How Curiosity Quiets Anxiety with Dr. Judson Brewer

Anxiety can make us feel like we’re trapped in our brain. So how do we open the door and gain freedom? This week in our inaugural episode, Dr. Heather Berlin and Dr. Christof Koch invite Dr. Judson Brewer to discuss the habit loops that increase anxiety, why anxiety contracts our Perception Box, and what steps we can take to change our relationship with anxiety and understand its evolutionary benefit. Dr. Judson Brewer studies the neural mechanisms of mindfulness. He is the Director of Research and Innovation at Brown University’s Mindfulness Center, where he’s also an Associate Professor at the School of Medicine. Dr. Brewer is a leading expert in the science of self-mastery and breaking habits. His books include Unwinding Anxiety, The Craving Mind, and The Hunger Habit. Dr. Heather Berlin is a neuroscientist, clinical psychologist, and Professor of Psychiatry and Neuroscience at the Icahn School of Medicine at Mount Sinai in New York City. Dr. Christof Koch is Chief Scientist for the Tiny Blue Dot Foundation and the current Meritorious Investigator and former President of the Allen Institute for Brain Science. Join us for new episodes every Thursday. Follow the show on YouTube, Spotify, Apple Podcasts, Amazon Music, or wherever podcasts are found. Love the show? Write us a review on your podcast app, or tell a friend about the show. Visit unlikelycollaborators.com for more information. Episode Chapters: (00:00) - Introduction (02:45) - Dr. Judson Brewer (05:54) - Habit Loops of Anxiety (08:16) - Breaking the Worry Cycle (10:52) - Will Power is a Myth (14:40) - Trigger, Behavior & Result (17:06) - Breaking Overeating Habit Loops (19:48) - The Feeling Body (22:40) - Opening the Perception Box (25:09) - Bigger Better Offers (28:01) - Curiosity, Compassion and Perception (31:40) - How Anxiety Can Box You In (35:14) - Learning to Allow Anxiety (36:05) - We Create Our Perception Boxes (37:40) - Perception Box Questions

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Speaker 00

  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.

• 0:08Speaker 01

  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 expand in states like awe, wonder and curiosity, or contract in response to anxiety, fear and anger. I'd like to introduce our esteemed hosts to incredible and distinguished minds. Dr. Heather Berlin, Professor of Psychiatry and Neuroscience

• 0:51Speaker 01

  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.

• 1:14Heather Berlin?

  Hi, everyone, and welcome to Science of Perception Box. I'm your co-host, Dr. Heather Berlin.

• 1:19Speaker 03

  And I'm Dr. Christoph Koch.

• 1:21Heather 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, Christoph, how do you manage your anxiety?

• 1:42Speaker 03

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

• 1:46Heather Berlin?

  What does your dog say to you?

• 1:47Speaker 03

  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 Bernis Mountain Dog.

• 1:56Heather Berlin?

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

• 2:00Speaker 03

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

• 2:02Heather Berlin?

  So oxytocin is...

• 2:04Speaker 03

  Oxytocin is, yes.

• 2:05Heather Berlin?

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

• 2:07Speaker 03

  You can also hug people, yes, but dogs are different.

• 2:12Speaker 03

  Heather, so are you anxiety prone?

• 2:15Heather 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.

• 2:37Speaker 03

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

• 2:39Heather Berlin?

  Can I borrow Felix?

• 2:40Speaker 03

  Mr. Felix.

• 2:41Heather 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 toxic, whatever. He's authored Unwinding Anxiety, The Craving Mind and The Hunger Habit. So welcome to the podcast, Jud.

• 3:22Speaker 00

  Thanks for having me.

• 3:23Heather Berlin?

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

• 3:33Speaker 00

  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 are a very helpful survival mechanism and it also helps us learn, you know? 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 learning survival mechanism in the present moment,

• 4:17Speaker 00

  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 of present moment, but fear of the future is actually where anxiety comes from. So 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.

• 5:02Speaker 00

  Because when we're anxious, it makes our prefrontal cortex go offline. So 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 from. And from a brain perspective, people have actually looked to see what gets activated. 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.

• 5:46Speaker 03

  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.

• 5:55Speaker 00

  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 Blorkevic, 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

• 6:37Speaker 00

  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.

• 6:51Speaker 03

  So you're thinking of it as a type of behavior?

• 6:53Speaker 00

  Yes.

• 6:54Speaker 03

  Although it's not an explicit behavior, it's an implicit behavior of my brain.

• 6:58Speaker 00

  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, we can't just peer into somebody's eye and say, oh, you're worrying, right? So that worrying tends to be this in 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.

• 7:34Heather 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 or?

• 7:47Speaker 00

  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 got to 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.

• 8:10Heather 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 and your 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?

• 8:29Speaker 00

  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 gonna do this. And so there's all, whether it's our parents saying, hey, stop worrying, or us telling ourselves and internalizing that and say, hey, you're anxious, stop worrying. Well, we can't just flip the switch and like, oh, there's the worry switch.

• 8:56Heather Berlin?

  Or like oppression, like just don't be depressed. Like, well, you know, it just doesn't work like that.

• 9:01Speaker 00

  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.

• 9:33Heather Berlin?

  So is the idea to accept it? Let it wash over you and not try to fight it?

• 9:38Speaker 00

  Yeah. So what we found is, and it's interestingly, I had been doing a lot of research on habit change, 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 anxiety is triggering me to eat. And I was thinking, prescribe medications. But it put this bug in my ear to look back. And then that's where I found this literature. And I 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.

• 10:16Heather Berlin?

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

• 10:19Speaker 00

  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's

• 10:35Speaker 03

  People know that it's bad, but they still can't stop them. Himself from worrying.

• 10:40Speaker 00

  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.

• 10:49Speaker 03

  And willing just isn't gonna do it.

• 10:51Speaker 00

  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.

• 11:04Speaker 03

  Well, but on the other hand, there are people like my ex-wife, she, the day she learned she was pregnant with our now forty 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 or their upbringing? But, but most, or at least people who are highly anxious, don't, and they have to go to other tools?

• 11:30Speaker 00

  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 gonna keep doing it. And if it's not rewarding, we're gonna 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 gonna 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, I, I, 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, you know, somebody.

• 12:14Heather 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.

• 12:27Speaker 03

  Well, you're a super achiever. You have two professional graduate degrees, right? So for those.

• 12:34Heather Berlin?

  And three books.

• 12:34Speaker 03

  And three books. I too, for that, you have to say, okay, I'm now gonna work towards these degrees. I'm gonna not do the things that my friends do and have fun, because I'm gonna study for all these degrees, right? So.

• 12:47Speaker 03

  Well, what is that? Is that willpower? Is that just the right habit forming?

• 12:50Speaker 00

  For me, it was just, I love learning. I was a chemistry major in college. I love these molecules that made up life.

• 12:56Speaker 03

  God, you're a nerd.

• 12:57Speaker 00

  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, I can do this and I can, I can get a stipend to study. Game on.

• 13:17Speaker 03

  It was a bigger offer.

• 13:19Speaker 00

  It was definitely a big.

• 13:20Heather 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.

• 13:34Speaker 00

  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.

• 14:10Heather Berlin?

  Yeah.

• 14:11Speaker 00

  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, urgey, 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.

• 14:36Speaker 03

  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.

• 14:44Heather Berlin?

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

• 14:47Speaker 03

  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.

• 14:54Speaker 00

  So let's use a real example. So I can think of a number of different patients that I have that that actually have used this. So one example, a guy comes in forty years of age. He's he's 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.

• 15:21Speaker 03

  Trigger, behavior.

• 15:23Speaker 00

  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 it. And I said, okay, you know, is your trigger thought these thoughts, your behavior is 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?

• 16:07Speaker 00

  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.

• 16:17Speaker 03

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

• 16:21Speaker 00

  Yes.

• 16:21Heather Berlin?

  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. So I'm like.

• 16:31Speaker 03

  What's a trigger there? The trigger is it's a new environment.

• 16:34Speaker 00

  New environment.

• 16:35Heather Berlin?

  Fear that I won't sleep.

• 16:36Speaker 00

  Right.

• 16:36Heather Berlin?

  And then I'll be tired the next day for whatever it is I'm there to do.

• 16:40Speaker 03

  And then the behavior is wrong.

• 16:42Speaker 00

  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.

• 16:51Speaker 03

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

• 16:55Speaker 00

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

• 17:03Heather Berlin?

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

• 17:10Speaker 00

  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 than 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, you know, 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

• 17:54Speaker 00

  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 in 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.

• 18:39Speaker 03

  How often does this happen? And how powerful does this have to do to get before it actively curtails my overeating? Is this like year long, many years practice?

• 18:49Speaker 00

  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.

• 19:00Speaker 03

  You're telling me in a week, I can reduce my overeating?

• 19:04Speaker 00

  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, and 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 thinking brain. We can't just say, I shouldn't overeat, right?

• 19:48Speaker 00

  The shoulds, it's a whole habit loop on to 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.

• 20:00Speaker 03

  Well, even if you have it for many years.

• 20:01Speaker 00

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

• 20:14Heather Berlin?

  So what you're saying is basically our, 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. Like, what did I just do? I 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?

• 20:39Speaker 03

  Be mindful.

• 20:40Heather Berlin?

  Be mindful while you're eating it and attend to your body signals. Cause 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.

• 21:01Speaker 03

  No pain, no gain.

• 21:04Heather Berlin?

  And then you get injuries.

• 21:05Speaker 00

  Yes.

• 21:05Speaker 03

  No, no gain. So tell me, how do, if we now return to the hotel room?

• 21:09Speaker 00

  Yeah.

• 21:10Speaker 03

  Where Heather is lying and she can't sleep. So where would be the negative predictive value there?

• 21:15Speaker 00

  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?

• 21:22Heather 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.

• 21:29Speaker 00

  Few things that can trigger this existential. So let's call it the onk sting.

• 21:34Heather Berlin?

  Yes.

• 21:34Speaker 00

  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 onked away all night and then, you know, check my phone to see how much, how little sleep I'm getting and onked 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.

• 22:16Speaker 00

  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.

• 22:26Speaker 03

  Wait, but 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?

• 22:41Speaker 00

  Yeah. And just to be clear about that, Chris, 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 angst? Does it feel contracted or does it feel expanded? You're nodding. What would you say?

• 22:54Heather Berlin?

  Closed.

• 22:55Speaker 00

  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, 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 around anxiety. I should also mention, he was 400 pounds. He was at a very unhealthy weight. So he had some health anxiety because he had obstructive

• 23:39Speaker 00

  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 looking at him, because we hadn't even talked about weight loss yet, I was going to save that. And I said, well, tell me what happened. He said, I'm mapping out my habit loops. And I realized my habit is feel anxious, eat fast food, and then numb myself. Right? So trigger behavior results. 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 100 pounds because

• 24:22Speaker 00

  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.

• 24:40Heather Berlin?

  So it was in shifting his perspective and maybe, you know, opening up this perception box and 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.

• 25:05Speaker 00

  Yeah. So I think of this as the third step. And I think of that as

• 25:10Speaker 03

  Like a meta step. You have to be willing to change your habits.

• 25:15Speaker 00

  Yeah. 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 very helpful for him. 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 that was the reward that helped him step out of the loop. So I think of that as

• 25:59Speaker 00

  like the 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.

• 26:32Speaker 03

  Compassion.

• 26:32Speaker 00

  Yes.

• 26:33Speaker 03

  So it's also compassion.

• 26:34Heather 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, what, where is that? How do you stop that mental loop of the overthinking?

• 26:51Speaker 00

  Yeah. So the key elements, and we can talk about mindfulness, or let's talk about the 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 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.

• 27:24Speaker 03

  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.

• 27:30Speaker 00

  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 sensations and those thoughts, right? 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.

• 27:58Heather 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, then I'm helping a patient or I'm doing therapy with someone, I forget about my own problems.

• 28:20Speaker 00

  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 be, bring compassion into our days as compared to be 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, you know, 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.

• 28:53Heather Berlin?

  Or safe.

• 28:54Speaker 03

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

• 28:59Heather Berlin?

  This is Kristoff's solution to anxiety. All the world's problems. It's just everyone get a dog.

• 29:05Speaker 03

  So Tommy, so you're really putting the thing on, people have to be incredibly attentive to their own state of mind, right? That's really critical.

• 29:14Speaker 00

  It is critical. And we've 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.

• 29:34Heather 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 going to have this feeling and let it sit.

• 29:42Speaker 03

  Like a distancing.

• 29:43Heather Berlin?

  So what about just saying, okay, I'm feeling anxious now. I'm just going to accept this.

• 29:46Speaker 00

  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 are just be learn to be with them, the more they'll come and go on their own.

• 30:25Speaker 00

  And so pragmatically, one way that I work with my patients to to 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.

• 31:08Heather 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.

• 31:15Speaker 03

  Well, it's also the the realization that we live in this this in this perception box, right? And to accept that and to try to to try to explore the boundaries of that and maybe expand them. Right? You keep on talking about expanding these expanding states versus these these contracting states. Tell me, in your book, Unworrying Anxiety, you make this this statement. It's less important to worry about the why, 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.

• 31:52Speaker 00

  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 dragging into the present moment.

• 32:32Speaker 03

  But how do you let go of your past?

• 32:35Speaker 00

  So that comes, herein comes the 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 sort of mean? 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.

• 33:07Heather Berlin?

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

• 33:11Speaker 00

  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 Immunity of Spirit, where he talks about, you know,

• 33:47Speaker 00

  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? 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.

• 34:03Speaker 03

  But she'd learned to identify herself.

• 34:05Speaker 00

  Exactly. Actually, that's where we start is to see, oh, this is jail that we've put ourselves in and the door is open.

• 34:12Heather Berlin?

  There's a way out.

• 34:13Speaker 00

  And that, that way out is through awareness, being curious. Oh, look, this is a, this is a box.

• 34:19Heather Berlin?

  Right.

• 34:20Speaker 00

  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, it, there's this 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, you know, 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.

• 34:59Speaker 03

  No, no, wait. So you're saying you still get anxious, but haven't you mapped out your habit loop and, and.

• 35:05Heather Berlin?

  But the feeling can still arise.

• 35:08Speaker 00

  Yeah. So these are, 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 that 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 want this.

• 35:36Heather Berlin?

  So bring a fact to your patient, whatever happened with his anxiety?

• 35:39Speaker 00

  So as I mentioned, my, you know, 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 it's a pretty busy street. Well, I got on 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.

• 36:08Heather Berlin?

  Wow.

• 36:09Speaker 00

  So that what that highlights is, you know, the idea here was that he was learning how to see what his mind was doing, how he was boxing himself in. Right? Oh, I'm an anxious person. He was learning to map out that as a habit loop and see already expanding that box. It's like, oh, 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 forward in his life.

• 36:44Heather 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.

• 36:55Speaker 00

  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 ever widening rings of being.

• 37:23Speaker 03

  I like that a lot.

• 37:29Heather 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.

• 37:38Speaker 03

  Honey, you had to ask that.

• 37:39Heather Berlin?

  I mean, we have some questions here. We don't know. I don't know what you're gonna ask. I have questions I'm gonna 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 of Judd. If you were able to drop all your identities, what would you be? Who would you be?

• 38:06Speaker 00

  Nobody. And it would be amazing.

• 38:09Heather Berlin?

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

• 38:14Speaker 00

  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 of them 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, to be inspired by people who are truly humble, you know, and seeing how, and then in a moment of humility, how much better that feels than trying to put myself out there in the world.

• 38:52Speaker 03

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

• 39:02Heather 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?

• 39:15Speaker 03

  My complete loss of self. It was absolutely terrifying, what happened there. But I ended up in this state of, 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 has completely removed most of my anxiety. It removed completely all my anxiety around death. I used to sort of lie in bed when, 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, for really, really long time.

• 39:53Heather Berlin?

  Yeah, I don't like this idea at all.

• 39:54Speaker 03

  Yeah.

• 39:54Heather Berlin?

  It's just making me anxious.

• 39:56Speaker 03

  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. And you, you freak out, you get this existential vertigo. But I not have since, I've never not a single, it hasn't happened a single night. And, and because I've experienced egotic death, my, my ego died and it was okay. So what is the biggest lie you've ever told about yourself, funny enough?

• 40:21Heather Berlin?

  About myself or?

• 40:22Speaker 03

  About yourself, about yourself, to yourself, not to others, to yourself.

• 40:26Heather Berlin?

  Oh, God.

• 40:27Speaker 03

  The biggest story you've told that turns out not.

• 40:30Heather Berlin?

  Not to be true or?

• 40:31Speaker 03

  Not true.

• 40:32Heather Berlin?

  I think early on, I told myself, um, when I was a child, I had a traumatic upbringing, um, 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, it was a driver and I was going to be independent and I worked really hard and get all these degrees and I don't, will never have to need anybody. And it, but then I realized that, no, you know, you actually do need people, you know? It's not, it's so, and it was a lie I told myself in order to survive being around people who were not serving me well. Um, and in those circumstances, it was better to be, you know, independent, but.

• 41:15Heather Berlin?

  As I got older, I realized that that is not, you know, that's not true. I do need people.

• 41:21Speaker 03

  And cats.

• 41:22Heather Berlin?

  And cats.

• 41:23Speaker 03

  And dogs.

• 41:24Heather Berlin?

  I'm not going to go as far as dogs. I'll stick with cats.

• 41:29Heather Berlin?

  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 perception 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, unlikelycollaborators.com. And you can also subscribe to our YouTube channel and watch the show or listen wherever you get your podcasts. So I'm Dr. Heather Berlin.

• 41:57Speaker 03

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