- Colleges and universities all over the United States are facing a wave of students suffering from depression and anxiety heightened by the last year and a half of the pandemic.

Today's guest says there are things everyone can do to be more mindful, to break bad habits, and to be happier.

He's Dr. Jud Brewer, this week on "Story in the Public Square."

(upbeat music) Hello, and welcome to "Story in the Public Square," where storytelling meets public affairs.

I'm Jim Ludes from the the Pell Center at Salve Regina University.

- And I'm G. Wayne Miller with The Providence Journal.

- Each week, we talk about big issues with great guests: scholars, journalists, authors, and more to make sense of the stories shaping public life in the United States today.

This week, we're joined by Dr. Jud Brewer, a neuroscientist and mindfulness expert on the faculty of Brown University, who's also the author of "Unwinding Anxiety."

New science shows how to break the cycles of worry and fear to heal your mind.

Jud, thank you so much for being with us.

- Thanks for having me.

- So there's a lot we wanna talk with you about, but I think for those who maybe are unfamiliar with it, maybe you could tell us a little bit about exactly what is mindfulness.

- Mindfulness is really about bringing two elements of experience together.

One is awareness, where we're aware of something, and another is an attitudinal quality of curiosity or non-judgment, where we're really bringing a fresh look at whatever's happening in this moment.

- Is there, is there a, so I think for some folks, when they hear about mindfulness, it has sort of a New Agey feel to it.

Is it born of that movement, or is there science behind it?

- There's a lot of science behind it.

So you know, it's not about rainbows and unicorns.

It's really about awareness and helping us understand how our minds work, and there's quite a bit of science.

You know, starting back in the '70s with Jon Kabat-Zinn forming this scientifically validated mindfulness-based stress reduction program that built a whole movement of research around these types of clinical programs as well as looking at the neuroscience and the behavioral science of how mindfulness helps people with everything from coping with anxiety to changing bad habits.

- So when you use the term awareness, what does that mean exactly?

Again, for those in our audience who might not be familiar with mindfulness or meditation.

What is awareness?

- It's simply being aware of something.

So for example, if somebody's talking, and we're not paying attention, we're not aware of them talking, or we are paying attention, we're aware of them talking, as an example.

So it's really that simple.

- So it's really living in the moment.

Is that not another way to describe that, to being there, to being present?

- Yes.

I think living in the moment, being present in the moment, is important, but we can, (chuckles) here's where the attitudinal quality comes in.

If we're paying attention and we're living in the moment, and we're thinking, "Man, this sucks.

(laughing) I don't wanna be here."

(G. Wayne laughing) That's not mindfulness.

Mindfulness is really about, "Okay, here's what's coming up right now in my experience," whether it's a thought, an emotion, a body sensation or whatever is happening in my environment, "and we're rolling with it," as compared to resisting it.

- So mindfulness has a very long tradition, and really an ancient tradition if you go to certain Eastern religions and traditions there.

Talk about that.

I mean, you obviously, and your fellow practitioners and researchers have brought science, you know, contemporary science to it, but long before there was contemporary science, mindfulness and meditation were very important to many people on the planet.

Talk about the roots of mindfulness.

- Yes, I think many spiritual traditions have contemplative elements in them, and often, you know, they're not highlighted as much in modern religious circles, but you know, every known religious movement, for example, or religion has some contemplative elements, so you know, whether it's Christian, whether it's Jewish, whether it's Muslim, and the underpinnings of mindfulness really date back 2,500 years to the ancient Buddhist practices where, you know, at the time of this historical Buddha, people were meditating.

You know, the Upanishads and others were still meditating, and he just took an element of it, where he focused on the causes of suffering and helping us understand how we're actually adding to our own suffering, and that if we can understand how our minds work, we can actually work with our minds to work with the suffering element, so it involves meditation as a way to start to be able to zoom in and notice what our minds are doing, but the main difference there with other types of meditation, at least of the time, were around really seeing these relationships in our minds and how our minds relate to our bodies and how thoughts can lead to emotions, and then we can get caught up in all of these things and really suffer as a result of that.

- Jud, what, you know, we live in a hyper-connected, stressed-out world where everybody's, you know, over-committed and overwhelmed, particularly, I think, in the last 15, 16, 17 months.

Obviously, the pandemic has introduced a whole new level of stresses in our lives.

If we were more mindful, if we were more mindful in our relationships and in our daily interactions with other people and with ourselves, what could we hope to achieve?

Well, I think we could hope to achieve basically less stress (laughs) and more connectedness, where we could start to see, and we can also start to see where we've formed unhelpful habits, so especially in this pandemic, where there's been a huge rise in anxiety, as an example.

A lotta people have formed unhealthy habits like binging on Netflix or binging at their, you know, in their kitchen because now, they're working from home, or spending a lot of time doom-scrolling, you know, looking at the news, and so we could start to see where we're kinda getting caught up in unhelpful habits and be able to dial it back and be able to work with our minds so that we can step out of those processes.

- So we wanna get into your work in these various bad habits, and we will in just a moment, but sort of frame this in terms of the popularity of apps and programs, your own, obviously, and we're gonna get into them, as I just said, but you know, there's Headspace.

There's Calm.

My empirical observation is that certainly, in the last 18 months, these have become increasingly popular.

Do you agree with that?

And why do you think that is?

- Well, I think largely on the heels of a lot of the science that's been, you know, building over the last decade, a lot of meditation apps have been born and have become very, very popular, and I think because of the ready accessibility to these things, you know, most people have smartphones in the US, for example.

People can access these practices much more easily and affordably than they could be offered previously, where somebody had to go to a, see a meditation teacher or go on a retreat or attend, you know, an in-person class, so I think just the availability of these digital frameworks has helped tremendously.

I even see this in my own psychiatric clinic where you know, I can see patients virtually without the risk of spreading, you know, COVID as an example.

- So let's get into anxiety, which is the subject, the main subject of your last book.

Talk about how mindfulness helps in a general sense, but also practically speaking.

Give us that overview.

- I'd be happy to.

So if we think about anxiety, you know, which is typically this feeling of nervousness or unease about an imminent event or something with an uncertain outcome, (chuckles) we certain had a lot of uncertain outcomes, you know.

- [G. Wayne] (laughs) You think?

(Judson laughing) Yeah, really.

- So we can see, yeah, we can see where anxiety has spiked over the last year, you know, all sorts of uncertainty.

I don't need to go into a list of details there, but what we can understand from a neuroscientific standpoint is that our minds, they're really trying to help us survive in several ways.

One is through kind of predicting the future, and we can only predict the future based on past events and accurate information.

So lot of things haven't happened in the past in our lifetimes, and so our brains don't have that past experience to draw from.

We also have, you know, it's hard to get accurate information in realtime when something is unfolding.

You know, let's say, you know, with the beginning of the pandemic, people had no idea what this virus was like.

You know, I for one was leaving my UPS packages out on the porch for three to four days (laughing) because I didn't know!

(laughing) You know.

- Yeah, nobody knew.

Nobody knew.

- Yeah, absolutely, so that uncertainty, you can think of fear being a helpful survival mechanism, right, but fear helps us react in realtime.

If you think of fear plus uncertainty, that leads to anxiety because it's basically fear of the future, so with that as a framework, what mindfulness helps us do is kind of dial it back.

As our mind wants to run off into the future and think, "Oh, no," you know, "What might happen?"

As we start to worry about all the bad, you know, the worst-case scenarios, mindfulness can help us dial it back into the present moment.

You know, it's kind of like my patients who struggle with alcohol use disorder, for example.

The saying in AA is, "One day at a time."

Well, with mindfulness, you can think of it as one moment at a time, and if we're kind of addicted to worrying, we can kind of dial it back and say, "Do I really need to know what might happen in a month?

Let me dial that back to a week.

Let me dial that back to a day.

Let me dial that back to right now.

What do I need to know right now?"

And right now, there's a whole lot less uncertainty than, you know, than looking a month out, and that awareness practice there can really help us dial it back and reduce the uncertainty as well as reduce the anxiety just from being aware.

- But- - And how does the?

Go ahead, Jim.

- How does that, how does that approach, how does mindfulness fit with other therapies for anxiety disorder, whether it's cognitive behavioral therapy or, you know, a pharmaceutical intervention?

- Well, as a psychiatrist, I prescribe medications for anxiety.

We can think of these in several ways.

One is just how efficacious they are.

So for example, with medications, the best medications, there's this term "number needed to treat," how many people you need to give a treatment to before one person shows a significant benefit.

With medications, unfortunately, that number is 5.2, so I have to prescribe medication to five people before one person shows a significant benefit.

So you know, we haven't quite nailed it yet in terms of the pharmaceutical industry really helping people with anxiety.

With cognitive behavioral therapy, there's this saying that what I learned in residency was, "Catch it, check it, change it."

So if you then catch a cognition, which is very similar to mindfulness.

You've gotta be aware of a cognition before you can work with it.

With cognitive behavioral therapy, the idea is to check it to see, you know, is it real?

Is it true?

Is it accurate?

And from there, change it to a cognition that's more helpful in the situation.

Mindfulness is slightly different than cognitive behavioral therapy in the sense that instead of changing our thoughts or changing our cognitions, it's really changing our relationship to them, so how am I relating to this thought?

Am I getting caught up in this thought?

Am I getting caught up in this worry?

And can I actually change my relationship so that I can learn to be with it?

Oh, here's a thought, and instead of, you know, being, you know, taken and pulled by it, I can actually observe it.

You know, it's interesting.

In physics, they have this thing called the observer effect.

This was identified when they were trying to measure the mass of electrons, I believe, and they would have to hit them with photons to measure the mass, and they found that they were, they had to take into account the mass of the photon because it was affecting the mass of the electron.

I think in the same way, mindfulness, being aware of something, so let's say we have a thought, and we're identified with that thought.

By observing that thought, "Oh, there's a thought," we could, that observer effect can apply psychologically as well where we could notice, "Oh, I'm having a thought," as compared to, "I am that thought," and that really can help tremendously in helping somebody reduce their anxiety.

- So you used the word change.

Does the practice of mindfulness change the, for lack of a better term, I'll use the layman's term, the wiring in the brain if you practice mindfulness over a period of time?

Is there actually a biological change?

And then also, maybe you can talk about the connection between mind and the rest of the body.

- There has been a lot of research by a number of different labs across the world that's really looked at, you know, the changes in the brain.

So for example, some labs have looked at how the brain connection's changed.

Some labs have looked at how the, you know, the size of the brain changes, you know, the size of the cortex.

My labs looked at how, you know, certain brain regions that get activated when we get anxious change when somebody is mindful or when they're meditating.

So for example, there's this network of brain regions that was dubbed the default mode network, which ironically, you know, they call it that because that's what we default to when we're not doing anything in particular, and that tends to be where we think about ourselves, you know, like we're regretting things that we've done in the past, or we're worrying about things that we're gonna do in the future, and in fact, there's a direct correlation with the more worried somebody is, the more activated some of the hubs of this default mode network get.

What my lab has found is that these specific brain regions get deactivated when somebody is mindful, and we've even gone on to do some neuro-phenomenologic studies where we can link up subjective experience with brain activity, where people can start to, you know, we can directly that it's not just the worry.

It's about getting caught up in that worry, and it's not just the mindfulness.

It's about that mindfulness helping us be with and not get caught up or let go of those thoughts or the emotions or the body sensations.

- You know, one of the phrase and the title of the book that caught my attention was, "Heal your mind."

For people who have struggled, many their entire lives with anxiety, that has to seem like too good to be true.

Can you talk a little bit about this idea of actually healing and being able to move beyond these cycles of fear?

- So a lot of, you know, true healing comes from truly understanding what the root cause of an issue is and getting at that root cause rather than putting a Band-Aid on it, and often, you know, we've tried things, you know, all realms of manner of things to kind of put Band-Aids on our brains, so to speak.

So for example, you know, medications tend to be pretty non-selective.

You know, there are these serotonin reuptake inhibitors, for example, are part of the gold standard treatment.

They affect the serotonin system broadly as compared to specific thoughts that somebody is struggling with, for example.

Well, here, the idea is if we can truly understand how our minds work, we can then heal at a deep level where we can work with our minds, and I've had patients in my clinic where we've, you know, I've had people who've come in with full-blown panic attacks and panic disorder.

I had a gentleman with both panic disorder and generalized anxiety disorder, and he'd had this generalized anxiety for nearly 30 years.

He was about 40 years of age when he came to see me, so three quarters of his life.

He went from, you know, being panicked and getting panic attacks when driving on the highway to literally becoming an Uber driver, and he went from having, you know, anxiety all day to, you know, having very, very minimal anxiety, and so there's an example of where, you know, when somebody knows how to work with their mind, they can truly work with it in truly transformative ways.

- It's really remarkable.

I was intrigued, I am intrigued by the work you have done with addiction and mindfulness.

Talk about that because as we know, many, many people live with, struggle with addiction to various substances.

Talk about that.

- Yes, so as an addiction psychiatrist, this has really been the field that I've been working in both clinically and also in my research lab.

We can think of, you know, addictions being the far end of the spectrum of habits, you know, and so the simple definition of addiction is continued use despite adverse consequences.

So you can think of any behavior, mental or physical, can fit into that category, but these tend to start as helpful things.

You know, habits, if we had to relearn all of our habits every day, you know, we'd be exhausted by breakfast.

So I just wanna highlight how important it is.

Like, this isn't saying that, you know, there's something wrong with all of us.

This is saying this is a process that's helpful for us, that helps us learn things, helps us be efficient throughout our days, but it can just kinda go off the rails as it gets to the far end of the spectrum, that continued use despite adverse consequences.

As an example, a phone, very helpful.

It helps me drive into Boston and not get lost, you know.

So there's a useful (laughs) use of technology, but if I'm sitting here all day checking my news feed or checking my social media feeds, and I'm not, you know, I'm not interacting with my family, I'm not getting work done, there's continued use despite adverse consequences.

So we can think of technology.

We can think of, you know, all sorts of things beyond or in addition to the classic addictions like alcohol or cocaine or opioids as falling into this category, and if we look at addictions, you know, we can really start to understand that underlying, you know, neural mechanism of how that's formed and then from there, actually in the same way as breaking any bad habits, we can start to work with these.

- So you have a program, Craving to Quit, which is aimed at another addiction, smoking, and obviously, there are still many people who smoke, and they understand that the health consequences are not good, certainly over the long term.

Just talk a little bit about that app and how it works with people who are smokers.

- Yeah, so the Craving to Quit app is set up to give people bite-size training.

So we had done this study back when I was at Yale, where we got five times the quit rates of gold standard treatment with mindfulness training, and so this was back in 2010 or so, and so we said, "Okay, can we actually package this in a way where people can use it in the moment?"

Because people learn habits in context, and so we wanted to take, package my, you know, my clinic, basically, and deliver it to them at their fingertips, so they get 10 minutes of daily, you know, videos, animations, in-the-moment exercises that help them work with their cravings in the moment that they're coming up, and bring awareness in.

So for example, the only way that's known to really, truly change a habit is to update the reward value of how rewarding that behavior is in our brain.

So for example, with smoking, people tend to start smoking around the age of 13.

If we can help them with this Craving to Quit app, we have them use this craving tool that helps them pay attention as they smoke, and when they really pay attention, they realize that cigarettes taste like crap, and what that does is it changes the reward value in their brain so that they are less excited to smoke in the future because they're seeing, (groans) you know, "Why am I doing this?"

That helps them start to break the habit without having to force themselves or tell themselves 'cause they all know that smoking's bad for them.

Even to extend this, you know, we have this app for eating called Eat Right Now.

We just published a paper on this.

Same type of craving tool applied to helping people stop overeating.

So we have people pay attention as they overeat rather than telling themselves not to overeat, and when we have them pay attention, it only takes 10 to 15 times for somebody to really pay attention to the results of overeating and see, "Oh, this really isn't that great," to drop that reward value below zero so they start to shift that behavior from overeating to not overeating, and that's really the, you know, the underlying, the secret sauce, so to speak, of the Craving to Quit and even the Eat Right Now app, is helping people bring awareness to what's happening right now and see how rewarding is this really?

- Does it work in reverse too, so if I wanna eat more vegetables or get more exercise, does that same mindfulness about those decisions and the benefit/reward valuation, does that work in a positive sense as well?

- I'm glad you bring that up.

Absolutely.

So when we, for example, personally, I can say, I used to be addicted to eating gummy worms.

You know, I would eat the entire bag (cohosts laughing) 'cause I was, like, "Well, I'm gonna feel crappy in the morning, but at least they won't be in the house," you know.

(cohost laughing) And so I started paying attention as I was eating those, and then I even compared that to eating blueberries.

So Jim, you bring up, you know, eating healthy food.

For me, I started to realize that these gummy worms started to taste like this sickly sweet petroleum product.

You know, they were kind of, (retches) and then blueberries, they have this natural sweetness to them, and I don't feel like I just gotta keep eating them because they don't lead to the same craving, and so with eating healthy food, especially afterwards.

You know, when I paid attention, "Oh, it tastes good now," and then afterwards, I felt much better than the gummy worm experience.

Same is true for exercise.

If somebody pays attention after they exercise.

You know, like, what did that feel like as compared to when I didn't exercise today?

To their brain, it tends to be a no-brainer.

You know, it just feels better, and when we bring that awareness in, that learning process can kick in, and it upgrades that value, like, "Oh, this is more valuable than I remember," and so we're more likely to do it again in the future.

- So a few years ago, you were down at Yale, and your topic was "A Life Worth Living."

Recap that, and tell us what are the components of a life worth living?

(Jud laughing) - [Jim] We got about three minutes left.

I should just, you know.

(G. Wayne and Jud laughing) - [G. Wayne] I realize that's a big.

(Jim laughing) We need three hours for that, perhaps, but go ahead.

At least reprise the talk, what you said.

- Yeah, so in a nutshell, there are, people are starting to think of different elements of well-being, so there's the hedonic happiness, like, pleasure, you know, nothing wrong with pleasure, but if we just constantly seek pleasure our entire lives, that's where addiction (laughing) comes from, you know.

So a pleasure's only a component of well-being, of a life, you know, well-lived.

There's also this eudaimonic happiness that Socrates, I think, talked about, which is about finding value and purpose in life, and so we find that, you know, when somebody pays attention, when they go and do something, you know, kind for others, or, you know, the proverbial volunteering in a soup kitchen, whatever that is for someone where there's purpose, or even teaching at a university, where there's purpose, there's that piece that adds to the richness of life, and then there's a third element around that adds to psychological richness, where we learn to lean in to uncertainty and really value curiosity and learning and discovery so that we're not just buttonholing ourselves into a static life, where we're constantly doing the same things over and over and over, but we're constantly learning and growing, and that curiosity can help us not only grow but at least in wisdom, some suggest, so I think of these three elements, and mindfulness can help with all of these.

These can help us see, you know, "Oh, there's pleasure in eating blueberries.

There's not so much pleasure in eating a whole bag of gummy worms."

There's pleasure in being generous, in being kind, in being helpful for others.

You know, "Oh, there's not so much pleasure in being selfish.

Oh, when I pay attention to that, that helps," and then the key element of mindfulness, curiosity, that in itself helps lead to the psychological richness so that we can keep learning and growing, and instead of, you know, moving out of our comfort zone into our panic zone whenever something is changing in the world, which, the world is constantly changing, we can move into our growth zone so that we're constantly growing and learning.

All three of those, I think, contribute to a, especially in balance, lead to a, you know, the good life, so to speak.

- Jud, we're down to about the last 45 seconds here, but I wanna, you work on a university campus.

(air whooshing) I work on a university campus.

We're concerned about the mental health challenges (air whooshing) that we're gonna see among our student population.

I think a lot of educators across the country are this year.

How can mindfulness play a positive role in meeting that challenge?

- Well, I think in a nutshell, mindfulness can help in all sorts of ways, and folks like Eric Loucks at Brown has actually developed a mindfulness for college, a program for college students, just helping college students, for example, pay attention and notice, you know, what is rich about college life, connecting with their friends, for example, as compared to what's not so rich, like spending a ton of time on social media.

Awareness can help them differentiate where they might be getting stuck in unhelpful habits and help them open to the world around them so that they can connect more.

They can really be, you know, develop their curiosity, and both of, you know, think of curiosity, kindness, and connection.

All of those are fostered by mindfulness, and all of those help us live a happier, healthier, less stressful life.

- Well, this is a remarkable conversation.

He's Dr. Jud Brewer.

The book again is "Unwinding Anxiety."

It's the right book for this time.

Jud, thank you so much for being with us.

That is all the time we have this week, but if you wanna know more about "Story in the Public Square," you can find us on Facebook and Twitter, or visit PellCenter.org, where you can always catch up on previous episodes.

For Wayne, I'm Jim, asking you to joins us again next time for more "Story in the Public Square."

(upbeat music) (cheerful music)