You Need to Hear This with Nedra TawwabThis week Nedra has an in depth conversation with psychiatrist and author, Dr. Jud Brewer. The two dive into anxiety, how anxious habits can affect the basic functions of our lives such as eating and sleep, and what we can do to start to take back some control.
Hi, listeners, Welcome back. I'm Nedra Glover to WOB and you need to hear this. This week, we have an exciting guest, doctor jud Brewer, the author of Unwinding Anxiety. I read this book, oh maybe about two years ago, and it was so helpful. Anxiety is one of those things that so many of us deal with and sometimes we don't even know it. We have physical symptoms, emotional symptoms, and sometimes it really does impact our relationships with others. Doctor Brewer's take on anxiety, I think is fresh. He talks about habits that we have around anxiety and ways that we can live with anxiety. And I am saying lived with because it doesn't go away. You know, a little bit of anxiety is okay, but we don't want debilitating anxiety. So let's listen to this interview with doctor Judd. So we are talking to a anxiety expert about a topic that I think most of us deal with and the strategies that I've found to be so helpful in doctor Brewer's book, Unwinding Anxiety was it was so helpful because I think so many of the things that we struggle with is figuring out how to move through anxiety, how to get over it instead of how to move with it, how to think differently about it. And I'm going to stop talking because I think he has so much to share on the topic.
Welcome, Well, thanks for having me.
Of course, of course, how did you shift into the work of focusing on anxiety?
Well, as a psychiatrist, I was kind of brainwashed in medical school to prescribe medications. And you know, I say that tongue in cheek, but it turns out that it's about one in five patients that shows the significant reduction in symptoms when they're given the best medications out there. And so, you know, I started getting anxious about what I could do to treat my patients because imagine, my practice has been set up around these very short visits to you know, or they can maximize their billing. And so it's like I've got this, you know, I've got twenty minutes with a patient, and you know, it's like I can try medication, I don't know for the of the next five patients that come in, which one of them might show a response, and then what to do with the other four. So I get anxious about treating my own patients with anxiety on top of that. You know, I've had some good run ins with anxiety myself. I was so anxious at the end of college before starting medical school that I developed irritable ball syndrome. And when I went to see the student health doc, you know, he's like, do you think you could be stressed to anxious? So I'm like, no, no, I must have a you know, Jardia bacterial infection because I go backpacking. And you know, because I was thinking, how could you know? I vegetarian, I play the violin, I exercise, I do all these things dot dot dot, therefore I shouldn't be anxious, right And in fact, you know, I was. I was had pretty high anxiety to the point where my body was saying, hey, you know we've got I've got to make you pay attention somehow, and I won't spare you the gory details of my guts, you know, spelling to me that I was anxious, but even would get panic attacks during residency. So from my own experience, you know, seeing that anxiety is really tough, to my experience of trying to help my patients with anxiety, had to find a different way.
You know, It's interesting because many folks don't recognize the physical impact of anxiety like you mentioned, just issues, eating issues one I don't want to say one hundred, A huge proportion of people with sleep issues. Oh my gosh, gosh, skin issues. I've seen people with psoriases and exema flare ups and rashes and neck pain. That's one thing that I noticed with myself. A few months ago. I was having an issue with my neck, went to a chiropractor putting, you know, cold pads on it, and I'm like, I need a new pillow. Thought that was my frustrated voice, but I needed a new pillow, right, So I'm looking up what is the cause of this neck pain? It said like ninety percent stress. I say it can't be true. So I don't need a new pillow. I don't need to go to a chirorector. I don't. I don't need an ice pack. I need to reduce my stress. Wow, how phenomenal. I meant, just these physical symptoms that we have that we often ignore because we get used to popp an appeal, taking a tile and all, or you know, eating small meals because if we eat too big or stomach will be messed up. And it's really anxiety.
Yeah, so true, so true. This is this is how divorced we are from our bodies right now, how little we listen to them and think, oh, it must be something physical, It couldn't possibly be anything else, like my mind.
Yeah, I know when you know, I'm working with folks and I'm seeing some boundary issues and some relational anxiety. I will just point out how leading up to, you know, this event with them, you haven't been sleeping, well, you've had more panic attacks. Could it be the relationship? It's like, you know, maybe you're allergic to your sister. Maybe maybe that's the cause of all this anxiety. And you know, it's not always like in the relationship or get away from this person. It could be, you know, maybe there's something you need to say when they tease you, or maybe there's you know, a know that needs to be said or something that needs to happen. So you're not in this situation feeling terrible all the.
Time, right and then associating, Oh, I get this rash every time my sister visits. What's going on? You know it's probably not the detergency uses to wash our clothes.
So what are some strategies you typically suggest for managing like generalized anxiety or just some routine anxiety people may have.
Well, I would say that as a neuroscientist, you know, outside of my clinical practice, I look at the scientific literature, and it turns out that back in the nineteen eighties, you're probably familiar with the name Thomas Borkovec, who was very well known for talking about approaching we're in anxiety in a different way. And I never learned this in medical school, but he actually suggested way back then that anxiety could be driven through negative reinforcement. And when I found that, I was blown away because my lab had been studying how to help people break bad habits for you know, for probably a decade. You know, we'd done good work, like we've gotten five times a quit rates of gold standard treatment for smoking, for example, and it had developed an eating program where we had gotten a forty percent reduction in craving related eating. But I never thought that anxiety could actually be driven like a habit. So that's the first place that I start is just helping people understand, you know, how anxiety can be driven like a habit. Just to be clear, it's not that we can get rid of anxiety, you know by approaching it this way. But it's the critical piece here is that anxiety actually triggers a behavior. And you know, certainly can be be stress, eating, whatever, but the behavior that's most common is worrying. And when I saw that connection, when I read about that connection, and then could start to see it in all of my patients, right because worry is such a cardinal piece of anxiety. The way that works is that worry makes people feel like they're in control, even though it doesn't actually fix anything because they're afraid of the future. That's how I think of anxiety. But it gives them enough of a reward in their brain that they feel like they're they're in control or at least doing something, and that is enough of a reward to feedback and drive anxiety like a habit. And just make this really clear, any habit needs three critical elements. One is a trigger, two is a behavior. One's a result or a reward. And so we can think of the feeling of anxiety triggering the mental behavior of worrying, which then results in feeling like we're in control at least we're doing something, and then that sets up the habitly of anxiety, triggering worrying, which then just feeds back and triggers more anxiety.
Yeah, I've heard people say that they feel really guilty for not thinking about a problem, you know, like the old advice of just trying not to think about it. Like, I have to think about it. I have to spend time on this because if I'm not thinking about it, then I'm not doing anything. And it's like, well, you're not actually doing anything by thinking about it, but you're very distracted from watching this movie. So it's not like, you know, that is productive work. And I think sometimes we think worrying is productive work. It is a way to show that we care about this thing that we can't control. And you know, I truly believe when I've had issues with anxiety or what I've seen folks challenge by anxiety, that there are some loops we cannot get out of, and that conversation it will just keep circling until we do something different or until it has reached its expiration in our brain.
Yeah, let's double click on that for a moment, just to make sure folks understand how important that point is that you're making. You know, this worrying. I think if this as an evolutionary bottleneck where planning and thinking right. If we need to think through a problem, that's really helpful. From a survival standpoint, Planning about the future is very different than worrying about the future. And as you said, you know, when we get stuck in that perseveration, when we're just worrying and worrying and thinking about something over and over and over, that thinking is not actually problem solving. It's just getting us stuck in that rut of more worrying. So I'm glad you highlight that because that is a critical distinction because people think, oh, there must be something helpful about this, but they're not actually looking at what they're getting from it. It's not helping. It's not helping them solve a problem. It's not keeping their family members safe if they're worried about that or whatnot. It's just making them more anxious.
In the moment, I want to talk for a minute about sleep issues. I have a practice here in Charlotte, and years ago I started getting all these referrals from a medical doctor who really believed in CBT for sleep, and he would have all these patients and they would do these sleep studies and he's like, it's nothing wrong with you. You should be able to sleep. That must be anxiety. And you know, we meet a few times and they practice some things and be able to sleep maybe a little bit better. And then you know, the challenge sometimes with therapy is a lot of the things that a therapist a psychiatrist might suggest, you have to practice those things. And so if you want the anxiety to go away, by doing nothing, the anxiety won't go away. And so a lot of the strategy is, okay, well what are we doing at be at times? So can we talk about some things that might help us sleep a little bit better?
Sure, I'd be happy to So. For example, CBTI is a very good evidence based treatment protocol to help people get to sleep. But it's a protocol it says, you know, don't do these that you know, use your bed just for sleeping sex for example, So don't watch television and bed, get rid of your devices things like that at nighttime. It doesn't really touch enough on one of the core problems that I see, and it sounds like you see as well, which is the worrying, Because we can't just shut off the worry switch, you know, like we can shut off our phone or our tablet or whatever. And in fact, it's so common that the NIH has specific measures in their battery of measures that relate worry and sleep. That's how common it is. So a couple of years ago, we did a study with our anxiety program and just said ask the simple question, which is, hey, if we treat people's anxiety and we don't touch on any of these other things, we don't even mention the word sleep, can we improve their sleep? And lo and behold, we've got a very significant reduction in anxiety, which we had seen in previous studies. But also we found that their sleep was improved simply by treating the worry piece. And the way I think of this, and I see this all the time is you know, somebody's head hits the pillow and their brain says, my turn, and it just starts worrying about everything. You know. It's like I didn't have time during the day, but now you know I've got got audience. Yes, And so it does that. And then anxiety is it revs us up right, because it's fear. Fear is supposed to get us into action, so it's it increases our inner you know, our arousal levels, so we can't sleep, and then we look at our phone or our clock and see that we're not sleeping, and we get even more anxious.
Nothing ruins your sleep more than tracking how much you haven't slept. That is the word. That's worse than using the phone and bit in my opinion, if you track, oh my gosh, I've been laying here three hours and I have two hours, that is the worst thing. It's like, even once you fall asleep, that thought is still in your head and that is impacting the quality that you get in maybe the hour two or six. But you know, I also find that there are times where people are sleeping more than they think and they're there's a lot of sleep misinformation around, like you must sleep eight hours, it has to be from this time to this time. And I think most people can benefit from sleeping through the night. And then there are some people. I have a cousin and from the time she was an infant, she did not sleep at night. You know you're thinking, oh, typical baby stuff. Well, fast forward, she just does not sleep well at night. Now. When she was younger in school, there was a peal she would have to take to be able to go to bed because she has to function in a world that's not set up for her particular sleep cycle, right, But now she has the opportunity. You would be a wonderful person to work the midnight shift, right, Like you don't you don't adhere to you know, regular sleep schedules. Now that's not common. But she sleeps the appropriate time but during the day. So sometimes it's important to think about, like, you know, how much you're sleeping overall, not just that nighttime sleep. You mentioned gastro intestinal issues, and I'd love for us to talk a minute about what we do with our eating when we're stressed, you know, like stress eating and poor appetite. I tend to be more of a poor appetite person if something is going on, Oh my gosh, I could just drink tea and water and completely forget. And then there are some of us where it's like I just want to feel and that is a way for me to feel. So can you talk about stress eating.
I'd be happy to. And in fact, you're highlighting something that's really interesting. I just wrote about it in my new book The Hunger Habit, where the term anorexia when you don't add the nervosa to it. Anorexia is actually a physiologically adaptive mechanism, and what it means is that we lose our appetite when we need to lose it. So if we're afraid, right, and that's what you know, I think of anxiety as fear of the future. So when fear kicks in, the normal response is for our body to say, hey, I've only got this amount of blood. I need to either you know, devote it to my digestive system or my muscles. And when we need to be prepared to run, you know, that's the fight flight freeze. Then we divert all that energy to our muscles, and so our stomach says, hey, I can't digest anything right now, so don't try putting something in here. You know, some people even describe that as fight flight freeze and fast as a reminder that our stomachs are not at their optimal when we are in danger, right, and they shouldn't be. It's a physiologically adaptive mechanism. So when we look at that term, what you're describing is the normal thing that most of us, I should say should But like you're highlighting, there's a lot of variability in people, but that's the normal response. It gets fascinating. This is why I wrote an entire book because it's it just becomes so interesting how different people learn to associate eating with different things. And you know, one is food mood, right, where when we're anxious, we learn to eat or stress eat or get some comfort food so that we can comfort ourselves. And this is our evolutionarily adaptive learning mechanism, you know, negative reinforcement. That's saying, hey, something's unpleasant, make it go away. And so when we're stressed out, we learn, oh, if I eat this type of food, especially you know, refine carbohydrates. Right. That's why comfort food is not broccoli. It's like you know, mac and cheese or something something like that, something with a lot of carbohydrate in it. We eat that because our body is tuned to say, hey, this is a good source of calories, and we interpret that as hey, this is comfortable, and so we learn to eat, you know not and we're hungry. But when we're stressed, we're bored, we're angry, we're lonely, we're tired, all of these things. And in fact, this is so common that scientists had to come up with the term called hedonic hunger, which is a misnomer because we're eating in the absence of hunger, but that hedonic aspect is highlighting that we're eating in the presence of emotions, and it's that emotional eating that drives us to eat, and then we learn to eat not when we're hungry, but because of an emotion. It's fascinating.
There are so many movies that when a woman breaks up, she grabs ice cream like that is I can't even think of one movie because I think of so many where it's like get the ben and Jerry's where's the spoon, where's the you know, where's the meme for this? Like have you seen this Doctor Brewer where it's like this when you're said do this sort of conditioning, it is ice cream? Or you know for some of us, you know, I've heard people say, like, you know, I just I've worked so hard this week, I'm so tired. I've just got to get a piece of this thing, because it is like, you know, this is my reward for being tired. This is the comfort I need to feel better after this breakup, Like this ice cream will make me feel so much better? Is it true? In some way. That is it some length of satisfaction that happens once you get that ice cream.
Well, it's there is a length of satisfaction, and it's a very short length.
Okay, how well twenty minutes.
I would say, I'm just trying to think, because I asked this question of my patients as well, I would say between five twenty minutes. Some of them say it's very short. You know, so afterwards and enduring, they're often not paying attention to what it actually feels like. It's just to get it in so that I can distract myself, and so the satisfaction often comes from that distraction, right. The certainly ice cream tastes good, but it's really about getting something in to distract ourselves. I'm thinking of one of my patients who used to have been eating disorder, and she would, as she described it, she would eat to numb herself from her negative emotions, and her particular food was pizza. She would eat entire large pizzas actually in one sitting, as a way to numb herself.
Was that New York style or deep dish that matters? Yeah?
Deep dish boy. Anybody that could shovel down an entire deep dish preach said, let me see you do it. Wow, that would be tough.
Yeah, yeah, but yes, you know, food is one of the ways that we sometimes manage anxiety. Let's talk about scrolling. And I'm not just talking about social media. I'm trying to unscroll myself because I find that my scrolling is not always social media. It's other little busy things on my phone. It's like checking the weather. Well, I wonder what the weather is like in Miami. If it's this weather in Charlotte, Oh my gosh, what hotels in Miami can? I mean, it's just like, you know, it's just like a thing to pass time. And I yeah, I wonder how that ties into the things that we do when we become anxious or when we're feeling a thing.
Yeah, so it sounds like you're all scrolled up. Is that what you're saying?
Oh yeah, I've reached the end of the Internet. I mean, just I know things about celebrities I shouldn't even know. I'm like John Travolta did what. I don't need to know these things. I preached the end of my limit to the point where I am in a space of really reducing I did remove like Instagram from my phone, and I'm trying to mindfully watch TV, especially you know, the shows that I really enjoy and I want to pay attention to. And when I find myself like veering toward grabbing my phone, I do wonder, like why why, Like you, you're busy when you're doing something, why are you doing this other thing? And it comes back to I'm missing out. There's something one there that like somebody you know. So it's it's a little bit of worrying there, right, like something something happened in your email, get it. It's like, oh my gosh, yes, I missed the email from World Market.
Right, And that's a very important one to actually open within two minutes of receiving it, because otherwise something terrible might happen.
Yeah, you can't go to the store in two days if you don't see it immediately.
So you're highlighting a couple of things. One is that our brains are set up to really crave information. And it's been shown that dopamine fires in our stomach when our stomachs are empty, as says, go get food, and when we don't have information about something, we get a similar mechanism firing in our brain. So I think of information is like, you know, is the food for our brain, right, And it's been shown that animals will forego food for information because it's a helpful you know, it's helpful to survive. So we get that piece and then the Internet, of course has endless information that we could get that we don't necessarily need, but there's that little tidbit of oh a little bit more could be helpful. On top of that, there's, as you mentioned, the fear of missing out right, So it's like, oh what if I miss something? And occasionally we'll get some tidbit of information we're like, wow, that was really helpful, really timely or whatever, But that actually gets reinforced through a process called intermittent reinforcement, which is basically like a slot machine. Right. You don't know when you're going to get that useful piece of information, and because you don't know when, we keep going back for more and like, oh, let me check, let me check. I see this all the time with news feeds, right, We check our news feed because we think, oh, I need to be up to date. How often do we really need to be up to date? You know, if something is terrible is actually going to happen. Somebody's probably going to call us. We don't need to be checking our news feed every ten minutes. But if we check it every ten minutes, maybe once a day, I don't know. It depends on what people count as useful information. We might get some big headline up and we're like, oh wow, and this dopamine fires in our brain. This says, oh, that was important information, and we think, oh, I should be checking my newsfeed all the time. The truth is we could probably check it once a day and our life isn't going to be materially different, except that we'll be happier and be spending our time on more productive things than checking our news. But I think that's an example of how we scroll in so many different ways. They all fall into that general theme.
Yeah. I think when we use the word scroll, people often think like, oh, you're looking at TikTok, you're looking at Instagram. But it's like weather apps, it's news, it's shopping sides, it's refreshing those emails, it's you know, looking at your ring doorbell too many times. It's all the things that you know we don't have to do in that moment, and that we're not doing intentionally, because it's okay to intentionally scroll, right, but what if we're it's supposed to be working and we're scrolling, you know, So there are some you know, parameters needed.
Yeah, and I think this is where we can even leverage the strength of our brain because often we think, you know, oh, the easiest thing to do is just to remove this from my phone or not do it. The problem is that will power is more myth than muscle. And so you know, I'd love the phrase what we resist persists. So if we think, oh, I'm not going to do that, that's just going to build up like a water behind a dam until we eventually, you know, succumb to whatever the behavior is. And on top of that, when we are deprived of something, we want it more. So if we say I'm not going to eat the cookie, then we suddenly want the cookie even more, even if we didn't want it that much because we told ourselves we can't have it. So here, knowing how our brain works is really really helpful. And whether it's resisting or move beyond the resisting of the food, or trying to stop ourselves from worrying, it's the same mechanism in our brain. And so what we found is that instead, you know, this might sound crazy, but what we've found is that having people go ahead and do the thing but pay attention to the result of the thing really helps them become disenchanted with it so that they can naturally be less excited to do it in the future. And that's where real behavior change happens. So, for example, you know, one study, we got a sixty seven percent reduction in anxiety, not by telling people to develop more willpower, but by having them explore what they actually get from worrying, right, and they start see, oh, worrying doesn't actually solve problems, It doesn't help anything. It just makes me more anxious. And you know, we did a study with our you know, our Eat right Now program that's around helping people change their relationship to eating. We got a forty percent reduction in craving related eating. Not because we told people to resist the cravings, but because we had people go ahead and eat, and if they overrate or they were eating junk food or whatever, we had them pay attention to the results. You're ready for this. It only took ten to fifteen times of somebody over eating for that reward value to drop below zero and for them to change that behavior. So it doesn't take a lot of time. It just takes knowing how our brain works, and it takes fostering that awareness so that we can ask these simple questions like what am I getting from this, and then we can leverage the strength of our brain.
Yeah, I have a following of significance on Instagram, and I was very hesitant to remove the app because I'm with you. I don't think it's the app is not the problem. I am the problem. And so I use it from my iPad and I could use it as much as I want to. However, my iPad is huge. It's just not as comfortable to use Instagram on my iPad and I'm not taking it everywhere with me. And the thing I wanted to cure more than anything was looking at things when I'd rather be reading. And so that's why I removed it from my phone, because I would find myself like scrolling what I could actually just open my Kindle app. So, like I want to read more books, I don't want to read captions. And so when I want to read captions, I go to my iPad and I look and I read all the captions I want to, but I don't have it on my phone. And I don't know if you know that's useful to anyone, but it helped me separate work from pleasure, right like, because a part of Instagram is work, and then the other part, when I'm looking at plants, it's like, Okay, this is the fun side. But you know, I can schedule twenty minutes to do the work on Instagram, but if that thing is on my phone, oh, the lines are just blurred.
Well, let me ask you when you you know, if you reflect back on reading more and scrolling lives, how does that feel?
It feels really good because I like to get lost in a book. I feel like I'm getting more the scrolling. Sometimes I feel like I'm looking at a lot of things that are not my business and I would better be better off not knowing. I'm like, I don't need to know this information. And I find myself really irritated sometimes with the information I find out, and then I have to tell myself that's not my business anyway. And I am the person going on here and looking at these and then I'm like, well.
Why would they.
Look at it? They could do whatever they want to do. You don't have to look at it. And I think that's you know, it's anything I think that, you know, when you're looking at the lives of others and people doing things, it's like, well, I want to do some stuff too, and it's not always hopeful for me to watch people do stuff and not do the stuff. So I think it gives me more freedom to live in my life and be less of viewer of others. Yeah, and I wasn't using it that much as the interesting thing. People laughed, They like, how much was you too much? Too? Man? Is too much? Too much for me?
For me? Right? Well? And be you know, asking this question, how do I want to live my life? You know? And you probably nobody's going to have on their gravestone. I wish i'd scrolled more.
And I really like getting information from people. I find that my clients, my friends, my family, when they tell me about the new story, or they tell me about this new trend, or they directly text me a meme, a video, I am able to connect with them around that thing versus it just being in this space. So I like the one on one connection that I can have with people without it me finding this stuff and telling them. It's really fun for a client to be like, did you go to the grocery store? Yet, I'm like, no, what's happening. It's going to be a storm, really, you know, And so we could tell I had no idea, you know. So it's a really interesting way for me to receive information. I like it that way.
I love that. Yeah. Yeah, and we certainly don't have well I'll put it this way. We could certainly all benefit from more connection in this very disconnected world. So I love that way of connecting with people.
Yes, so please list your books and tail folks where they can find you.
Sure. So. My website's just doctorjud dot com, drg ud dot com. I'm also on Instagram at dr period Gud. And then the news books called The Hunger Habit and the book that we've probably most been talking about today is called Unwinding Anxiety, and the app that we've studied is of the same name. And people can find those, you know, anywhere they like to buy books. I'd say you support your independent booksellers, but you can also find links to a bunch of different places. Folks can find them on my doctor Judd dot com website.
Yes, well, thank you so much. We are in the family of publishing. You're on Avery, I'm on Charture, So I deeply appreciate your work. I can't wait for your next book. The work you're doing is incredible, valuable, and important. So thank you so much.
Well, thank you, it's been a pleasure.
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