prone?

[Dr. Heather Berlin]

I do tend to be higher on the dimension of anxiety than, say, the average person. But although I travel a lot and always have my first night in a new hotel room, I really have trouble sleeping. And I've read this actually a common phenomenon because your fight or flight response is sort of triggered. It's a new environment. You're hyper vigilant, you know, anything could happen. And so it's. I always have trouble the first night in a new. In a new hotel.

[Dr. Christoph Koch]

Maybe you should bring a dog along, particularly on the first night.

[Dr. Heather Berlin]

Can I borrow Felix?

[Dr. Christoph Koch]

Mr. Felix?

[Dr. Heather Berlin]

Mr. Felix. Sorry. So let's introduce our guest and I can't think of a more qualified and interesting academic to bring to the show to explore this topic. So today we're thrilled to have Dr. Judson Brewer with us. He studies the neural mechanisms of mindfulness, and he's the director of research and innovation at Brown University's Mindfulness center, where he also is an associate professor at Brown School of Medicine. He's a leading expert in the science of self mastery. He's the guy you basically want to talk to if you want to kick a bad habit, like smoking or a toxic whatever. He's authored Unwinding Anxiety, the Craving Mind, and the Hunger Habit. So welcome to the podcast, Judd.

[Dr. Judson Brewer]

Thanks for having me.

[Dr. Heather Berlin]

Yeah, great for you to be here. So you're basically the guy to talk to you about anxiety. So why don't we just start out by explaining a little bit about how anxiety works in the brain?

[Dr. Judson Brewer]

Well, I wish we knew more about it, but what we do know is that anxiety tends to be this ramping up of kind of fear of the future. And how that works is we have these two very helpful survival mechanisms. One is fear, you know, in the present moment. Like, if you're in a hotel room and you don't know if it's safe or not, you hear some unusual noise, your brain's going to say, hey, what is that? Let's go figure that out. Let's reduce that uncertainty. So fear, a very helpful survival mechanism. And it also helps us learn. So if we step out in the middle of a busy street or something, we almost get hit by a car because we're looking at our phone or something like that. Then we learn, hey, put your phone away. Look both ways before crossing. So fear, very helpful learnings. Survival mechanism in the present moment helps us learn to change behaviors, like looking at our phones when we shouldn't be. And then also, another helpful survival mechanism that probably came along later in evolution is planning. Right? Planning for the future, always very helpful. Don't need to explain that. But the interesting, probably evolutionary bottleneck is when you bring fear and planning together. So think of it as fear, present moment. But fear of the future is actually where anxiety comes from. So this, this anticipatory oh, no, oh, no, oh, no, where we start to worry is not actually planning. It's just getting stuck in a talk track of oh, no, oh no, oh no. And that stuckness actually makes it harder for us to be present and react to what's happening in the present moment, because when we're anxious, it makes our prefrontal cortex go offline so it's ironically, it's harder to think and plan for the future when we're anxious right now. But that's where anxiety seems to come. And from a brain perspective, people have actually looked to see what gets activated. You know, people who are anxious, they feel pretty activated. Well, their brain is pretty activated as well. There's a part of the brain called the default mode network, which is ironically what we default to when we're not doing anything in particular. And people with, say, generalized anxiety disorder, they default to worrying a whole lot. So it's been shown that the more people worry, the more they activate core hubs of this default mode network, like the posterior cingulate cortex.

[Dr. Christoph Koch]

So is that because they think about themselves and think about what might happen here and what might happen there? And they have this, I think you call them, loop, Right? This sort of habit loop?

[Dr. Judson Brewer]

Yes. People can get stuck in these habit loops. And as you're pointing out, Christoph, this network, this default mode network has been now shown to be this self referential network. So when we're thinking about ourselves in the past, when we're thinking about ourselves in the future, even when we're caught up in cravings for substances or even social media, that network gets activated and this loop can form. It's ironic. I never learned this in medical school, but as I was struggling to help my own patients with anxiety, I started to see, going back in the literature, somebody had suggested, this guy, Thomas Blerkovic, had suggested back in the 1980s that these habit loops form through negative reinforcement through this learning process. And the way that it works is that anxiety triggers the mental behavior of worrying, which I often think of behaviors like, oh, I stress eat, I smoke a cigarette, I this or that. Oh, worrying actually counts. And it counts a lot because it can actually drive results and drive other types of behavior.

[Dr. Christoph Koch]

So you're thinking of it as a type of behavior? Yes, although it's not an explicit behavior, it's an implicit behavior of my brain.

[Dr. Judson Brewer]

Yeah. So it's not something that we can, somebody else can see like, oh, you look a little anxious. Are you worrying? And then we can ask, but we can't just peer into somebody's eye and say, oh, you're worrying. Right. So that worrying tends to be this internal thing and that worrying. Interestingly, it's been shown in the literature that it can lead to a distraction from the unpleasant feeling of anxiety. And also, and perhaps more importantly, it can make us feel like we're in control. Now I want to highlight something really important. Worrying doesn't actually give us control. It just makes us feel like we're in control because we're doing something as compared to doing nothing.

[Dr. Heather Berlin]

Well, what's reinforcing about that? Right, so is it. Because the idea here is that somehow the worrying itself will reduce the anxiety, and then you get. And then it's reinforced. How does it actually reduce the anxiety at all?

[Dr. Judson Brewer]

Yeah, so that's a. That's an interesting question. It doesn't actually reduce the anxiety. Paradoxically, it increases the anxiety because it feeds back and says, hey, next time you're anxious, you should worry. So the only way that reinforcement works is that there's gotta be something rewarding for our brain. So that feeling of control may be rewarding enough as compared to just sitting and wallowing in our anxiety.

[Dr. Heather Berlin]

So it is a bit of a distraction or it gives you a bit of a feeling of control. So then how do you break out of that cycle? How do you get a. Because you're imagining. I mean, anxiety is just fear of a potential future threat that might never happen, right? And then you're ruining this present moment by imagining something that's terrible that might never happen. So how do you break that cycle?

[Dr. Judson Brewer]

Let's start with how people have tried to break the cycle and how they all show up in my office because they've struggled with that. So there's this real emphasis in modern age around willpower and individual, like, I'm going to do this. And so there's all, you know, whether it's our parents saying, hey, stop worrying, or us telling ourselves and internalizing that and say, hey, you know, you're anxious. Stop worrying. Well, you know, we can't just flip the switch and like, oh, there's the.

[Dr. Heather Berlin]

Worry switch, flip, flop, or like, depression, like, just stop. Just don't be depressed. Like, what? You know, it doesn't work like that.

[Dr. Judson Brewer]

And then we hear that, what's wrong with you? Right? And so that's what's wrong with us. And then we internalize that as well, and then it feeds more anxiety. So the idea here is that we think that we have a lot of control over our thoughts, over our minds, over our worrying. We don't. And the more we try to push against that worrying, the more it pushes back. I love this term where it's like, what we resist persists, right? And so as we resist our thoughts, as we resist that worrying, the more it persists, the more it pushes back, and the more it also just gets fed into this anxiety loop.

[Dr. Heather Berlin]

So is the idea to accept it, let it wash over you and not try to fight it.

[Dr. Judson Brewer]

Yeah. So what we found is, and it's interestingly, I had been doing a lot of research on habit change, you know, helping people quit smoking, helping people quit overeating, stuff like that. And somebody in one of our eating programs said, hey, can you actually develop a program for anxiety? Because I'm, you know, anxiety is triggering me to eat. And I was thinking prescribed medications, but it put this bug in my ear to look back. And then that's where I found this literature and was like, wow, I wish I'd learned this in residency. And so I said, well, I know something about habit change and maybe we can apply what we're doing to help with the habit of anxiety.

[Dr. Heather Berlin]

So it's almost like anxiety is like an addiction or in a way.

[Dr. Judson Brewer]

In a way, yeah. So I think of addiction, the definition that I learned in residency was like continued use despite adverse consequences. So if we're continuing to use our worrying and it's causing adverse consequences, you know, it could probably fall into that realm. So absolutely it can.

[Dr. Christoph Koch]

It's certainly people know that it's bad, but they still can't stop themselves from worrying.

[Dr. Judson Brewer]

Exactly. And that in that sense it's very similar to other addictions. Right. So they know that it's bad, they know that they can't stop and then they start internalizing there's something wrong with me.

[Dr. Christoph Koch]

And willing just isn't going to do it.

[Dr. Judson Brewer]

I would say willpower is more myth than muscle. You know, if you look from a neuroscience standpoint, behavior change isn't, doesn't rely on willpower. Otherwise, you know, my, my clinical practice would look very different. You know, I just tell all my patients to stop smoking, stop.

[Dr. Christoph Koch]

Well, but on the other hand, there are people like my ex wife, she, the day she learned she was pregnant with our now 40 year old son, she stopped smoking. She was a big smoker before. So some people seem to have what conventionally is called willpower. Is it just something that some people have traits of genetics of a ripe upbringing? But, but most, or at least people who are highly anxious don't and they have to go to other tools?

[Dr. Judson Brewer]

Well, I would say that, and I can't speak for your ex wife, but in situations like that, if you look at the neuroscience, the way we form habits is if something's rewarding, we're going to keep doing it and if it's not rewarding, we're going to stop doing it. So let's bookmark that for a second because what you're Talking about is, in that same paradigm, if something is more rewarding, that's going to supersede the old habit. And so if it's more rewarding, if the, the motivation for a healthy child is stronger than an urge to smoke a cigarette that she can overcome, people can overcome these urges. It's like, this is more important. This is a. I think of this as the bbo, the bigger, better offer. And so they've got that bigger, better offer of somebody who.

[Dr. Heather Berlin]

And it's very immediate, right? Like, whereas a smoker who you think, oh, well, you might die of lung cancer, maybe that's so far off that it doesn't have that impact. Whereas this is like in the moment, you know, a greater good that supersedes it.

[Dr. Christoph Koch]

Well, you're a super achiever. You have two professional graduate degrees, right? So for those three books and three books, right? So for that you have to say, okay, I'm now going to work towards these degrees. I'm going to not do the things that my friends do and have fun because I'm going to study for all these degrees. Right. So what I said is that willpower, is that just the right habit forming?

[Dr. Judson Brewer]

For me, it was just. I loved learning. I was a chemistry major in college. I love these molecules that made up life. Yeah. So I was like, oh, I can, you know, and I can apply some of this research into helping people. And, you know, so it turned out that this MD PhD program was better than just going straight into a PhD for me. And so it was really that. The joy of learning. I was like, oh, I can do this and I can, I can get a stipend to study. Game on.

[Dr. Christoph Koch]

You know, that was a very bigger offer.

[Dr. Judson Brewer]

It was definitely a big.

[Dr. Heather Berlin]

I mean, or you can look at it like it's the alternative source of dopamine, right. Of pleasure, in a way. Because if curiosity is giving you that pleasure and the dopamine, you don't need to get it from, say, the drugs or the partying, you know, it's just an alternative form of pleasure.

[Dr. Judson Brewer]

The one thing I would say here is we need to carefully differentiate dopamine with pleasure. Because I think in the common parlance is that dopamine is a pleasure molecule. It's a. And as you know, it's a motivation molecule. And so in my clinic and also in our research, like, the idea is that dopamine gets us to do something, right? If we're hungry, it gets us off the couch to get some food if we're, you know, whatever. So it's not supposed to be pleasant. It's actually supposed to be unpleasant to light that fire under our butt to get going. So I just want to be clear about that because often people think, oh, dopamine pleasure, as you're saying, it's motivating. And so there can be a joy that comes with learning that can certainly activate some dopamine pathways as we learn. But that motivation feels very different than that itchy, urgy, driven. I have to do this. And I think one thing that's important to highlight here that also relates back to anxiety is those types of dopamine driven habit loops, they become habituated. So we also, we always have to get more and more and more and more.

[Dr. Christoph Koch]

Okay, so let's go, let's leave the brain behind and let's go back to the mind and let's put ourselves in the mind of somebody who has this habit.

[Dr. Heather Berlin]

Yeah, I want to know how to break it. I want to know how to break this habit.

[Dr. Christoph Koch]

And so what happens in the mind now of this person who's worrying because, you know, there's something might happen or may not happen.

[Dr. Judson Brewer]

So let's use a real world example. So I can think of a number of different patients that I have that actually have used this. So one example, a guy comes in 40 years of age, he's. He meets all the criteria for panic disorder and generalized anxiety disorder. So the first thing we did, as I was taking his history, was I was listening for these elements of this habit loop, right? Three key elements. A trigger, a behavior and a result. For him, trigger behavior and result, or from a brain perspective, a reward. Right. So for him, he would get these thoughts like, oh no, I'm going to get in a car accident. And those thoughts would trigger him to avoid driving on the highway. That would help. The reward of that was that he wouldn't get a panic attack on the highway because he'd gotten several and they really freaked him out. And he really thought, you know, if I panic while I'm driving on the highway, I could actually hurt somebody. So the first thing we did in that first session was I literally pulled out a sticky note and wrote trigger behavior result on. And I said, okay, you know, is your trigger thought, these thoughts, your behaviors, this avoidance, and then the result is that you don't get a panic attack. And he said, yeah. So then I drew arrows between the three and his eyes went. I said, well, what did you just realize? And he said, I didn't realize that my brain is doing this. Right. So we mapped out that's the first step in changing this and stepping out of these loops is being able to see what they are, mapping them out.

[Dr. Christoph Koch]

You trigger the behavior that it triggers and then the reward that you get.

[Dr. Heather Berlin]

Yes, but how does that, let's say, how does that relate to me not wanting to be in the hotel room the first night? Right. So let's say that brings uncomfortableness. And then I anticipate that.

[Dr. Christoph Koch]

So I'm like, so what's the trigger there? The trigger is, it's a new environment.

[Dr. Heather Berlin]

New environment, fear that I won't sleep and then I'll be tired the next day for whatever it is I'm there to do.

[Dr. Christoph Koch]

And then the behavior is slowing.

[Dr. Judson Brewer]

Your behavior might be hypervigilance, might be worrying. Those types of things that keep you from sleeping. And then the result is that you don't sleep well.

[Dr. Christoph Koch]

But where's the reward there? Why would the brain do that?

[Dr. Judson Brewer]

So here it was probably rewarded in the past by being hypervigilant in like, oh no, is this a dangerous situation or not?

[Dr. Heather Berlin]

But still, I want to understand how you then break it. So you identify it as one thing, Then what?

[Dr. Judson Brewer]

So let's go through. So the second step here is really leveraging some of the strengths of our brain. So if we know that willpower is more myth and muscle, we don't go there. But we go to the kind of, the older, the stronger parts of the brain, which is where we can actually leverage this reinforcement learning process. And the key there is knowing the cause and effect relationship. If a behavior is rewarding, we're going to keep doing it. If it's not rewarding, we're going to stop. Let me use a simple eating example. My lab's been studying these overeating habit loops. And the idea with overeating is not just telling ourselves to stop. Anybody that's struggled with overeating knows that that's, that's a failed, you know, that's, that's dead on arrival. So instead what we have people do is we have them pay very careful attention as they're overeating and as they notice what it feels like to overeat. Nobody has come back and said, boy, it feels great to overeat. You know, they're like, oh, this is pretty terrible. And what that does is it triggers this learning mechanism on our brain, this reward based learning. When we pay attention, two things can happen. One is we get a positive prediction error if it's more rewarding than expected. And the other is we get a negative prediction error if it's less rewarding than expected. So when we overeat and we pay attention and it's less rewarding than expected, negative prediction error, dopamine fires, we learn, oh, this isn't so good in pragmatic terms. I think of it as we become disenchanted with the behavior. We're less excited to do it in the future.

[Dr. Christoph Koch]

How often does this happen and how powerful does this have to do with to get before it actively curtails my overeating? Is this like year long? Many years. Practice?

[Dr. Judson Brewer]

It's a great question. So in a study that we published relatively recently, ready for this, it took 10 to 15 times of somebody paying attention as they overate. 10 to 15, that reward in a.

[Dr. Christoph Koch]

Week, you're telling me in a week I can reduce the overeating.

[Dr. Judson Brewer]

It could happen in a week. It could happen faster than a week if somebody's really paying attention every time they overeat. It depends on how often they do that. So the key here is the reward value has to drop below zero to shift that behavior right below it being rewarding anymore. And the second piece with that is that they really have to be able to link that up like, oh, this does not feel good. Right. So as they do that, they start to become disenchanted and then it becomes much easier for them. We've got to notice what it feels like in our body. So here a key element, and this is actually key for mindfulness in general, is I think of it this way. The feeling body is much stronger than the thought thinking brain. We can't just say, I shouldn't overeat. Right? This should. It's a whole habit loop unto itself. But it's really feeling like, what does this feel like? And that's what shifts reward value. Right? So 10 to 15 times seems crazy for changing a habit.

[Dr. Christoph Koch]

But if you have it for many years.

[Dr. Judson Brewer]

Yeah, but if you look at, from a survival standpoint, we don't have 20 times to determine whether that's a mountain dog or a mountain lion. Right? We've got to, we've got to run when there's danger, you don't get 20 chances to survive.

[Dr. Heather Berlin]

So what you're saying is basically our body knows is adaptive and we need to be paying attention to the signals that our body is giving us. So I think about this like you're in a movie theater eating popcorn and you're mindlessly eating it and you're watching the movie and then all of a sudden the whole thing is gone. You're like, what did I Just do, I just ate. But if you are focusing your attention on either the. Each piece of popcorn, is it crunchy? How does it taste? What does it feel like?

[Dr. Christoph Koch]

Be mindful.

[Dr. Heather Berlin]

Be mindful while you're eating it and attend to your body signals. Because your body has this whole, you know, normally unconscious processes that are keeping this equilibrium. But I think sometimes we override that. Right. So the idea is to attend to what our body is telling us. Listen to your body. It's like people over exercise. You know, if you're feeling sore the next day, don't go push yourself, do it again. Listen to your body.

[Dr. Christoph Koch]

No pain, no gain.

[Dr. Heather Berlin]

And then you get injuries.

[Dr. Judson Brewer]

Yes.

[Dr. Christoph Koch]

No pain, no gain. So tell me how, if we now return to the hotel room where Heather is lying and she can't sleep, so where would be the negative predictive value there?

[Dr. Judson Brewer]

So the first step is to map out these habit loops. The habit loop of the hotel, for example, could be thoughts of, oh, you know, is this dangerous place?

[Dr. Heather Berlin]

There's also existential angst, like, I'm alone in the world, you're dislocated from your home. There's all those thoughts. But yes, there's a few things that.

[Dr. Judson Brewer]

Can trigger this existential. So let's call it the, the Onk sting.

[Dr. Heather Berlin]

Yes.

[Dr. Judson Brewer]

Where, you know, that actually is activating. It keeps us awake. And then the result of that is don't get good night's sleep. So from a survival standpoint, our brain is asking, is this dangerous or is this different? Right. And so to step out of that, we could be asking questions like, oh, well, grounding ourselves in our body, like noticing it, noticing the thoughts like, oh, here's this, here are these thoughts that are happening. And then we can ask, what am I getting from this? Right. As I angst away all night. And then, you know, check my phone to see how much, how little sleep I'm getting and angst even more. Is this actually helping me? Right. What am I getting from this? So we can feel into it directly like, oh, this is actually making me more activated, more anxious, and we can become disenchanted with that. And then we can also see, you know, this probably isn't going to solve all my life's problems now. And so then we can shift to the third step, which is wait, but.

[Dr. Christoph Koch]

Before we come to that, so you really have to experience this closed state, talking about perception box. This closed state that I'm very anxious. The world I'm concerned, I'm afraid, I'm lonely. But then how do I open the Walls of this. Of this box.

[Dr. Judson Brewer]

Yeah. And just to be clear about that, Christoph. So how does it. We can all do this together. It's like, how does it feel when we're anxious? How does it feel when there's existential. Honest. Does it feel contracted or does it feel expanded? You're nodding. What would you say?

[Dr. Heather Berlin]

Closed.

[Dr. Judson Brewer]

Yeah. Closed down, Contracted. Right. So we can actually even take that and start to ask, well, how does this contracted experience feel? How does getting stuck in this mindset feel? Doesn't feel very good. Not very rewarding. So we can actually leverage that so that we become disenchanted with that as well. And this is where we can then start to step out of it and actually just to bring it back with my patient that I talked about with panic. So he had generalized anxiety, probably had it for about 30 years. And what I sent him home to do in that first visit was just to start mapping out his habit loops or anxiety. I should also mention he was £400. He was at a very unhealthy weight. So he had some health anxiety because he had obstructed sleep apnea, high blood pressure. His liver was very fatty because of the food he was eating. So he comes back and the first thing he says to me is, hey, doc, I lost 14 pounds. And I'm looking at him because we hadn't even talked about weight loss yet. I was going to save that. I said, well, tell me what happened. He said, mapping on my habit loops. And I realized my habit is feel anxious, eat fast food, and then numb myself. Right. So trigger behavior result. And he said, you know what eating fast food was? Actually the other result was it was making me more anxious. It was contributing to my health anxiety. So I got totally disenchanted with that. I don't know if he used that term, but he said, so I stopped eating fast food. He went on to lose over a hundred pounds because he was just total. Like, it was more rewarding to be healthy than to have this temporary relief of eating fast food. And he said it was the easiest weight loss he'd ever had. And he's actually maintained it for years, which a lot of people when they try to force themselves to diet, they'll yo, yo diet, they'll regain that weight.

[Dr. Heather Berlin]

So it's in shifting his perspective and maybe, you know, opening up this perception box. I mean, not being so closed, that helped him change his behavior in a way that shifted the whole habit. It wasn't just a temporary, like, I'm going to go on a diet Right. And then he found that became more rewarding. And it can be painful for people to change a habit. And there does need to be a kind of shift and a reward for something else. Like that shift alone is very difficult for some people.

[Dr. Judson Brewer]

Yes. So I think of this as the third step, and I think of that.

[Dr. Christoph Koch]

As like a meta step. You have to be willing to change your. Your habits. Yeah.

[Dr. Judson Brewer]

And it's interesting you say that because often the willingness comes from the pain that the habit causes. So for my patient, the pain was all this anxiety. And that's actually what he was focusing on first. But then he started to notice the pain of his fast food eating habits. And so there it was actually, you know, just helping him start to see that and become disenchanted with the overeating. And the eating of the fast food was. Was very helpful for him. He. He wasn't. He knew that he needed to lose weight. He didn't know how to do it. And so it was really just seeing that it was more painful to eat fast food than to not eat it, that was the reward that helped him step out of the loop. So I think of that as like this third step is these bigger, better offers. And for some people, it can be simply stepping out of an old habit loop that is more rewarding for others. And I think more generally, we can start to see what are intrinsic behaviors that we can tap into that are probably not dopamine driven, so that they aren't habituating, but are intrinsically rewarding. And I think of two flavors here. And this is also what our research has shown and others has shown as well, is around mindfulness training. Right. It's curiosity, and it's also kindness, compassion.

[Dr. Christoph Koch]

Yes, Curiosity and compassion.

[Dr. Heather Berlin]

So if you're stuck in a habit loop, that's not necessarily externally behavioral, but it's just in the anxiety and the overthinking. And you realize, okay, this isn't doing anything for me, then the switch would be into mindfulness, into, you know, where is that? How do you stop that mental loop of the overthinking?

[Dr. Judson Brewer]

Yeah. So the key elements, and we can talk about mindfulness, but let's talk about the elements of it in case. Mindfulness is a confusing concept for some people. So it's really about being aware of what's happening and also bringing this curious, this nonjudgmental, this compassionate attitude to that. So not saying, oh, this is what's happening. It sucks. Right now, we're keeping ourselves closed in our own perception box of what's happening. But we're really stepping back and going, oh, this is what's happening. And we're even bowing to it. As a teacher, like, what can I learn from this? Right. Really seeing what's happening.

[Dr. Christoph Koch]

So I can learn that those thoughts I don't have to identify myself with. That's not me. I can sort of observe me.

[Dr. Judson Brewer]

And that's a key aspect to it. So noticing. So for example, if we're worrying, so if you're worrying, if you're in a hotel room or if somebody's worrying that, you know, oh, am I going to be anxious all day? We can first, you know, help our brain see what's more rewarding, worrying or being curious about those, those sensations and those thoughts.

[Dr. Heather Berlin]

Right.

[Dr. Judson Brewer]

So to our brains it's a no brainer. Being curious feels better. My lab's done research on this. It's just more rewarding.

[Dr. Heather Berlin]

So you shift your perception from just being in the feelings to, oh, that's an interesting feeling. Let me explore that. Or get curious about that. But also, I like this compassion piece is about opening yourself up and maybe incorporating other people too. Right. So I find that if I'm worrying about something but then I have to go, that I'm helping a patient or I'm doing therapy with someone, I forget about my own problems.

[Dr. Judson Brewer]

Yes. So as you're highlighting it, just connection feels good. Connection literally is expanding beyond our own little like this is me and I'm stuck in this little thing to, oh, this is we, you know, we're working together. And so it can actually be very energizing to bring compassion into our days as compared to being completely focused on ourselves. Like, oh no, am I going to get through today? Oh no. I look at my patient list, oh no, I'm an hour behind in seeing my patients and all of that stuff, all of that keeps us locked, you know, contracted in our worry boxes.

[Dr. Heather Berlin]

Safe potentially.

[Dr. Christoph Koch]

No, that's why it's great to have a dog with you in your bed. You can just hug him.

[Dr. Heather Berlin]

This is Kristof's solution to anxiety. All the world's problems, it's just everyone get a dog.

[Dr. Christoph Koch]

So tell me, so you're really, really putting the finger on. People have to be incredibly attentive to their own state of mind. Right? That's really critical.

[Dr. Judson Brewer]

It is critical. And we found that, you know, in one randomized controlled trial of our unwinding anxiety app, we actually got a 67% reduction in these clinically validated anxiety measures. So by training people to be curious and pay attention, it actually can lead to really significant, clinically relevant results.

[Dr. Heather Berlin]

Does acceptance fall into this as well? So let's say you're feeling anxious. You say, okay, this is me feeling anxiety. Like, this is okay, I'm just gonna have this feeling and let it sit like a distancing. So what about just saying, okay, I'm feeling anxious now I'm just gonna accept this?

[Dr. Judson Brewer]

I think that's key, and that's actually one of the key elements that some people describe as being core to mindfulness training. It's like bringing that acceptance in. And you can think of it this way. There's this great quote attributed to Marcus Aurelius where he says, what stands in the way becomes the way. Or another quote related to that is like, you know, the only way out is through. So we can't avoid things. But if we accept, oh, here's anxiety, then we can learn to be with it. And the paradox here is that we don't have to do anything about these thoughts, about these sensations. The less we do, the more we just be. Learn to be with them, the more they'll come and go on their own. And so pragmatically, one way that I work with my patients to kind of put this into action is to, you know, think of what anxiety feels like, what worrying feels like. It's like this. Oh, no. Oh no. So we're kind of closed down. We're contracted. We're kind of stuck in our box. So if we bring inject some curiosity, we can flip that oh, no to oh, oh, here's a thought. Oh, what does this feel like in my body? And that helps us expand and not be stuck in that box, but really being, you know, be with our experience. And the other part of that. Oh, is we can watch a thought come up, we can watch it go away. We can watch another thought come up. Instead of like, oh, no, there's that anxious thought, oh, no, there, there, I'm worrying again.

[Dr. Heather Berlin]

So it's like incorporating it into. It's expanding this box in a way that incorporates it and allows for it all, and we're not stuck in that.

[Dr. Christoph Koch]

Well, it's also the realization that we live in this, in this perception box. Right. And to accept that and to try to try to explore the boundaries of that and maybe expand them.

[Dr. Judson Brewer]

Right.

[Dr. Christoph Koch]

You keep on talking about expanding, expanding states versus these, in these contracting states. Tell me in your book Unwinding Anxiety, you make this statement. It's less important to worry about the.

[Dr. Judson Brewer]

Why?

[Dr. Christoph Koch]

Because people worry a lot. I know somebody very close. She keeps on Wondering why she's so anxious and trying to go back into early childhood. But you're saying that's not really so relevant.

[Dr. Judson Brewer]

So if you look at it, the short answer is, yes, it's not. And it is often where people get stuck because they think, if I can just find that trigger, I can fix it or avoid it. Well, if it's life, hard to avoid life, and if it's something that we don't have control over, which is most of life, neither of those is going to work. So people get stuck in these rabbit holes of why, why, why, why, why, thinking, if I can figure out why, I can fix it. The other problem there is, if it's something from the past, it's in the past. And I love this saying, forgiveness is giving up hope of a better past, giving up hope of a better past. We've got to let go of the past instead of drag it into the present moment.

[Dr. Christoph Koch]

But how do you let go of your past?

[Dr. Judson Brewer]

So that comes. Herein comes. This second step is, what am I getting from being stuck in this? So it's like, oh, it's. It's heavy. Oh, it's not helping me move forward. All of these things are, you know, it's not rewarding to hold on often to not to hold on to the past. So instead of saying, oh, I need to let go of this, we can say, how is this serving me? What am I getting from this? Oh, nothing. And we bring in that bigger, better offer. So it's both seeing how painful it is, whatever the old habit is, but also finding that bigger, better offer and.

[Dr. Heather Berlin]

Wanting to make the change. I think there has to be that motivation to do that.

[Dr. Judson Brewer]

Absolutely. So as an example, somebody, an early pilot test of our Unwinding anxiety app wrote me an email, and she said, you know, I feel like anxiety is deeply etched in my bones. That's how identified she was with her anxiety. That's how much she had created this very strong box where she's like, I am anxious. And so the idea there is to, like, you're pointing out, recognize, oh, this is actually a box that I've put myself in. You know, there's this Rumi poem, like community of Spirit, where he talks about, you know, we're stuck in our. We put ourselves in jail, basically, where it's like, why do you stay in prison when the door is so wide open?

[Dr. Heather Berlin]

Right.

[Dr. Judson Brewer]

You know, so he even talks about this closeness of putting ourselves in jail. You know, step outside that tangle of worry. Thinking, I think is the quote.

[Dr. Christoph Koch]

But she learned to identify herself with anxiety.

[Dr. Judson Brewer]

Actually, that's where we start, is to see, oh, this is jail that we've put ourselves in. And the door is open, there's a way out. And that. That way out is through awareness, being curious. Oh, look, this is a. This is a box, right? This is a box that I've created. And if I've created it, I can uncreate it. And this box could even be a habit. You know, some of us win the genetic lottery. Some of us get big dogs and hug them a lot. And then for the rest of us, you know, there's this thing feeling like, oh, there's something wrong with me if I have anxiety. Me. Boy, I was pretty anxious in college. I still get anxiety. I used to get panic attacks during residency. I created a fricking program. I wrote a book about anxiety. I still get anxious, right? But it's okay. It's like, okay, here are these feelings of anxiety, and the more I can learn to accept them and be with them and open to them, the more they're going to come and go on their own and not create a problem.

[Dr. Christoph Koch]

Wait, so you're saying you still get anxious, but haven't you mapped out your habit loop and open?

[Dr. Judson Brewer]

Yeah. So this is really critical because often people think that anxiety is something they need to do something about for a habit loop. It's a behavior. And what we tend to fall into the habit of doing is worrying. So that's something they can work with and unwind as. A habit loop is the worrying piece with the anxiety. It's learning to be with it, allow it, open to it, you know, even, you know, embrace it. Like, oh, here it is. As compared to, oh, no, I don't.

[Dr. Heather Berlin]

Want this to bring it back to your patient. Whatever happened with his anxiety.

[Dr. Judson Brewer]

So, as I mentioned, my patient at that second visit was starting to map out these habit loops. He was becoming disenchanted with eating fast food, and at the same time, he was starting to learn to work with his anxiety. I was walking out of our school of public health one day at Brown University. So a pretty busy street. Walk out onto the sidewalk. This guy pulls up, rolls down his window. It's my patient. I'm thinking, great, he's driving, gives me this huge grin, and he goes, hey, doc, I'm an Uber driver now. I'm headed to the airport to pick someone up. So what that highlights is the idea here was that he was learning how to see what his mind was doing, how he was boxing himself in. Oh, I'm an Anxious person. He was learning to map out that as a habit loop and see already expanding that box, like, oh, so it's not me, it's a habit. And then taking that one step farther and saying, oh, by being curious about those sensations, he could not feed the habit, step out of it, and actually lean into it so that he could go along and, you know, move. Move forward in his life.

[Dr. Heather Berlin]

That's a really wonderful story. I mean, just to show how you can really turn things around by changing your perspective and being aware and noticing these habits and learning how to step away from them and break them and become curious.

[Dr. Judson Brewer]

Absolutely. And one thing I just want to highlight here as related to the perception box is that we create these. One, we make them habits. Two, we blame ourselves. Three, which gets in the way of us being able to see them as boxes and then open those doors so that, as Rumi put it, we can, you know, move into whatever widening rings of being.

[Dr. Christoph Koch]

I like that a lot.

[Dr. Heather Berlin]

Well, I thought we would do something that would be kind of fun, is just to ask each other maybe some perception box questions to probe a little bit deeper.

[Dr. Christoph Koch]

Honey, that you asked that.

[Dr. Heather Berlin]

I mean, we have some questions here. We don't know. I don't know what you're going to ask. I have questions I'm going to ask. But I think it would be a fun little exercise for us to, as individuals, probe a little bit deeper and see where. How closed in our boxes are and if we can expand them out. Let me ask a question. If, Judd, if you were able to drop all your identities, what would you be? Who would you be?

[Dr. Judson Brewer]

Nobody. And it would be amazing.

[Dr. Heather Berlin]

So you're comfortable with the infinite nothingness of not having an ego and just being.

[Dr. Judson Brewer]

Well, I'd like to say I'm completely comfortable with it. And that would probably be a big lie. I would say the just seeing how painful it is and how much energy it takes to hold up some ego identity, you know, the more I can look into those, and, boy, I had plenty over. Over the years. It's like, wow, that's painful. That's painful. That's painful. It makes it easier to let go of them and also to see the, you know, the seat to be inspired by people who are truly humble, you know, and seeing how. And then in a moment of humility, how great. Much better that feels than trying to put myself out there in the world.

[Dr. Christoph Koch]

There's something very restful about those people. They sort of spread this atmosphere of just equanimity. And, you know, very quickly, when you interact with them, they're just calm and cool and.

[Dr. Heather Berlin]

Yeah, yeah, there's like a presence of that. Kristoff, for you. Have you ever gone through something that was very upsetting or painful that you later viewed as a blessing?

[Dr. Christoph Koch]

My complete loss of self was absolutely terrifying what happened there. But I ended up in this state of what Buddhists call non dual self where there was no more Kristoff, no more memory, no more body, no more world, no more dreams, desire, memory, no time, no space. But there I was. And it is completely removed most of my anxiety to remove completely all my anxiety around death. I used to sort of lie in bed when you, you know, you can't sleep and you, you worry about what happens after you die and you're dead for a long time or for a really long time. Or for a really, really long time.

[Dr. Heather Berlin]

Yeah, I don't like this idea at all. Yeah, it's just making me anxious.

[Dr. Christoph Koch]

No, it's like looking, you know, I'm a climber. So it's like, you know, looking down at an abyss, but it's bottomless abyss, right. And you freak out, you get this existential vertigo. But I not had since that episode, not a single. Hasn't happened a single night. And because I've experienced egotic death, my ego died. And it was okay, so what is the biggest lie you've ever told about yourself? Funny enough.

[Dr. Heather Berlin]

About myself or yourself?

[Dr. Christoph Koch]

About yourself, to yourself, not to others, to yourself? The biggest story you've told that turned.

[Dr. Heather Berlin]

Out not to be true? I think early on I told myself when I was a child, I had a traumatic upbring, very traumatic at an early age. And one of the things I told myself to protect myself was I don't need anybody. I can do this all on my own. I don't need these people. I don't need. I'm just going to be really independent. And it was a great. It served me well. It was a driver and I was going to be independent. And I work really hard and get all these degrees and I don't, we'll never have to need anybody. But then I realized that, no, you know, you actually do need people. You know, it's not so. It was a lie. I told myself in order to survive being around people who were not serving me well. And in those circumstances it was better to be independent. But as I got older, I realized that that is not, that's not true. I do need people.

[Dr. Christoph Koch]

And cats.

[Dr. Heather Berlin]

And cats and dogs. I'm not going to go as far as dogs. I'll stick with cats. I mean, this has been a really wonderful conversation. Thank you so much for being with us, Dr. Judson Brewer. And if you'd like to learn more about your own percept box, spend time this week answering the same Perception box questions that we asked Dr. Brewer. And check out our other questions on the website unlikely collaborators.com and you can also subscribe to our YouTube channel and watch the show or listen wherever you get your podcast. I'm Dr. Heather Berlin.

[Dr. Christoph Koch]

And I'm Dr. Christoph Koch. Thank you very much.