Herald columnist and Radio Hauraki breakfast host Matt Heath is taking on a new role as Happiness Editor for our Great Minds mental health project. He will share his own insights in his search for wellbeing as well as interviews with international experts in the field.
American psychiatrist and neuroscientist Dr Judson Brewer believes anxiety can be a habit similar to cocaine and smoking addiction. He's been hugely successful in helping people break these habits and - many more. His team's programme for smoking earned five times the quit rates of the American gold standard treatment. His app-based mindfulness training achieved a 67 per cent reduction in clinically validated anxiety scores in people with generalised anxiety disorder. He's also a great communicator. I've listened to his The Craving Mind and Unwinding Anxiety audiobooks multiple times.
Dr Brewer appears on my zoom bright-eyed and smiley.
Dr Brewer, what is anxiety?
Well, our brains don't like uncertainty. If you can think of information as food for our brain. When we don't have food in our stomach, our belly rumbles until we eat; when we have uncertainty happening, our brain rumbles until we get that information. Anxiety is our mind spinning about the future. What if this, what if that, what if this? Nowadays, there's too much information for us to process. There's always more we don't know. When our ancient ancestors saw a tiger, they could trust that that was a tiger, and they'd run away. They weren't thinking it might be a fake tiger. Now not only do we have access to a tonne of information, but we also have to figure out for ourselves what information to trust and believe.
How is anxiety similar to other addictions?
Anxiety can be driven through negative reinforcement, just like any other habit or addiction. You need three elements to form a habit: a trigger, a behaviour, and a result. The feeling of anxiety can trigger the mental behaviour of worry. That feeling of worrying makes us feel like we're doing something. That's rewarding enough that it feeds back to the next time we get anxious. Our brain says, oh, do that again, so we get into anxiety and worry loops that drive each other.
So there's a buzz or enjoyment in worrying that gets rewarded?
I wouldn't say enjoyment. Dopamine gets mischaracterised as a happiness or bliss molecule. Dopamine is anything but bliss. It's actually there to get us to do something. So when we have that urge to get some food from the refrigerator or go on social media, that urge is not pleasant. It's itchy. It says I'm going to make you uncomfortable until you do this. That's how dopamine is set up.
You get the dopamine hit for worrying even though it did no work to help your situation. That means you are being rewarded for doing an unhelpful thing. How come our brain gets it so wrong?
You naturally think that we're evolved to do the right thing, but that's not the case. We have to decide what the right thing is. The natural instinct to jump when we hear a loud noise that's probably not something we want to unlearn. At the same time, we can be learning unhelpful habits. It's really helpful to know how our minds work so we can learn to see which habits we're forming are helpful for us and which ones are not.
So if we recognise a habit is bad. Why can't we just will ourselves to stop?
As much as we'd like to believe that willpower is powerful, it's more myth than muscle. In order to be able to break these habits, we have to use the powerful parts of our brain. Willpower relies on the youngest and weakest part of our brain, which ironically goes offline when we're stressed or anxious. We fall back into our old habit patterns when we're in those situations.
So how do we stop this habit of anxiety and worry?
Through the mechanism of being aware. If we can pay attention and see very clearly what the result of a behaviour is, we can either reinforce a helpful habit or let go of an unhelpful one. That's why this process is called reward-based learning. If something's really rewarding, we're going to keep doing it. If it's not working, we can stop. Awareness can help us pay attention and see how unrewarding some of these habits are. I've had plenty of patients come into my clinic who want to quit smoking. I tell them to go ahead and smoke but this time, clearly pay attention to the taste and experience as they smoke, and they realise the cigarettes taste like crap. When they realise that, they're less excited to smoke, and eventually, they don't have to tell themselves to stop smoking. People can smoke a pack a day for years without ever really paying attention. When they do, they realise it's pretty disgusting. That's how we change our habits. We become disenchanted with these old habits, and then we can replace those with healthier habits. So, for example, when somebody's anxious, they can worry. When they pay attention, they see that worrying doesn't actually do the work to solve problems, and it doesn't feel good.
So you teach your brain that worrying doesn't help, and as a result, it stops handing out the dopamine reward for worrying?
Yes, I ask patients to be really curious about the worry. Curiosity feels better than worry. Use that curiosity to explore every physical sensation that comes up when you worry. That helps them not only foster the habit of being curious but also helps them step out of the habit loop of worrying. Finally, it helps them see that these physical sensations pass. If you simply be aware and curious of them, they will go away. That is tremendously empowering.
It's worth getting your head around Dr Brewer's research. He's helped me and a number of struggling buddies who I've given his books to. Give Judson a read; he offers a practical and palatable way to deal with our bad habits.
WHERE TO GET HELP
If it is an emergency and you or someone else is at risk, call 111.
For counselling and support
Lifeline: Call 0800 543 354 or text 4357 (HELP)
Suicide Crisis Helpline: Call 0508 828 865 (0508 TAUTOKO)
Need to talk? Call or text 1737
Depression helpline: Call 0800 111 757 or text 4202
For children and young people
Youthline: Call 0800 376 633 or text 234
What's Up: Call 0800 942 8787 (11am to 11pm) or webchat (11am to 10.30pm)
The Lowdown: Text 5626 or webchat
For help with specific issues
Alcohol and Drug Helpline: Call 0800 787 797
Anxiety Helpline: Call 0800 269 4389 (0800 ANXIETY)
OutLine: Call 0800 688 5463 (0800 OUTLINE) (6pm-9pm)
Safe to talk (sexual harm): Call 0800 044 334 or text 4334
All services are free and available 24/7 unless otherwise specified.
For more information and support, talk to your local doctor, hauora, community mental health team, or counselling service. The Mental Health Foundation has more helplines and service contacts on its website.
Stool and goods fly as pair fight at Pakuranga night market on Saturday. Video / Supplied