Interview Judson Brewer English Version

Addiction psychiatrist, neuroscientist, and Director of Research and Innovation at the Mindfulness Center at Brown University

Conducted by Agathe Feoux at Brown University on August 16, 2019

AF : We hear a lot about mindfulness meditation now, and it is becoming more and more famous. People have a lot of books, trainings, videos, and audio recordings available to them. What do you think about that? 

 JB: A lot of those are conceptually interesting to people and so these concepts can be helpful, but if they don’t land and they don’t blossom as wisdom, then we actually just get addicted to reading more books and watching more videos and we don’t actually progress.

So retreat is really helpful. I don’t know if you’ve noticed, but sometimes on retreat if we don’t know how our mind is working, the retreat may not be as useful for us to have these concepts actually land in our bodies. 

 AF : Yes, and it takes time. I like your mathematical equation that says suffering equals pain times resistance. The resistance plays a role in the suffering? 

Figure 1.

[Suffering = Pain x Resistance]

Judson : Yes! The resistance plays a role in everything!

You can really boil all of practice down to resistance versus non-resistance or closed versus open.

And mindfulness just uses awareness training to help see those things as simple… you know, somebody can get really lost in meditation or mindfulness training, thinking “what do I look at?”, but if we help give them something very specific to focus on, it can really help them to find a track to move forward.

There are these concepts, it’s like : if you get into a big swimming pool and you just start swimming, the likelihood that you are going to swim in the straight line is not great, you know? But if you give somebody swim lanes, they are much more likely to move straight and make progress. 

So if we give people clear swim lanes around helping them understand how their brains work or focus on “when am I closed down and when am I open? Does this feel more painful than this?”

That type of thing can provide that direction that can help. They still have to do the work, but it can help them. It could be more painful to resist. 

AF : I think for people at the beginning it can be scary. When you tell them to open themselves to a kind of suffering, they probably think “What? I tell you I’m afraid to die and you tell me to stay with this feeling?” It is kind of contradictive!

JB : And I would not do that, for that reason. We are seeing that people tend to get more open when they see how painful it is to not be open. 

For example, if somebody says “I am afraid to die” we could dial into that feeling and ask “What does it feel like? Does it feel contracted?” And instead of that concept of “I am afraid to die”, which is in the future anyway, we keep them in the present moment of what does this contracted state feel like and it can help them see “Oh, this is a contracted state” and now how does it feel compared to thinking of a time when you were joyful? Which one feels better? You know, to just really step beyond something they are not ready to think about but into the direct experience of this moment, which can actually be a good learning experience for them.

AF : You have a space here for research and you are working on researching a variety of things I am curious about. Can you talk about some of these?

JB : Certainly! So we do clinical research, we do translational research, which combines clinical research with basic neuroscience research, and we also just do basic neuroscience research. 

The clinical center overall studies mindfulness-based stress reduction.

My lab mostly studies the app-based mindfulness trainings that we have developed to see : Do they work? For whom do they work? Are there problems with them? And then mechanisms of how do they work. For example, can we target specific rewards-based learning systems?  

Just for an example, say somebody comes in and they are having trouble over-eating. We have a project we just started this summer with our eating program where we have people imagine eating the amount of food that they normally eat. And then we ask them how much is your craving higher or lower now based on your imagining of eating… And sometimes when people just imagine over-eating they are like “ugh, it’s doesn’t feel that good …” and then that craving reduces. 

Sometimes, when people are still really caught up in the experience, their craving goes up, so it can help us get a measure for how caught up people are in that habit loop. And if they are still caught up, we then have been go through mindfulness eating exercises, like “go ahead and eat the food!” and afterwards ask them how much did you eat and how content do you feel, like how good do you feel now? And if they overeat, the idea is they’ll pay attention and see that they don’t feel as good, which drops that reward value.

And then it feeds back and helps them see the next time they’re about to do the same behavior that they’re not as excited to do it again. So it is a way to measure the behavioral mechanisms of people becoming disenchanted and less excited to do a certain behavior because the reward is less… 

Have you ever smoked cigarettes? 

AF : Yeah…

JB : Ok, how do cigarettes taste to you?

AF : Not good. 

JB : So that’s a simple example of what we are doing with this study, basically having people pay attention and be mindful when they smoke. They realize that cigarettes don’t taste very good and so they are less excited to smoke in the future. And that’s really how mindfulness works to change many behaviors.

We are just starting a project now where we’re looking for universal language around specific behaviors, so let me ask you this question: 

Think of a time you where afraid. If you had to categorize it as either open or closed in terms of how it feels, what category would you put it in?

AF : Closed.

JB : Closed, yes. How about joy?

AF : Open.

JB : So we think that there is actually a universal language where there are bunch of different experiences that lead to a closed or contracted states, and a bunch that lead to open and joyful states.

Now if you pick one, which one would you prefer? 

AF : Open! (both laughing)

JB : I know, it’s a no-brainer! So that suggests that there is a hierarchy of value in our brains. And the ones that are more rewarding are the way our brains are going to naturally move. So if we can use awareness, we can actually help train people just to seewhen they are closed and just to see when they are open. And if they can see how painful it is when they are closed versus how joyful and nice it feels when they are open, their brains will naturally start to move in that direction. And I think that is really the heart of what mindfulness training is about!

So we’re doing a whole study on that where we are going to see if there is a universal language. We going to see if people value certain things more than others and we are going to see if we can actually link up mindfulness training with helping people move from the closed to the more open states. 

We are really excited about that project! We also want to scan people’s brains when they are closed versus open to see how that shows up in their brains. 

AF : You said sometimes we mistake excitement for happiness. For example, how about addiction to romantic love… when do you know if it’s real love?

JB : So think about excitement, so all of these can fit into these open or closed categories… so if you had to pick excitement versus joy? Which one put you on close versus open? Which category would you put excitement in?

AF : I think closed because it can have so much tension! It can be too much excitement…

JB : Totally! So excitement actually falls into probably more of a driven quality of experience and that why romantic excitement drives behaviors as compared to this open quality that comes with joy. 

So think about romantic love, there can be an excited quality to that, like when we first start dating somebody,  it’s like an addiction. But when we actually mature in that relationship, it moves toward a more open feeling, where we are not just trying to get stuff for ourselves, but just the joy of being connected with the person is what feels most important. That moves to a more open state, so we are moving from a contracted state to a more open state with love as it matures. 

So behavior itself isn’t actually anything special, it’s what the result of it is,  it’s what it leads to…

So for example, I can eat a piece of cake and if I’m starving it might taste really good, but if I’m stuffed it might not taste very good. 

So the same behavior could have different effects… one can be really rewarding, like “oh yeah, eat that again!” whereas the other could say “oh man, don’t eat that again!”. 

So a lot of people think you can just change a behavior, and they’ll change. They focus on the behavior but that’s not how actually our brains work. 

I put together an animation on my web site ; www.DRJUD.com, and its called “Solutions for Everyday Addictions”. It’s an animation that explains all of this and it walks through how all of this stuff works. 

AF : Can you talk about the importance of compassion versus empathy for healthcare professionals while they are administering care?

JB : That is something you can explore yourself. So you can notice times when you are putting yourself in somebody shoes, does it feel contracted or does it feel open?

You can notice times when you are just really being with somebody who is suffering but you’re not protecting yourself. You see if that’s more open, this tends to be depleting and tiring. We can get tired with this approach. Think of romantic love you know, we’re exhausted constantly thinking and doing whereas if we’re more in a more mature romantic relationship, it feels life giving. I think compassion and empathy can be in the same categories where empathy, if we’re constantly feeling someone’s pain or protecting ourselves against their pain, it can feel very tiring. Whereas when we are in this open stance, it brings energy… so that’s something for you to explore yourself and see what it’s like for you. 

AF : What about the importance of non-judgment? You think when we criticize ourselves, it adds another layer of suffering?

JB : So you tell me, what does it feel like when you criticize yourself?

 AF : Yeah, horrible. But sometimes we don’t even realize we’re doing it!

JB : But as soon as you see how painful it is, your brain will start looking for future times when you’re doing that. Because now we will know “Oh, this is painful”. It will actually be easier to recognize more and more in the future so that you can then become aware of it and then if it’s painful we tend to let go.

You remember the hot coal analogy? We touch the hot coal and as soon as we do, we let go. We don’t need to think “Oh, I need to drop this”, it just happens naturally. But the awareness has to be there and if we didn’t notice that something was painful we are not going to ever change that behavior. But if we do see that it is painful and the more we are able to see how painful it is, the easier it is to drop. That’s the beauty of mindfulness! It’s all about just bringing awareness to what’s happening. 

AF : So why do you think it is so necessary for the world to study mindfulness? 

JB : Our planet won’t survive without it ; we will just be stuck in selfishness. You know there is so much focus on individual happiness  that is driven by consumerism because that makes people money. 

If I were to pick one drive that is killing the planet it is that we are using all of our natural resources to make things to sell to other people, so we can make money and we are told that that is what happiness is. 

So without awareness to see, one: that doesn’t actually lead to very much happiness and… two: there is greater happiness that comes with connection or with joy or with helping people. As soon as we see this,  we’re going to naturally move in this direction. The more people see that this is how our brains are set up. So, that’s why I think the world needs mindfulness. 

AF : Yes, that’s beautiful and we need that for our feelings and our emotions too because sometimes as human beings, we are suffering from that. So it could help to change our relationship to that.

JB : Absolutely, in a beautiful way! It’s like, we can hold all the pain. We realized there is so much space to hold pain. When before it felt like we don’t have enough space to hold the pain, in fact there is an infinite amount of space to hold the pain!

AF : Because you are a psychiatrist and a neuroscientist, do you think there are some contraindications for praticing Mindfulness?

  JB : I’ve actually taught mindfulness on a inpatient psychiatric unit before, with people with schizophrenia who were in the hospital… 

The biggest places for people to be careful is when somebody has a history of trauma… we have to be more careful there than with schizophrenia. There have been some studies about this and I have even seen it in my own practice and I think people with schizophrenia can benefit from mindfulness training quite a bit because it helps them learn how their minds work. 

When somebody has a trauma history, that could be really challenging if they just learn a little bit of mindfulness and don’t have a good skillful therapist or a teacher to help them through the process. If they have a good teacher or a good therapist, I think it could help them through the process and it could be very healing. 

In general, learning how our minds work helps us move forward. 

There is a great book written by David Treleaven called “Trauma-Sensitive Mindfulness” David talks about different ways to help people who are starting to learn mindfulness if they get into a territory were they struggle so that they don’t get into trouble. It’s a good book.

AF: Thank you so much!

JB: Of course, you are welcome!