Thursday 14 March 2019

Podcast: How to Break Habits – And Keep Them Broken

We all have habits we’d rather not have, whether it’s smoking, emotional eating, or any of a hundred other things. And it’s likely that we’ve all, at one point or another, tried to break one or more of them, only to have the break be only temporary. What’s the secret to permanent habit change? Listen to this episode and find out!

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About Our Guest

Judson Brewer, MD, PhD is a thought leader in the field of habit change and the “science of self-mastery,” having combined over 20 years of experience with mindfulness training with his scientific research therein. He is the Director of Research and Innovation at the Mindfulness Center and associate professor in psychiatry at the School of Medicine at Brown University. He also is a research affiliate at MIT. A psychiatrist and internationally known expert in mindfulness training for addictions, Brewer has developed and tested novel mindfulness programs for habit change, including both in-person and app-based treatments for smoking, emotional eating, and anxiety. He has also studied the underlying neural mechanisms of mindfulness using standard and real-time fMRI and EEG neurofeedback. Dr. Brewer founded MindSciences to move his discoveries of clinical evidence behind mindfulness for anxiety, eating, smoking and other behavior change into the hands of consumers. He is the author of The Craving Mind: from cigarettes to smartphones to love, why we get hooked and how we can break bad habits (New Haven: Yale University Press, 2017).

www.drjud.com

www.goeatrightnow.com

www.unwindinganxiety.com

www.cravingtoquit.com

BREAKING HABITS SHOW TRANSCRIPT

Editor’s NotePlease be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Narrator 1: Welcome to the Psych Central show, where each episode presents an in-depth look at issues from the field of psychology and mental health –  with host Gabe Howard and co-host Vincent M. Wales.

Gabe Howard: Hello everyone and welcome to this week’s episode of the Psych Central Show podcast. My name is Gabe Howard and with me as always is Vincent M. Wales. And today Vince and I will be talking with Dr. Jud Brewer, who is a thought leader in the field of habit change and the science of self-mastery. Jud, welcome to the show.

Dr. Jud Brewer: Thanks for having me.

Gabe Howard: It’s our pleasure. Now, my first question is: when you say the science of self-mastery, can you kind of explain that a little? Because it’s not a common phrase I think our listeners are familiar with.

Dr. Jud Brewer: Simply put, it’s really about understanding how our minds work and it might be an odd phrase because a lot of people don’t really have a good sense of what this is.

Gabe Howard: Fair enough, fair enough. Now when you say that it’s how our minds work – and I was going to ask the most open-ended question ever, just to make this the most exciting show, but – how do our minds work? I mean it’s kind of a loaded question, isn’t it? It’s the science of how our minds work. Really? That’s it? There’s like a… I mean, can you kind of narrow it down maybe a bit?

Dr. Jud Brewer: Sure. And that’s it is, wow, there’s actually a whole lot here, like you’re talking about. I think of this more in terms of what drives us every day. And from a very simple standpoint and from a very pragmatic standpoint, is about habits. You know about, I would say 90 to 95 percent of our day’s driven by habits. We’re on autopilot. We’re mindlessly going about our thing and not even knowing it. And so, if we’re going about on autopilot, how can we possibly be in control of ourselves?

Vincent M. Wales: I often wonder that.

Gabe Howard: That’s a very good point.

Vincent M. Wales: So, habits. Habits are sometimes great and sometimes awful. How do habits actually form? I’ve been told by some people that, you know, once you do a particular thing X number of times, it becomes a habit and it’s no longer something you have to force yourself to do. I think they are full of baloney. But what’s your on that?

Dr. Jud Brewer: I think I agree. You know, habits… some habits are helpful, some habits, not so helpful. So if we think about it from a very simple standpoint, and this goes all the way back evolutionarily to the sea slug. So we learn habits in the same way that sea slugs learn habits. Where they only have twenty thousand neurons, we have like 86 billion. Yet there is this fundamental process that similar and it was actually set up to help us remember where food is. And on a very… and this is overly simplified, but just taking the core elements… there are three things that we need to form a habit. We need a trigger, a behavior, and a reward, from a brain standpoint. So, if we’re out foraging for food and we see some food, that’s the trigger. We eat the food, that’s the behavior. Our body sends this dopamine signal into our brain that says, remember what you ate and where you found it, so that next time we’re hungry, that new trigger of hunger says, Oh go back to where you found that food. It also helps us avoid danger. We see some saber-toothed tiger or whatever it is, we know to avoid that spot in the future. So this is actually setup for, you know, very basic survival mechanisms. Yeah, it’s really helpful in modern day. You know, imagine if we woke up every morning and had to relearn everything from walking to talking to tying our shoes to eating to whatever… we’d be exhausted by lunch.

Gabe Howard: And we’d accomplish nothing.

Dr. Jud Brewer: And we would accomplish nothing, absolutely. So, in some aspects, you know, this simple process literally helped us survive. But in other aspects, we’re seeing the same thing get hijacked, especially in modern society, where there’s there’s food that’s engineered to be addictive, there’s social media, there’s everything that’s kind of driving us to habitually consume all those things.

Gabe Howard: You know, it’s interesting that you say that about social media, because, one, I happen to agree. And here’s why I agree. About a year ago, I got a Facebook message that said, You’ve posted every day for 350 days in a row. Congratulations. And it gave me some stars. And I thought, oh, well that was neat. OK, that’s neat. I’m on top of my social media game. Yay. And then, you know, a month or so later, I was tired and it was near the end of the day, it was like nine o’clock and I realized that I really hadn’t put anything on Facebook. I hadn’t shared any blogs or, you know, any hints and tips about living with mental illness or anything like that. And I actually thought, I need to find my phone. I need to do something or I’m going to break my streak. It wasn’t about reaching out. It wasn’t about helping people. It was purely about not breaking my streak.

Dr. Jud Brewer: Yes, getting your little pellet of shiny star, good job, didn’t break your streak.

Gabe Howard: Yeah.

Dr. Jud Brewer: Fabulous.

Gabe Howard: I want to be fair, it didn’t hit me at the time, but a couple of days later I thought to myself, Well now wait a minute. I didn’t have anything good to offer my followers on that day. I didn’t offer them anything bad. It was just, you know, You can find inspiration in everything. Not exactly my most engaging quote, but the reward piece was that I could get this long-running streak and Facebook would reward me by telling me that I’m – I don’t know, I’m good? I thought that I was doing everything to win my mother’s approval. But it turns out that I’m only motivated by Facebook, apparently.

Dr. Jud Brewer: That’s a great example.

Gabe Howard: But this this did create the reward system. That, in that case, that was the reward. And somebody probably studied that and figured out that you can get much more engagement on Facebook by telling the people who are doing this work that they have a streak and give them stars.

Dr. Jud Brewer: Yes. Yeah absolutely. You know it’s it’s so interesting you say this, because I think of this term “everyday addictions,” where you know, when I was in residency training, training to be a psychiatrist, I learned this simple definition of addiction: continued use despite adverse consequences. And that was this big light bulb moment for me. Where I was, like, really!

Gabe Howard: I can see that.

Dr. Jud Brewer: This goes way beyond. You know, I was working with people with all sorts of cocaine, alcohol, heroin, you know those types of addictions, and I was like, Wait a minute, this goes way beyond that. You know, at a very deeper level, you know, this is about unhealthy habits around food, around shopping, or gaming, or social media, like you’re talking about.

Gabe Howard: We tend to look for giant negative consequences, like I don’t think there’s anybody that would disagree that, you know, somebody that was addicted to drugs or alcohol… that’s a habit that that is very bad, it has major consequences, and we need to break it, especially when we see… you know, you can die from a drug overdose. People have lost their their children, their marriages, their jobs and families from being addicted to alcohol. But you’re saying, and please let me put words in your mouth, that everybody notices when it’s gigantic, but nobody notices and when something small. Like if I would ignore my wife in order to make that Facebook post. And by doing that day after day after day, we can get to those, you know, certainly bigger negative results. And that’s what we kind of need to… I’m going to say nip it in the bud. I like that phrase, I guess.

Dr. Jud Brewer: Absolutely. This is kind of like I think of cigarette smoking as like a slow burn. You know, you don’t get cancer the first time you smoke a cigarette. Otherwise, nobody would smoke a cigarette. So that’s that slow burn where you get emphysema, cancer, or it affects your skin over decades in years. And in the same way, there’s that slow burn that happens when we are spending our time doing things that aren’t helping us. You know, I’m just thinking… I was grading my assignment for one of my my classes at Brown this morning, and one of the students pointed out – I have them like follow some of their own habits – and one of the students was pointing out how she was spending like over an hour a day on some social media platform, whether it’s Instagram or something like that. And she said, oh my gosh, I never realized I was spending this much time doing this thing. You know, kind of wasting my time. And so that’s kind of like the slow burn of social media. That’s not that much. I mean, it doesn’t necessarily give us cancer, but it’s kind of, you know, you can think of it as, well if we’re not, you know, if we’re spending all of our time doing these things, how are we actually living our lives? You know, we’re just on autopilot.

Vincent M. Wales: And it’s not just social media, it’s watching television, you know, Netflix binges. I have something that I do five days a week for like eight or nine hours a day and it just eats up my entire life and one day I hope to quit.

Gabe Howard: Vin, working is not an addiction.

Vincent M. Wales: Then where’s the term workaholic come from, then?

Gabe Howard: I think that the issue is the term workaholic is when you do it past the point where you need to. For example, when they stopped paying you, you leave. All joking aside, you are not a workaholic because you’re working to survive. You are a write-aholic, because you write. But at the same time you get enjoyment from it. But this does bring up a good point for our guest. When does something become a habit? I mean if it’s destroying your life, but if you enjoy it, we all understand that maybe people will go back to the drug and alcohol addiction and maybe they enjoy it. They don’t realize it’s destroying their life. But how do you decide when a habit is bad? I think that a lot of people watching somebody see the negatives or potential pitfalls before the person who is doing it. I think you’d be hard pressed to find somebody smoking who thinks that it’s bad. Otherwise they’d quit.

Dr. Jud Brewer: Or would they?

Gabe Howard: You are correct. Am I oversimplifying? Can you sort of speak to that a little bit?

Dr. Jud Brewer: Yeah. This makes a lot of sense and I’ve been, you know, I’ve been working with people trying to quit smoking for over a decade now, and almost all of them come to me wanting to quit, but not being able to. You know, I’m thinking of a guy who’d been smoking 40 years, you know about a pack of cigarettes a day. And if you add all that repetition up in terms of that habit loop, he’d been repeating that thing about three hundred thousand times. That’s a lot of repetition. I’ve yet to meet somebody that comes to me and says, you know, smoking is really good for my health. You know, I think I should smoke more. People that smoke know that it’s not good for them and they might be doing it because you know for whatever reason, but most of the folks who come to me want to quit, but can’t. So it sounds great that we could quit, you know, and be like, wow this is bad for me, I should quit. Yes, for most of us, these habits that are hard to break are hard to break for a particular reason and that’s because these habit loops have been reinforced so much. So here’s the paradox, and this is where it gets really interesting. A lot of folks have come, they’ve tried to quit whatever the habit is. So let’s just use smoking as an example, but but we can think of overeating, that’s another one that we worked with a lot. Even anxiety, there are habits formed around anxiety. With worried thinking and things like that. But people come in and they, their cognitive minds say, yeah I want to quit smoking. And then they just can’t do it. Now we think, well why wouldn’t they just quit? Why not just use your willpower to quit? Well I think the only or non-person that can do this is Mr. Spock, you know with that Vulcan… I have no emotions, I just use logic and I, you know, do these things. And ironically, Leonard Nimoy died from emphysema. He was a chain smoker and spent a bit of the rest of his life really trying to help people quit smoking. So you can even see the irony there, is these you know just this willpower part of our brain, which driven driven by the prefrontal cortex, it actually goes off-line when we’re stressed out. So the part that says, oh you should quit smoking… It doesn’t work when we’re stressed. And that was something that I got really interested in as part of my research. OK. If this willpower thing doesn’t work so well. And this is poorly it works – so people who try quit smoking, when they quit, the likelihood that they’re going to stay quit a year later is 5 percent. And the whole yo yo dieting thing. A lot of people that, I would say a majority of people that lose weight actually regain that weight or even then some, because their willpower gives out.

Gabe Howard: Yeah. Absolutely.

Dr. Jud Brewer: So I’ve really tried to understand you know what that process is and how we can actually hack the process. And that’s what my lab has studied. So for example we found that you can actually bring awareness in to that process and awareness itself helps hack the reward-based learning system. And in a very simple way, there’s a part of our brain that’s called the orbitofrontal cortex that actually holds relative reward value. And so if habitually were smoking because it holds some certain reward value, but we’re not paying attention to that, later we come in and we say OK, just pay attention when you smoke. You know this is the first thing we start with is pay attention when you smoke and they’d realize this stuff actually tastes like crap. I’ve never had a patient come in and say when we do that exercise and say wow, I never realized how good cigarettes taste. That’s why they’re menthol and they flavor them, because it actually tastes pretty crappy. And that actually decreases that reward value in the brain. So we’re less excited to smoke in the future and this is where we in one study we got five times the quit rates of gold standard treatment when we used mindfulness practice, which is really bringing awareness to what’s happening in and help people you know use that to quit smoking. Another example was that we help people pay attention when they’re eating and bring awareness to that and see you know what’s it like when I overeat. Oh it doesn’t actually feel that good. We got another study… This is actually with app-based mindfulness training with a simple app. We got 40 percent reduction in craving-related eating. And so you can start to see if we really understand the process, if we can understand how this will reward-based learning works, that it’s driven by rewards, not the actual behavior. We’re focusing on the reward, bring awareness to that, our brain said oh wait a minute, actually I’m not that excited to do that anymore, with pretty significant results.

Gabe Howard: That’s incredible.

Vincent M. Wales: There are so many things like that you know the realization that cigarettes don’t taste good or how much time we’re spending on social media. I have a very good friend who was a smoker for years and years and years and one day she realized just how much money she and her husband were spending on cigarettes and quit cold turkey. And I’m happy to say has been quit ever since.

Gabe Howard: That’s how I dropped my coffee habit. Seriously, there’s not even a joke there. I realized that I was spending anywhere from 12 to 20 dollars a day on coffee. It would just become a habit. I wanted in the morning before work, I would go at lunch, I would go on breaks, I would go after work, and you know at four or five, six dollars a pop, tips, etc. It just started adding up.

Dr. Jud Brewer: Yeah. Not very rewarding.

Gabe Howard: Well, right. And that was the other thing it was sort of just, oh it’s break time. It’s time for coffee. That was it. That was the connection. It wasn’t a, I want a coffee. It was, it’s break time, it’s time for coffee.

Vincent M. Wales: And this is what we do on breaks.

Gabe Howard: After these words from our sponsor, we will be right back.

Narrator 2: This episode is sponsored by BetterHelp.com, secure, convenient and affordable online counselling. All counselors are licensed, accredited professionals. Anything you share is confidential. Schedule secure video or phone sessions, plus chat and text with your therapist whenever you feel it’s needed. A month of online therapy often costs less than a single traditional face-to-face session. Go to BetterHelp.com/PsychCentral and experience seven days of free therapy to see if online counselling is right for you. BetterHelp.com/PsychCentral.

Vincent M. Wales: Welcome back everyone. We’re talking about breaking habits with Dr. Jud Brewer. So when we’re talking about being aware of things, it brings to mind mindfulness, right. So how does mindfulness play into this? Because I’m sure it must.

Dr. Jud Brewer: Yes. And there are a lot of different definitions of mindfulness out there. So I like really focusing in on you know how it works with these mechanisms. So I think of mindfulness as two components. There’s this awareness that we’re paying attention to what’s happening, but we’re also not bringing… we’re not judging it. We’re just being really curious. And what that curiosity does is help us open to learning as compared to saying, oh God I shouldn’t do that. Right? You’ve probably heard this term, “we should all over ourselves.”

Vincent M. Wales: Yes.

Dr. Jud Brewer: But when we come in and observe some bad habit and we’re like, oh I shouldn’t do that, we’re actually just closing down and beating ourselves up – probably in another habit unto itself. So mindfulness is about bringing awareness to the habit and really understanding and kind of the first step is mapping out how our… what our habit loop is. Oh what was it that triggered me to eat? Was it anxiety? Was it stress? Was it boredom? And then that was that trigger. What am I eating and how am I eating this? Am I just mindlessly shoveling down a bunch of processed food? And then, the result. You know what does my body feel like as I’m eating this? What’s it feel like after I eat this? So bringing awareness to all those aspects of that habit loop and then really focusing in on the results. There’s a simple question I have folks in our Eat Right Now program really just ask themselves, which is What do I get from this? As in. pay attention to the reward or non-reward as you’re doing a behavior, whether it’s smoking or eating or even getting caught up in a worry habit loop. And that helps their brain start to recalibrate. Oh this isn’t actually that rewarding. So mindfulness, bringing awareness, whether it’s to mapping out the habit loop or bringing in, it bring it in to help us see what those rewards or non-rewards is a big aspect of this. And then the third piece is around just being really curious. So you guys tell me: what feels better, a craving or a curiosity.

Gabe Howard: I would say that a curiosity feels better, but a craving, I would probably respond to faster. But curiosity feels better. I guess when I’m curious about something, I have an interest in it, and interest is fun. Craving something is I need it, I need it now.

Vincent M. Wales: Yes, it’s like the difference between starving – Oh my God give me food – and hey I wonder what that tastes like. I’ve never had that before.

Dr. Jud Brewer: So remember that definition of addiction. Continued use despite adverse consequences. So if we’re hungry, we’re gonna eat. But if we’re driven to eat habitually or because we’ve formed a habit loop around you know stress eating, that’s a whole different story. And so we can actually hack that reward- based learning system right in that moment, when we have that craving, we can bring awareness to that and be curious. Oh what’s this? Just like you guys described. We’re interested instead of driven, we can actually open up and see what this actually feels like, which gives us the space to not only notice what craving feels like in our body, but also gives us the space to see, Oh I’m about to automatically reach for this food that’s not required. That’s not necessary. I can simply be here and be with this thing because curiosity is intrinsically rewarding itself.

Gabe Howard: Earlier in the episode, you talked about how apps are helping people change their habits and live better lives and I don’t doubt this. There’s apps for everything now. You know ten years ago somebody told me they were using an app to lose weight and I thought they were crazy. I was like, How can an app help you lose weight? But lo and behold, it did. It was amazing and I myself have used it. And you’ve written apps. You’re not just saying hey go find a random app. You have actually researched, released, and continue to watch over different applications to help people break bad habits. Can you talk about that a little bit?

Dr. Jud Brewer: Sure. The research that we were was doing… this is when I was at Yale University back in, I think it was 2010/11/12, somewhere around there. We were really kind of digging in and understanding these mechanisms that I was just talking about earlier, and we were learning that you know I had this aha moment where I was thinking, well wait a minute, my patients don’t learn to stress eat in my office. So what if I could actually bring my office to them, because this is actually set up as a context-dependent learning mechanism right. We learn to remember to do a certain behavior in a certain context. So we started developing… back then, apps were not very well known. Android had probably just started to come out with its thing that looked like a big old calculator that they called a phone.

Gabe Howard: Oh yeah.

Dr. Jud Brewer: This is pretty early on. So we said, can we actually package these evidence-based training into apps and deliver this in a way that meets people where they’re at? So you know we have to use short videos animations and, most importantly, in-the-moment exercises that can give people short, bite-sized pieces of mindfulness training. So they do a 10-minute training in the morning and they actually build that into their every day. So the important thing here is you don’t want to give people something that it’s going to be another thing that they don’t check off on their to-do list and then feel guilty about. It’s about you know OK take a little tidbit you know as soon as you start your day. and then practice that as you go throughout your day. And we use 30 core modules for whether it’s our eating program called Eat Right Now, it’s 28 core modules. The anxiety program, it’s called Unwinding Anxiety, is 30 core modules. And so through those you know through that period of time, whether somebody goes through one module a day or takes a couple of months to go through this and really learn how their mind works. They incorporate these practices into their everyday life and we actually build this based on the science of how you know how these habits form and how we can actually hack them.

Vincent M. Wales: So if I was a user of one of the apps. what would I experience when I was going through one of these modules?

Dr. Jud Brewer: You’d start by seeing you know let’s say it was your first day of the program, you’d see a short video that kind of you know, like on day one, we actually explained this habit-led piece so that people can really understand how their minds work. And then there might be a short exercise that you’d go through to make sure that you really understand and can do the practice, and then it would give you a suggestion on how to incorporate that into your daily life. And then throughout the day, let’s say it’s our Eat Right Now program, the eating program, and you’re trying to work with stress and emotional eating. For a lot of people, they’ve lost the ability to differentiate whether they’re actually hungry or they’re just eating out of stress or emotions or other triggers. You know they can’t differentiate physiologic hunger versus emotional hunger. So we actually have a little you know part of the app that’s this stress tests that that’s actually a self-mindfulness exercise, where it has them drop into their body and see you know check x, y, and z, and algorithmically, it can give them an idea to help them see okay, am I actually stressed or am I hungry? And then if they’re hungry, it gives them suggestions on how to eat while they’re paying attention so they can stop when they’re full and they’re not just automatically reaching for junk food. It also has this thing that I think of as the panic button. So whenever somebody has a craving, they can click on this button and it’ll walk them through an exercise to help them ride out a craving, rather than getting sucked into it. And so as they go through the program, not only are they understanding how their mind works, but they’re getting these pragmatic, in-the-moment exercises as a way to really work with these things so that they are back in the driver’s seat, rather than the back of the bus with their cravings driving them all over the place.

Gabe Howard: That is absolutely amazing. Now you’ve mentioned multiple apps. Is there a place where we can find all of your apps? I’m sure that they’re in the Android store but you know what are they called? How do they… how to folks find them?

Dr. Jud Brewer: The simplest way to find these is just my Web site, DrJud.com. But the smoking program’s called Craving to Quit and just cravingtoquit.com I think is its Web site. The Eat Right Now program, I think the Web site’s goeatrightnow.com. And then the Unwinding Anxiety program is just unwindinganxiety.com. You can find all of those through DrJud.com.

Gabe Howard: Judd thank you for being on the show. Aside from DrJud.com, what are some other ways for people to reach you and are they able to ask you questions if they have any?

Dr. Jud Brewer: Folks can follow me on Twitter @JudBrewer and start a conversation that way.

Gabe Howard: Well we appreciate it. Thank you so much. And of course they can hop over to the website and the show notes contains all of the information that you have. So if you’re driving please don’t start writing furiously. Your safety is important to us at Psych Central. Thank you everyone for tuning in and remember that you can get one week of free, convenient, affordable, private, online counselling anytime, anywhere by visiting betterhelp.com/psychcentral. We’ll see everyone next week.

Narrator 1: Thank you for listening to the Psych Central Show. Please rate, review, and subscribe on iTunes or wherever you found this podcast. We encourage you to share our show on social media and with friends and family. Previous episodes can be found at PsychCentral.com/show. PsychCentral.com is the internet’s oldest and largest independent mental health website. Psych Central is overseen by Dr. John Grohol, a mental health expert and one of the pioneering leaders in online mental health. Our host, Gabe Howard, is an award-winning writer and speaker who travels nationally. You can find more information on Gabe at GabeHoward.com. Our co-host, Vincent M. Wales, is a trained suicide prevention crisis counselor and author of several award-winning speculative fiction novels. You can learn more about Vincent at VincentMWales.com. If you have feedback about the show, please email talkback@psychcentral.com.

About The Psych Central Show Podcast Hosts

Gabe Howard is an award-winning writer and speaker who lives with bipolar and anxiety disorders. He is also one of the co-hosts of the popular show, A Bipolar, a Schizophrenic, and a Podcast. As a speaker, he travels nationally and is available to make your event stand out. To work with Gabe, please visit his website, gabehoward.com.

 

 

Vincent M. Wales is a former suicide prevention counselor who lives with persistent depressive disorder. He is also the author of several award-winning novels and creator of the costumed hero, Dynamistress. Visit his websites at www.vincentmwales.com and www.dynamistress.com.

 

 

 



from World of Psychology https://psychcentral.com/blog/podcast-how-to-break-habits-and-keep-them-broken/

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