Dr. Judson Brewer – Making Good Habits A Habit

The expression “no pain, no gain” applies not solely to getting good results at the gym.

Pain is also commonly the big motivator for most of us to start exercising our minds to rid ourselves of problem behaviors and begin to lead happier and healthier lives. Becoming open to trying mindfulness sadly often requires us to hit painful bottom. Denial is over, and continuing the status quo has become unacceptable. no one knows this pattern of behavior better than psychiatrist Judson Brewer MD PhD, one of the world’s foremost experts in mindfulness and the developer of highly effective hand-held technology to help people overcome addictions and anxiety disorders.

He wrote the book on craving (“The Craving Mind: From Cigarettes to Smartphones to Love –Why We Get Hooked and How We Can Break Bad Habits”). His presentation of “a simple way how to break a bad habit” was the fourth most watched TED Talk video of 2016, viewed by 10 million people. Dr. Brewer is the Director of Research at the Center for Mindfulness and associate professor in Medicine and Psychiatry at UMass Medical School. He is also adjunct faculty at Yale University and a research affiliate at MIT.

I remember clearly the first time I meditated. It was my first day of medical school. I had been engaged to be married my senior year at college. At Princeton, they kind of brainwash you to marry your classmates, probably so they can get more annual giving! But it didn’t seem like we should be together the rest of our lives. We broke up just before we both started medical school, and she wasn’t super excited about that. This was a person I had been dating for 3 years and was my best friend, and suddenly she wouldn’t talk to me. Needless to say, this was causing a lot of stress in my life.

Looking for answers, I somehow found Jon Kabat Zinn’s book Full Catastrophe Living, and more importantly, started listening to guided-meditation cassette tapes. It was immediately helpful in helping me sleep better. I would also meditate during boring medical school lectures. I really got into it.

I am one of those “go big or go home” types of people. By the time I finished my MD/Ph.D program 8 years later, I had been meditating and using mindfulness practices daily. I had a teacher and was going on long silent retreats. I was also going for it professionally as well. I shifted my entire career focus from molecular biology to studying mindfulness. People were telling me I was going to kill my career. I told them, I’d rather fail at science doing something I love than succeed at doing stuff that I wasn’t as interested in.”

Nobody was really studying mindfulness at the time, nor was it a career path that anybody would recommend. I could see how useful it was to me and how it directly lined up with my patients’ struggles. I could see how it was filling a gap that modern medicine was not. The pharmacology was not working in particular for people with addictions. And even the behavioral trainings and treatments were largely missing the mark because they were relying on cognitive control-based approaches. It’s well known when we get stressed out, our prefrontal cortex goes offline, and we lose most of our cognitive control. So relying on that part of the brain to help change addictive behavior is not a great strategy.

For example, a lot of people with anxiety have tried all the medications. The ones that are nonaddictive do not work very well for the general populations. SSRI’s like Prozac and Zoloft are often one of the first lines of treatment. Developed for depression, these drugs have only a moderate effect for anxiety. Given the disappointing outcomes, many are willing to look for alternatives, and learning how our minds work is pretty rewarding in itself.

That is our starting point, helping people learn to map their minds. They learn to better understand how their mind works and how they can better work with it. Going through a simple systematic training, they often experience an immediate relief, even if it’s only to a small degree that can be built upon over time. For us, it has been a winning formula. It’s been working.

What is behind much of the habitual actions we do is a reward-based learning system, more specifically the trigger-behavior-reward mechanism. What we’re doing is using mindfulness to specifically target and hack this reward-based learning system. With mindfulness practices, you see clearly how truly unrewarding the old behaviors are—and how much more rewarding and healthier the new ones become.

Technology is making our work easier. The iPhone has been around for over 10 years, and people are pretty comfortable with app-based training at this point. We have doctors and therapists using the products we’ve developed for themselves and when they see that it works for them, are then turning around and recommending them to their patients. It’s a really fun challenge to figure out how we can deliver app-based mindfulness training in a way that it’s sticky enough on the first day that they say, “Wow, I want to keep doing this.” For example, on average, in one study we found that people used our mindful eating app for stress emotional and binge eating (Eat Right Now) twice a day for an average of 12 minutes daily, which is remarkable for something that’s not Facebook or gamified like Angry Birds. It’s aimed to help people understand how painful their life has been—and they’re still coming back because they’re seeing relief from it.

One noteworthy success story using these digital therapeutic tools was a man in his mid-60s who was referred to me for alcohol use disorder. He had been consuming 6-8 drinks a night over a long time. It was causing him problems. He was getting hangovers. He was not getting his work done, and drinking itself was costing him a lot of money. He had mentioned something about how he was anxious as well.

At our first visit, I taught him about the triggerbehavior-reward piece and gave him our app-based anxiety program (Unwinding Anxiety). I asked him to just start going through the program and notice if there was anything that he was learning. When he came back the next week, he told me, “oh my gosh, I realized that I’m drinking as a way to work with my anxiety.” So, his trigger was anxiety, the behavior was the 6-8 drinks and the reward was temporary relief from the anxiety.

When he came back a few weeks later, he told me that he had quit drinking. “It’s not worth it,” he told me, “this drinking is not doing it for me.” It was exactly what the Unwinding Anxiety program trained him to do—to notice the “non-reward” of the old behavior by simply bringing awareness to it. During the third visit he told me, “I can actually use this to work on my anxiety.” He was now sober and his anxiety had dropped by 80 percent. “I’m noticing my habit, and I’m able to use mindfulness to ride it out.”

He came back the fourth time and told me, “My wife was traveling, and when she came back, I noticed how my anxiety was due to my interactions with her. and I realized I was contributing to it.” She would speak excitedly and would cause him to feel anxious. The trigger was she would speak excitedly—the behavior was to tell her to quiet down—and the reward was she would basically do as he asked. He realized this was also causing friction in their relationship. “I hadn’t realized this. Instead of me reacting to tell her to quiet down, I would just notice and get curious about the anxiety in my body, and then it quieted down, and my wife didn’t have to.” His anxiety had gone from an 80 or 90 to a 20 and back up to a 40 with his wife, and then back down to a 20 after he realized he was a contributor to the anxiety. Not that he’s perfect. He’s had his slips ups now and then. But he’s got the fundamental tools to deal with it.

Another patient with a binge-eating disorder, a 30-year-old morbidly obese woman, had a similarly remarkable result from using mindfulness to overcome her problem. Her mother started emotionally abusing her when she was about 8 years old. What she learned was she could eat to numb herself from those really intense, unpleasant emotions. By the time she came to see me, she was eating an entire large pizza at one sitting, sometimes more than once a day, at least 20 out of 30 days a month. You can think of the trigger as an unpleasant emotion, the behavior being binge eating and the reward was this numbing out. She went through our Eat Right Now program and learned how to work with all of this. Long story short, she went through the program for 6 months. Four months later, I saw her and she had lost 40 pounds. Most impressively, she told me, “I want to thank you because I feel like I have my life back. I can eat a single piece of pizza and actually enjoy it.” She was basically saying that food is not the enemy. She broke a whole bunch of habit loops, like how when she binged, she felt bad and would beat herself up, which would lead to more binges. Her mindfulness practice led to self-kindness, which felt a lot better than self-judgment.

Compared to when I started, mindfulness has become very popular right now. A lot of people have jumped on the bandwagon to get in on the market, pitching their approaches to improve our sex lives and workplace relationships and other nice sounding fixes. “Follow your breath for 10 minutes, and magic will happen” is often how mindfulness is pitched or hyped. Do it for 20 minutes, maybe rainbows and unicorns will fly out your rear end! So, one of the big challenges is to help consumers wade through all the mindfulness products that are out there now and find good evidence-based training that’s really going to help them versus just lightening their wallet.

The excitement for me comes in the form of marrying these ancient practices with modern day technology where we start to deliver these tools through your phone. From our experience to date, these programs actually work, amazingly. With smartphone based platforms, we now can reach underserved populations who might not otherwise have good access to healthcare. We can also make it affordable, at the same time as maintaining the high fidelity that is really critical for evidence-based treatments and the emerging field of medicine, called digital therapeutics, that these apps are part of. Who knew that we’d be using mindfulness to hack reward-based learning pathways and ironically delivering this through a technology that in itself can be addictive. I guess our next digital therapeutic will need to be for smartphone addiction.

Dr. Judson Brewer is a member of the GIFT Global Advisory Board. 

For more information on Jud Brewer and his work. please visit – 

www.judsonbrewer.com

www.unwindinganxiety.com

www.goeatrightnow.com

TedTalk – A Simple Way To Break A Bad Habit – over 10,000,000 views on Ted.com.

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By |2018-08-07T12:48:12+00:00June 29th, 2018|