White Coat, Black Art

3 steps to break the bad habit of worry

People who are anxious can rid themselves of the habit of worry by first learning to recognize the unhelpful thoughts and replacing them with more openness and curiosity, a psychiatrist and neuroscientist says. 

Anxious people can rid themselves of the habit of worry by recognizing and replacing unhelpful thoughts

Anxiety can trigger the behaviour of worry, neuroscience suggests. (Shutterstock)

People who are anxious can rid themselves of the habit of worry by learning to recognize unhelpful thoughts and replacing them with more openness and curiosity, a psychiatrist and neuroscientist says. 

Dr. Judson Brewer directs research and innovation at Brown University's Mindfulness Center and is executive medical director at the digital health company, Sharecare. He's the author of Unwinding Anxiety: New science shows you how to break the cycles of worry and fear to heal your mind.

The book draws on his more than two decades of experience with mindfulness training, coupled with brain research, to contribute to knowledge about how people can make permanent and positive changes in their lives.

He spoke with Dr. Brian Goldman, host of White Coat, Black Art, about what's going on in our brain to make a habit of unpleasant thoughts like worry and anxiety. He also talked about how to shift your mind out of the habit loop behind negative emotions and addictions like smoking, gambling or even reaching for a third piece of chocolate cake. 

The conversation comes on the heels of Statistics Canada's report last month that found 13 per cent of adults screened positive for generalized anxiety disorder in the previous two weeks. That's based on self-reported symptoms such as excessive, ongoing anxiety and worry that are difficult to control. The rate climbs to 21 per cent when major depressive disorder and posttraumatic stress disorder are included. 

Here is part of their conversation.

In the book you say that worry is a habit, not unlike an addiction. What do you mean by that? 

Well, if you think of any habit, it gets formed through three elements: a trigger, a behaviour and a reward. Think of the basic survival mechanisms. We see food, we eat food. There's the behaviour. And then the reward is, our stomach sends a dopamine signal to our brain that says, "Remember what you ate, where you found it." So it helps us learn things. Any habit is formed that way.

I didn't actually know that anxiety could be driven through worry habits until recently. The way that it works is that the feeling of anxiety can trigger the behaviour of worry. That worry can either make us feel like we're in control or at least make us feel like we're doing something even if we are not in control. And that feels better than not doing anything. 

What the heck is going on in my brain scientifically to make a habit of unpleasant thoughts? 

Dr. Jud Brewer draws on more than 20 years of experience with mindfulness training and research into how our brains work to help people make permanent and positive changes in their lives. (Penguin Random House)

There's an interesting piece from a neuroscience perspective that has to do with a network of brain regions called the default mode network.

This is the network that is running in the background almost all the time basically thinking about ourselves, regretting things we've done in the past, or worrying about things that might be coming up in the future. Worry activates this default mode network.

This network also gets activated with a bunch of different types of addictions, so smoking, cocaine, gambling, even people eating chocolate.

My labs looked to see exactly what's going on in this network. We've done these experiments where we can link up people's direct experience with their brain activity basically in real time. What we found is this network gets activated when we get closed down, when we get contracted, basically when we get caught up in our experience. So somebody can get caught up in a craving and they can also get caught up in worry or caught up in anxiety. 

The challenge then is to help people flip the switch from being constricted and caught up in the loop, to getting out of the loop. 

Yes, absolutely. One reason that my lab has been studying this default mode network is that we found that experienced meditators deactivate this network when they're practising mindfulness, basically when they're being aware. 

A key component of that is this attitude of curiosity. If you think of anxiety, it feels closed, it feels contracted. Curiosity feels open and expanded, and you can't be closed and open at the same time. 

When we're feeling closed and contracted, we can actually inject some curiosity and start opening ourselves up simply through being curious about what the sensations feel like, what the thoughts are, what the emotions are.

The method that you've described in the book mentions three gears for hacking your mind. First gear, you get your patients to map out what you call their habit loops. So what does that involve? 

It's as simple as noticing the trigger — the behaviour and the reward in a habit loop — and how the reward feeds back onto the trigger. 

For example, I talk about one of my patients in the book. He had anxiety for over 30 years and he really had no idea how his mind works. I pulled out a piece of paper and I wrote down trigger, behaviour, reward. 

And so he started mapping out his triggers. He'd have these thoughts that he might get in a car accident. The behaviour was to avoid driving on the highway. And then the temporary reward for him was that he wouldn't have those unpleasant thoughts. But, of course, it was leading to all sorts of problems for him because he was having trouble driving. 

With each bite, ask yourself is this better than the last one or is it the same or is it starting to get worse? (Getty Images/iStockphoto)

Really focusing on the behaviour first, for example — worry or procrastination or stress eating — and then mapping it back to the trigger. See if you can identify those and then map it forward to the result, like, what am I getting from this? That's the first step. 

Second gear: updating your brain's reward system. How does that work? 

Our brain sets up these reward hierarchies so it makes it easier for us to make decisions every day. We don't have to relearn everything and say, "Oh, do I like this type of chocolate or this type of chocolate?"

Well, the same is true for any habit. The way to change that habit is to make sure that that reward value is as updated as possible in real time.

Ask simple questions like what am I getting from this right now? 

You did an experiment in which you asked participants to have the thing that they craved — that piece of chocolate cake — then offered second and third pieces. By the time they got to the third piece, what were they thinking or feeling? 

Noticing how a trigger, behaviour and reward work a habit loop, helps to manage anxious feelings, says Dr. Jud Brewer. (Dr. Jud Brewer)

We can even break this down into a bite by bite basis. Our brains are going to have this pleasure plateau.

My friend Dana Small, who's a food researcher at Yale, did a chocolate experiment where she just kept feeding people their favourite chocolate. 

The idea is: we're going to have this pleasure plateau where it's going to be good and then it's going to be, well, not quite as good as the last bite. We're going to hit that plateau and then we're going to go over the other edge as somebody kind of force feeds us the chocolate. 

The idea is to ask ourselves, with each bite, is this better than the last one, or is it the same, or is it starting to get worse?

And just that awareness can help us find where we can stop when we've had enough and not overindulge. 

OK, so talk about the third gear: the bigger, better offer. 

In that second gear, once we've started to identify what is not as rewarding as we thought it was, whether it's the whole bag of chips or comparing ourselves [to others], this opens up the space for that bigger, better offer where our brain says, "OK, give me something better."

The nice thing here is we can actually look internally. There are two things that we can access, foster and support that are always available: curiosity and kindness. 

If you look at comparison, for example, it feels contracted. If we look at kindness or curiosity, it feels expanded. So we can already start to inject those qualities of expansion simply by being curious, "Oh, here I'm going and judging myself again." That helps us open up. Or, "here I'm beating myself up. I'm being unkind to myself." 

Do you have any methods that you can recommend for being kind to yourself? 

First notice what it's like to be unkind to yourself so that we can see how unrewarding that is and we can kind of break out of those habits. 

Once we noticed that, the other thing we can do is just practise small acts of kindness for ourselves throughout the day.

If we've got a busy day and we've just finished a project, taking 10 seconds to stand up and stretch and give our body a change of posture, just noticing what that feels like to take that little time to care for ourselves, that's a great thing we can do to be kind of ourselves.


Written by Amina Zafar. Produced by Willow Smith and Jeff Goodes. Q&A has been edited for length and clarity.

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