Jud Brewer, MD, PhD (“Dr. Jud”) is a thought leader in the field of habit change and the “science of self-mastery,” having more 20 years of experience with mindfulness training with his scientific research therein. Dr. Jud is the director of research and innovation at the Mindfulness Center and associate professor in psychiatry at the School of Medicine at Brown University, as well as the executive medical director of behavioural health at Sharecare, and a research affiliate at MIT. Previously, he held research and teaching positions at Yale University and the University of Massachusetts’ Center for Mindfulness.
As an addiction psychiatrist and internationally known expert in mindfulness training for treating addictions, Dr. 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 (Eat Right Now, Unwinding Anxiety and Craving to Quit). Based on the success of these programs in the lab, he co-founded MindSciences, Inc. – acquired by Sharecare in 2020 – to create app-based digital therapeutic versions of these programs for a wider audience, working with individuals, corporations, and hospital systems to put effective, evidence-based behaviour change guidance in the hands of people struggling with unwanted behaviours and “everyday addictions.” He regularly gives talks on the intersection of modern science and ancient meditative practices, helping to expose a modern audience to specific techniques and insights first discovered 2,500 years ago. He has published numerous peer-reviewed articles and book chapters, trained U.S. Olympic athletes and coaches, foreign government ministers and corporate leaders. His work has been featured on 60 Minutes, TED (4th most viewed talk of 2016 with over 15 million views), TIME magazine (top 100 new health discoveries of 2013), Forbes, CNN, BBC, NPR, Al Jazeera (documentary about his research), The Washington Post, Businessweek and others. He is also 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).
In this interview, I speak to Jud Brewer MD PhD (“Dr. Jud”), one of the world’s foremost experts in habit change, addiction, self-mastery and mindfulness. Dr. Jud has more than 20 years of experience in research and clinic, and we discuss the very fundamentals of building and breaking habits, the importance of mindfulness, paying attention, and how curiosity can change our lives.
Q: How critical is positive & negative reinforcement to human learning?
[Judson Brewer]: It’s not just us – sea slugs with the most basic nervous systems, at 20,000 neurons, also learn using positive and negative reinforcement. It’s very fundamental. Our ancestors didn’t have refrigerators, they needed to find food and remember where it was so they could go back and get it the next day. This is positive reinforcement. It can be broken down into three elements: a trigger, a behaviour and a result. You see food (trigger), you eat food (behaviour) and your stomach sends a dopamine signal to your brain that says, ‘remember what you ate and where you found it because there are calories there’ (result). The same is true for negative reinforcement, you see a lion or tiger (trigger), you run away (behaviour) and you remember where it was so you take precautions to not get eaten (result).
Q: Are habits the optimisation of positive and negative reinforcement?
[Judson Brewer]: Imagine we woke up every morning and had to re-learn everything from walking to putting on our clothes and putting food in our mouths. Think of babies, they get positive and negative reinforcement when they’re trying to find their mouths with a spoon. It starts with food all over their face, they gradually get less and less messy, and eventually they’re eating cleanly. That’s a habit we all have – getting food in our mouths. We don’t think about it! You can think of it almost as a habit-skill so to speak. You can think of habits as a ‘set and forget,’ we set the habit, we set the behaviour, and we forget about the details. That frees up our brain to learn new things throughout the day.
Q: How does our brain decide what does (and does not) warrant becoming a habit?
[Judson Brewer]: It really depends on how rewarding the behaviour is. For example, with positive and negative reinforcement, the more rewarding something is, the more it’s going to get laid down. Our brains have these reward hierarchies where they decide to eat A over B (for example) – why do we prefer cake over broccoli? From an evolutionary standpoint, cake is more calorically dense. You could even call this the bliss point where you try to get that perfect ratio of sugar, salt, and fat. Our bodies are saying, ‘ooooh, that’s good, do that some more!’ – if something is rewarding, we’ll set it down as a habit. If something isn’t rewarding, we can break that habit too.
Q: Can we short-circuit habit formation to lay-down positive habits?
[Judson Brewer]: It’s hard to short circuit the habit formation process. As humans, we like to believe we can think our way out of problems and into solutions. When it comes to habits, that’s more a hand-waving-process than a truth. Neuroscience shows us that habit formation is based on how rewarding something is, not willpower. Willpower isn’t even in the equation. We like to think of willpower is something, but it’s more myth than muscle. So good luck short circuiting the process! Some people do have ‘Mr. Spock’ like abilities to reason their way into things, but even that has a reward component to it.
You have to double down on the reward system and leverage it by focusing on the reward of doing something. We might know intellectually that exercising is good for us but telling ourselves to exercise isn’t going to get us out of the door when the weather is bad or when we’d rather be watching a show on television. If we remind ourselves how good it felt last time we exercised, we can tap into that and pull ourselves out of the door.
Q: How can we break habits?
[Judson Brewer]: I’ve been exploring habit breaking in my psychiatric clinic, and also in my lab. To give you an example, let’s look at smoking. I can’t just tell my patients to quit, it doesn’t’ work like that. I turned it on its head and told them, ‘you know what, go ahead and smoke…’ – my patients looked at me like, ‘…what? A doctor just told me to smoke?’ I told them to pay attention as they smoked. This is based on models by Rescorla and Wagner who, in the 1970s, found that you can introduce an error term into a reinforcement learning model which changes the equation. You’re an get a positive prediction error if something is better than expected, or a negative prediction error if it’s worse than expected. If you smoke, and it’s worse than expected, it will reduce the reward value, and it will help you quit. I’ve never had a patient come in after I told them to pay attention to smoking who was full of joy at how delicious cigarettes taste and smell, they often come in and balk at how they didn’t’ notice it sooner.
We’ve built an app in our lab that we’re trialling to help people who overeat. By encouraging them to pay attention as they overeat, we can reduce the reward value of that habit to zero in just 10-15 sessions of eating. These are people who could have been overeating for decades, but their behaviour can change quickly. That makes sense form an evolutionary standpoint- you don’t have 20 opportunities to see whether the tiger is dangerous, you must learn fast.
Q: How can habits help us understand anxiety and our mental health?
[Judson Brewer]: In the 1980s, researchers suggested that anxiety could be driven by negative reinforcement. They suggested that worrying could be a mental behaviour in the same way that eating is a physical behaviour. The feeling of anxiety can trigger the mental behaviour of worrying. That behaviour [worrying] can make us feel like we’re in control or at least doing something… even when that something is making us more anxious. Anxiety doesn’t feel good but worrying feels better than not worrying. Worrying gives a sense of control, and we all love to have more control than we do. Habits also become familiar, and familiarity gives a level of comfort which almost acts as a reward. It’s like putting on a sweater that we know well.
When I learned that, it was a lightbulb moment. We studied digital therapeutics in my lab and created an app called Unwinding Anxiety. We got a 67% reduction in clinically validated anxiety scores in a randomised controlled trial of people with generalised anxiety disorder, which is significantly better than the current gold standard medicines. If you get at the behavioural mechanisms, it’s amazing how much people can tap into reward-based learning to leverage and unleash unhelpful habits like worrying.
Q: What are the warning signs we need to look out for with habits?
[Judson Brewer]: An addiction is very simply the continued use of something despite adverse consequences. Habits have continued use through their automatic nature. Most habits (95%) are helpful. It’s when a habit becomes continuous despite adverse consequences that we need to worry, so for example, if we’re in the habit of checking our phone every time we get a text, and that habit carries over to when we’re driving, that’s shown to be even more dangerous than driving while drunk.
Q: How is paying attention seen in clinical context(s)?
[Judson Brewer]: There is a stigma around mindfulness and attention. It’s seen as a seventies, hippy-dippy, rainbows and unicorns practice, and that creates baggage. It’s also hard to imagine how something as simple as paying attention would be transformational. When we do practice mindfulness, we realise that the effects – curiosity and kindness – are super-powers. I remember someone telling me that I was going to kill my career because I was shifting from molecular biology to the neuroscience of mindfulness, but I was utterly convinced it was real and warranted research.
Q: How does mindfulness work?
[Judson Brewer]: Mindfulness consists of two core components, awareness, and curiosity (or awareness and kindness). The Buddhist underpinnings of mindfulness emphasise cause and effect. You do a behaviour and there is a result, mentally or physically. It sounds a lot like positive and negative reinforcement, right? It’s reward-based learning, and if something is rewarding, we will keep doing it.
If we pay attention, bring awareness, and are curious about what’s happening in any given moment, we can break a lot of bad habits. We did a study where we had five-times the quit-rate of the gold standard treatment for smoking cessation, and we achieved that through mindfulness. When you become aware of what’s happening, you can start to see all the things that you do habitually which actually take-away from your joy and happiness. You then start to see things that you could do to add joy and peace to your world. For example, you may start to realise that when you beat yourself up, it doesn’t feel good. You might then bring kindness in, and notice how much better you feel when you’re kind to yourself, that’s reward based learning. Being kind to yourself feels better than being judging.
These techniques existed even before paper was invented, they’re ancient. Mindfulness training beat Kandel to his Nobel prize by 2500 years <laughs>.
Q: How is mindfulness part of a business resilience toolkit?
[Judson Brewer]: We’ve done studies on burnout – like clinician and physician burnout. We found that anxiety and burnout are highly correlated, and that mindfulness training helps with burnout. I would speculate that there are business leaders in the c-suite who value humility, kindness, curiosity, and awareness. I remember seeing the cover of a Harvard Business Review where they were talking about the business case for curiosity.
The more businesses wake up to the power of mindfulness the more they realise that mindfulness is cheap to train and generates better health outcomes, higher retention, and leads to more curious and kinder employees. Who doesn’t want that?!
There is also a fair amount of research on the detriments of set-switching or task-switching. It’s really inefficient to switch from task-to-task. Multitasking is bad for our brains! Mindfulness helps us to reduce the overactivity of a network called the default mode network which basically gets activated when we’re ruminated or worried. Imagine you have some task, and then a board meeting, and then other tasks. If you’re carrying mental baggage from meeting to meeting, you won’t have effectively task switched! I think you can make a very good argument that mindfulness and mental-wellness are critical in roles where this kind of switching happens.
Q: How should we inject mindfulness and attention practices into our lives?
[Judson Brewer]: Pay attention, bring curiosity into your life, and notice how good it feels to be curious rather than jumping to conclusions or not paying attention. Just notice how good it feels to be curious, and let that positively reinforce itself. Also, notice how it feels to be kind and generous and see how life-affirming and life-giving that is, how much energy it gives you, rather than how much time it will take away…. It’s a life bolstering activity that gives a return on investment. I’ll just put it that way.
Q: What do you hope your legacy will be?
[Judson Brewer]: I don’t know if, or how much, impact I will have; I’d be happy if I even helped a couple of people wake up to the power of kindness and curiosity. It’s pretty rewarding every time the patient comes back and says, yeah, I quit smoking using this method where I’ve tried everything else for 15 years. Even one or two stories like that, who needs more? It’s powerful and rewarding.
I approach my work one person at a time. Everybody’s story is so unique and powerful. It’s just meeting it where it’s at, and that common humanity and even the bond that forms in that moment, even if it’s gone the next moment, is just like you highlighted, it is transformational. It’s enough. But I take it one person at a time.