Hidden Brain - The Curious Science of Cravings

Episode Date: April 15, 2024

We've all had those days when all we want is a little treat. Maybe it's a bag of chips, an ice cream sundae or a glass of wine. But sometimes, these desires become all-consuming. This week on the show, psychiatrist Judson Brewer helps us understand the science of cravings, and how we should respond to them. If you liked today's conversation, be sure to check out other Hidden Brain episodes about ways to regain a feeling of control over your life: Creatures of Habit and Taking Control of Your Time.

This is Hidden Brain. I'm Shankar Vedantam. In the 4th century, a young man named Aurelius Augustinus found himself in a struggle with himself. He was born in what is today Algeria, but at that time was part of the Roman Empire. Aurelius found himself torn between the dictates of his faith and the impulses of his own body. of his faith and the impulses of his own body. I was bound down by this disease of the flesh, he wrote. Its deadly pleasures were a chain that I dragged along with me. Aurelius was infatuated with his lover. He felt his attraction to her was purely physical, and this felt wrong to him.

Aurelius happened to be one of the most prolific writers of his time, so we have a detailed picture of his mind from his various books and writings. At one point he said, Aurelius, whom devout Catholics know today as St. Augustine, is said to have prayed for divine assistance to battle his cravings. But his appeal to God revealed his own divided self. Lord, give me chastity and continence, he prayed. Only not yet. For thousands of years, human beings have tried different techniques to get control over their desires and cravings.

These battles have made their way into myths and legends. In the Odyssey, the famous epic by the Greek poet Homer, the warrior Odysseus orders his men to bind him to the mast of his own ship, so he cannot succumb to the temptations of the beautiful, human-like creatures known as the sirens. In modern times, the diet industry has offered thousands of books and videos to help people get control over their food cravings. The pharmaceutical industry has come up with drugs that suppress appetite. Addiction researchers and treatment centers all over the world

help people battle cravings for alcohol, drugs, and sex. Our long battle with ourselves is testament to the deep powers of human desire. Over and over, as you look down history, people have reported that they felt powerless and helpless in the face of their cravings. This week on Hidden Brain, the science of cravings and provocative ideas to get a hold

of them. From the time we are newborns, our minds come with a built-in drive to crave things. We instinctively seek out sources of sustenance and safety. As we grow older, our desires grow complex. Over centuries, humans have discovered many substances that change the way we feel. The popularity of alcohol, cigarettes, and drugs are testament to our enduring capacity to seek out exhilaration, relaxation, and relief. At Brown University, psychiatrist Judson Brewer studies the science of cravings, how we usually respond to them, and how we should respond to them.

Jud Brewer, welcome to Hidden Brain. Thanks for having me. Judd, I want to take you back to your days in high school. I understand you were a serious athlete, but every once in a while, you would be consumed with a craving for ice cream. Tell me about that. In high school, I had a very strict diet,

because I was trying to dial in everything that I had control over to try to improve my athletic performance and I needed all the help I could get. So I, you know, it was no sugar, no refined foods, no sweets, no candy, no fast food, no junk food, and certainly no ice cream. And when I was off season, you know,

I would see people eating ice cream and I would just be struck with this craving. I was like, oh, that looks so good. And I remember eating close to half a tub, like half a gallon of ice cream, you know, in single settings. Generally I would do this by myself, but I was like, oh, I just, you know,

I just had to get it in. When Judd was older, his sweet tooth cravings took a turn from ice cream to gummy worms. He simply could not get enough of those multicolored strips of candy made of gelatin, corn syrup, and flavorings. The way they work is I think they're designed, as somebody put it, to taste like more. Meaning they're not necessarily gonna taste good, but they're gonna be in your mouth making you want that next one before you even finish chewing the one that you're eating. And that few turned into many turned into the whole bag,

virtually every time. And it was generally late at night, plenty of food that I'd just eaten, so I wasn't hungry. And suddenly I'd hear them calling. It would be that siren song of the gummy worms, where they'd be in the cabinet calling to me, saying, you know, eat me, eat me, come, come. You know?

And I guess I wasn't quite a disius where I was lashing myself to the masts to keep myself from eating them or having somebody do that for me. It was basically, they would call and I would come. So as a psychiatrist, Judd, you work in a professional capacity with people who have trouble managing their cravings. One patient whom you call Jackie struggled for years with her eating

habits. Take us back to the start of her childhood. What was her relationship to food like as a child and as an adolescent? Well, Jackie back as a kid had this idea that she needed to look more like Gwyneth Paltrow, but she had the build of the rock star Pink, who is pretty muscular, I have to say. That's how I would describe her physique. And so she would try everything that she could to meet this societal norm of what skinny looked like and really struggled for a long time

to the point where she would restrict eating. At some point she discovered cigarettes and found that that could be a way to curb her appetite. She also fell into this pattern with a friend of eating to soothe her emotions. She would learn to eat because she was sad. And then eventually just got into this cycle of severe restriction and then binging

when she couldn't stick with that restrictive diet. As Jackie entered adulthood, she began to try to restrict her eating in accordance with a long list of rules that she had set for herself. You say that she often felt like she had been sentenced to food jail. Yes, and she's not the first person to describe this.

I think it's a very common thing where she would set all these food rules and then she would put herself in jail for violating the rules and then beat herself up for not being able to resist the urges. She felt like there was something wrong with her and ironically, she would put herself in jail for something that she couldn't control.

So living under this very restrictive regime, she even came up with her own name for the irresistible desire to eat certain foods. I understand she even personified these cravings. Jackie described what she called the craving monster, where there was this big, looming, lurking, powerful, scary monster that would just basically say, eat. And it could often start as a whisper, like, oh, you know, you like this, you want this.

And then if she ignored it or didn't listen to it, it would get louder. Like, well, you're going to do this anyway, so you might as well do it now. And then eventually just like taunting her and then egging her on and then even yelling at her. Jackie would try to ignore the craving monster. Then she would try to fight it. But the more she battled it, the stronger it seemed to become. It was like one of those sci-fi movies where you kill a monster only

to see it reassemble itself and rise up again. How many times could she slay it? You know, feeling like there was no way to win, she'd relent and so she'd dial her Chinese restaurant in order as she put it, disgustingly vast amounts of carbs, so fried potatoes and rice and rice noodles with curry dishes. And then, you know, interestingly, she said that there's this huge relief that it's not there anymore, even though you feel all battered and bloated. But she described it, at least you're not fighting that monster anymore.

So what's striking is that this sequence, you know, holding out and holding out against temptation and then giving into it in spectacular fashion, this is so familiar, not only from our own lives, but from scenes played out in books and in TV shows and in movies. In the movie Chocolat, a woman and her daughter move to a small French village and open a chocolate shop,

but complications quickly ensue. I understand that you're a fan of this movie. What kind of complications, Judd? Oh, I love this movie. It's about this small, quaint French town that's very clean and orderly and pious. And this woman blows in on the North wind or something and she's wearing this red cape,

kind of signifying the devil. And this is really, this is about temptations. And she sets up this chocolate shop and then starts making these amazing chocolates that nobody in the town can resist. And so the mayor of the town who considers himself to be the most pious and the model citizen, this is during Lent, of course.

And so I think he's giving up sweets for Lent. And so he drinks like lemon water as his you know, throughout the course of Lent. But over time, this temptation builds up more and more and more throughout the movie. I want to play a brief clip from this film, because I think this is emblematic of the way we've come to think about the best way to battle our desires. In this clip, the mayor drops to his knees in church and pleads for relief from his long

denied desires. All my efforts have been for nothing. I have suffered willingly. I've fasted. I've hardly eaten for weeks now. I'm sorry. I'm sorry. my suffering is nothing. It's just I feel so lost.

I don't know what to do. Tell me what to do. He goes, and I don't want to ruin the movie for anybody that hasn't seen it, but I'm gonna go ahead and, you know, it's a spoiler alert. End of the movie, he goes in to destroy the chocolate shop. So he literally busts into the chocolate shop

and starts destroying the place. So he has all these beautiful chocolates set up in the front window, and he goes in there and he just starts, you know, treading them, starts tearing them apart, breaking them, you know, destroying them. And at one point, a little drip of like chocolate nougat or syrup lands in his mouth.

And it's like his kryptonite. And suddenly he's like, oh, I can't do this anymore. And he just starts gorging himself on chocolate. And he passes out from his chocolate frenzy just covered in chocolate. It's like, oh no. It's a story that many of us can relate to. With great effort and self-discipline, we hold the line on our cravings until we cannot. on our cravings until we cannot. When we come back, why self-control often fails us and a glimpse into a better approach? You're listening to Hidden Brain, I'm Shankar Vedantam.

This is Hidden Brain, I'm Shankar Vedanta. Throughout human history, the story of progress has been about gaining control over the external world. Raging rivers have been dammed, forest fires have become controlled burns, the wind and the waves have been turned into electricity. It is not surprising that our many successes in science and technology have prompted us to believe that our capacity for control is endless. But how does this approach work when we try to control that most unruly of forces? Our own minds.

If we can bring mighty rivers to heel, if we can plan and prepare for earthquakes, if we can split atoms and control the terrible power they contain, surely we think we should be able to control our own desires, urges and cravings. When Judd Brewer was in medical school, his teachers taught him that the way to overcome cravings was straightforward. Drugs? Alcohol? Overeating?

No problem. Just say no. They basically said, you know, there's this formula, calories in, calories out. And they stated it like it was a fact of Newtonian physics. You know, it was like, this is the law. And this is true. and it works every time. What they didn't tell me was, that's not actually how it works in clinical practice.

The formula is true, I think students probably still learn it, but that's not how it actually works in real life. For smoking cessation, for example, which is one of the hardest addictions to quit, there are these evidence-based five A's. So you ask, you advise, you assess, you assist, and you arrange. But the idea is just check to see if somebody's ready to quit at this time.

Give them a very strong statement that smoking's really bad for them, which they all already know. And then say, okay, let's help you quit. And the counseling piece was mostly focused on willpower, just grit your teeth and quit. So at one of your first jobs at the Veterans Administration Hospital in West Haven, Connecticut,

many of your patients were soldiers who had seen combat. They had struggled with the trauma of their experiences, but also with a host of addictions, like Wachat. Everything from cocaine to alcohol to opioids to social media and then porn and all sorts of things. So, you name it, they were addicted to it. And, you know, they had this warrior mentality. And so it was baffling to so many of them

that they could do all of these extremely hard things that so many other people could never even think of doing, yet they couldn't quit smoking. You tried a number of approaches to help your patients quit cigarettes. Many of them were extensions of what you had been taught in medical school. One involved controlling the triggers or cues

that led to unhealthy behaviors like smoking. Tell me about this approach, Judd. Yes, so there's this saying, the people, places, and things. So for example, somebody struggling with alcohol, if they avoid bars, if they avoid the liquor store, if they avoid their drinking buddies, they're much less likely to be triggered to drink. And that actually makes sense from a mechanistic standpoint.

These triggers kind of set off the process. If you think of smoking though, if somebody smokes a pack of cigarettes a day, there are 20 different times or places that they are triggered to smoke. So it could be their car, it could be outside of work, it could be on their front porch or in their house. And so they basically have to be dropped

onto a desert island if they wanted to use the avoidance approach. So we can see it can be somewhat helpful in some situations and in other situations like smoking extremely difficult to use that method. Another commonly used strategy for responding to cravings involved distraction, drawing your attention away from the craving to something else. How did this technique work out for your patients? Well again, it makes a lot of sense.

It's very logical, you know, just distract yourself. If you have a craving for a cigarette, you know, go for a walk or watch a YouTube video or do something that distracts you. The problem is that it's always lingering in the background. You know, kind of like we talked about with Jackie, it's going to be there behind the curtain. It's just a matter of when they eventually, you know, when eventually it gets out.

The most common strategy of all was to resist cravings through willpower. The failure rate of this approach was extremely high, but asking people to fight cravings with willpower always came with a built-in escape clause. When people succumb to their cravings, you could always tell them, clearly you didn't exercise enough willpower. If you did, you could have just said no.

Two things would happen, and one of them is so common that there's now a scientific term for this called the abstinence violation effect. And what that means is that when somebody, they've resisted smoking for a long time or resisted drinking, that first cigarette or that first drink just, you know, opened the flood gates and they would just go nuts. So somebody could quit smoking for six months and suddenly they're back up to a pack a day in three days. And then on top of it, they would castigate themselves. They'd feel guilty for what they did. They'd feel ashamed as a person and the guilt and shame kind of fed on each other as these vicious cycles where, you know where guilt would feed shame, which would feed more behavior,

which would then lead them to feel more guilty again. I'm wondering what it was like to treat patient after patient after patient like this. I mean, would you see that on a regular basis that your efforts to help them were not working? Yes, pretty much every day. It was pretty humbling. And I felt like I'd missed something in medical school.

Maybe I slept through some class that was really important or I hadn't gotten something. And my patients were really struggling, but I was really struggling to help them. Yeah, I understand that there was one moment in particular where you were forced to recognize the futility of your efforts to help your patients resist their cravings.

You were standing in your office at the VA hospital. Tell me what happened, Jett. Yes, this is kind of a light bulb moment for me. So the VA hospital is a smoke-free campus, and so my patients couldn't smoke on campus, but they could find the parking lot where nobody would really police that. And so I was looking out my window one day and seeing, you know, my patients smoking in the parking lot. And I had this aha moment because my lab had been studying habit change for years. And I was thinking, wait a minute,

my patients don't learn to smoke in my office. They don't learn to overeat in my office. They don't learn to get into any of their addictive behaviors in my office. Is there some way that I could actually develop a way to port my office to them in their situations because the mechanism behind this is really about them learning things in a particular context.

It's in their home environment, it's in their car, it's when they're stressed, and hopefully they're not particularly stressed in my office. So that was a big aha for thinking, well, there's got to be a different way to do this. But I can also imagine that looking at these patients from your window, I mean, they've just come in to see you. You've given them the best advice and you've communicated all the right health messages and, you

know, they step outside and walk to the parking lot and light up. And at some point, if you're a doctor looking at the scene, there has to be a sense of futility, a sense of helplessness there. Oh yes, it's tremendously humbling. I ate a lot of humble pie. So you had a moment at one point where you were working with a group of patients.

These were women who had issues with eating. I understand it was just after 5 p.m. on a Thursday evening. Paint me a picture of the scene, who these women were, why they were talking with you, and what happened. Yes, in my outpatient clinic, we would have these group medical visits where people with similar conditions, I could kind of work with them all

at the same time as a group. And so I collected a group of individuals, happened to be all women at the time, who were really struggling with binge eating disorder, very severe clinical disorder where they're, they basically just can't stop eating in certain situations. And so I was really excited to get started, trying to help these people.

And for about a month, I was sitting there thinking like, what am I missing? I felt like we were speaking a different language. So my language was, well, you know, I had this assumption that people would eat when they're hungry. I was really blind to what their experience was. And so I started asking them to put me in their shoes and like starting from the first bite, sketch out the details for me, what urged them to eat, what were their cravings like, when did they eat? So they all started talking at once like,

oh, finally he wants to understand our world. So another humbling experience for me. And so they were describing all the different times and triggers that led to a binge. You know, it could be time of day, it could be different emotions, it could be people. They were recounting how their cravings and urges really were the same relentless drive to eat. One of the people said, well I just eat when I have a craving and then I was thinking, oh tell me more about this, you know, like

what are the cravings like when you're hungry? Everybody was quiet and they're like, hunger? I have an urge and I eat like full-on, that's it. And so, you know, it's like angry, lonely, tired, bored, sad, distracted, excited, all of these things had one thing in common, they caused a craving. And so it was that hedonic hunger, right? Not actual physiologic hunger, it was the emotional hunger for most of them that was driving them

to eat most of the time. So in some ways from a medical perspective and from a health perspective you can see why you know doctors would say you know we have these hunger signals that have been fine-tuned over many tens of thousands of years of evolution we should just listen to those hunger signals and those hunger signals will tell us when to eat and when to stop eating. But of course, what's happening here is something that's layered on, on top of those thousands of years

of evolution teaching us when to be hungry, because it's our emotional lives that actually might be driving when we're choosing to reach for that candy or that cigarette or that drink. Absolutely. And I would say for so many of us, this is the case most of the time. When we talk about our cravings, we usually talk about the things we are craving.

Cigarettes, alcohol, a gigantic slice of cheesecake. What we often don't talk about are the things that are behind our cravings. When we come back, Judd decides to try a different approach our cravings. When we come back, Jud decides to try a different approach to cravings, no willpower required. You're listening to Hidden Brain. I'm Shankar Vedantam. This is Hidden Brain. I'm Shankar Vedantam. Many of us constantly tell ourselves to eat right, to avoid unhealthy habits, and to engage with temptations only in moderation. But after holding out and holding out, we often give in to uncontrolled indulgence.

One of Judd Brewer's patients personified her urges in the form of a craving monster. The monster was huge and powerful and no matter how hard she fought it, it usually won in the end. In time, Judd Brewer came to see that the monster had a puppeteer who was pulling its strings. In his books, the craving mind from cigarettes to smartphones to love, why we get hooked and how we can who was pulling its strings. In his books, The Craving Mind, From Cigarettes to Smartphones to Love, Why We Get Hooked and How We Can Break Bad Habits, and The Hunger Habit, Why We Eat When We're Not Hungry and How to Stop, he asks what would happen if we examined the puppeteer standing behind the monster. Judd, after you had the insight that we lack awareness into why we engage in unhealthy

behaviors, you ran a little experiment on yourself. You were about to snarf down a bag of gummy worms. Paint me a picture of what happened that night. I don't even remember what prompted me to go on the gummy worm binge that night, but there I was and I'd been kind of learning how to pay attention to my own, my own senses more. So I kind of started just paying attention as I was eating gummy worms. And so instead of just chowing on them in like craving the next one,

while one was, you know, while I was chewing on one, I ate one at a time and really paid attention to what they felt like and what they tasted like. And I can still remember to this day, and this was years ago, cause it was so vivid cause it was such a shock to me. I, my first, my first reaction was, Oh, this tastes like a slimy petroleum product.

Not exactly food. The mouth feel was slightly off. The taste was too sickly sweet. They were getting stuck in my teeth. So that was kind of annoying. It was like, you can't really bite all the way through it, but you can. And so it was, it was, everything was kind of off in terms of probably what my brain and body had evolved

to expect in terms of food. But I had never paid attention to that before. I was just busy shoveling them in my mouth. Something extraordinary happened to Jad as he paid close attention to eating the gummy worms. He realized he didn't really like that taste. When he was inhaling an entire bag, he wasn't tasting anything. But the moment he paid attention to what his senses were telling him,

he realized that he wasn't enjoying himself. A second realization followed almost immediately, although this was less of a deduction and more of a conclusion his own body had reached. He no longer felt like stuffing his mouth with gummy worms. Judd thought back to the patients he had tried to help, and he asked himself, have I been approaching this all wrong? You know, I've learned so much from my patients. Often they're not motivated to change until they've often lost everything, literally.

And so for me as a clinician, I'm thinking, you know, I am failing as a clinician. So it was a rock bottom moment for me as a clinician. And so I started, I did this crazy thing, which was, or seemed crazy at the time, which was, I thought, well, okay, if the standard approaches, the willpower approaches aren't working for me and my patients, let's try something completely different. And so I started, my patients would come in, they wanted to quit smoking, they'd all tried willpower before, it hadn't worked. And so I said, okay, go ahead and smoke.

And they would look at me like I was crazy. And they're like, did I hear you right? My doctor just told me to smoke, right? And they all know that smoking is one of the worst things for them. So I don't need to reiterate that at some lecture on a, you know, from a podium, but I can say, hey, you know, well, when you smoke,

cause you're going to do it anyway, right? You can't stop. So just pay attention as you smoke. And I would give them a homework assignment. I would say, report back to me exactly what it's like when you smoke. So what does it taste like? What does the smoke feel like going into your lungs?

What does it smell like coming out of your mouth or your nose? What do your clothes smell like? You know, what is your breath smell and taste like? All of that. So I had them do a science experiment, and they were the experiment, and they were the experimenter,

and they would come back blown away. And in some ways, this is along the lines of what happened when you decided to pay attention when you were actually eating the gummy worms. Your experience of the thing completely was transformed. Yes, I was really curious. Often the joke in research is research is me search

and often people go down these rabbit holes where they're like, oh, something worked for me and so it must work for everyone. And often these are very smart, very disciplined scientists or psychologists. And so then they go and develop a treatment. They're like, well, it worked for me. It should work for everyone else.

And it may not work for everyone else if it's not really based on a mechanism. And so for me, I was like, well, let's look at this to see how this works and do some randomized controlled trials to see if it actually works. But first, I had a lot of patients who were generous enough to kind of try this out themselves. So I could just do some pilot trials to see if it actually works. But first, you know, I had a lot of patients who were generous enough to kind of try this out themselves. So I could just do some pilot work to see if there was even a signal there.

And every time I do this, I still love it. Cause I can't wait to hear back from my patients. So, you know, typically I remember a guy had been smoking for 40 years. And so the first thing we did was calculate the number of times he had reinforced this habit. He was ready for this. It was roughly 293,000 times that he had kind of reinforced this habit.

So, and so I said, start paying attention. He comes back and he goes, how did I not notice this? You know, for 40 years he'd been smoking. He's like, these things taste like crap. How did I not know this? He was blown away. I've never had a patient come back and thank me for helping them realize how delicious cigarettes taste.

Never. So when you ask people to exercise curiosity, you also ask them to exercise something that you call kind curiosity. What is the difference, Judd? Yes, well, I think of kindness and curiosity being best friends. So often to truly be curious, which means we're not going in

with a preconceived notion or a judgment. We're just going in like, oh, let's see what this actually is. So in Zen, they often talk about beginner's mind or don't know mind, right? And it's like, oh, I don't really know. Let's explore this. let's see what this actually is. So in Zen, they often talk about beginner's mind or don't know mind, right? It's like, oh, I don't really know, let's explore this. Well, often we have these voices in our heads

that are like judging everything and that judgemental voice kind of gets in the way of us seeing clearly. And one thing that our brains so often do is get in this habit loop of judging ourselves and shaming and blaming and all of these things that just suck all of this energy away from us being able to be curious in a situation and also get us stuck fighting ourselves

instead of actually addressing the issue. So if somebody can be kind to themselves, they can help step back from the self-judgmental stories and truly explore what's happening in their experience without that judgmental lens. And there's a metaphor here that multiple people have used of thinking about a parent who is dealing with a child who is very upset,

maybe a small child who's having a tantrum, for example. And of course, the parent could get swept up in the tantrum as well and get excited and upset and angry or fearful. But really, what you're really called upon to do if you're a parent is actually to not get into the tantrum with your toddler. You actually have to stand outside of the tantrum,

but not ignore the tantrum altogether. Not just sort of say, I don't care what's happening to the kid, but who actually say, I'm curious about what's happening to you, but I'm not so wrapped up or so consumed with what's happening to you that I'm in the maelstrom with you.

Yes, I love this metaphor. We even use it in our digital therapeutic programs. This highlights several things. One is if the parent gets wrapped up in the story, it becomes about them and not about their child. So if they ignore their child, it's about them. If it's fighting, it's like kind of resisting their child's tantrum, it's about them.

Instead, we can get curious and ask a very different question that's gonna actually solve the problem and also take care of the child. So it's really about being able to step back and instead of going, oh no, they're screaming again, I need to get them to be quiet as quickly as possible, they can go, oh, what do they need?

And that brings in kindness, it brings in curiosity and turns it toward the question that is critical that needs to be answered then. It's like, what does my child actually need? And the analogy here with our own emotions and cravings is that if we think about our emotions and cravings like that crying toddler, instead of battling the child, instead of battling our cravings, the idea is by being curious about them, we in some ways can quiet them down Yes, and this is a paradox. So I think of it this way, you know, we're so trained to do something Oh, no, they're screaming. Oh, no, there's a craving. Oh, no, there's this I need to do something about it to make it go away

Well the doing something about it is just like what Jackie was doing with the craving monster We either run away it runs after us or we fight with it and it gets stronger. So here the paradox is that if we can learn to be with our experience, that curiosity helps us lean in and just explore, oh, what is this experience? And that being with our experience becomes the new doing. We learned that these are thoughts, these are sensations, these are emotions that come and go. And by opening ourselves to them,

allowing them to manifest in all their colors and energies and timeframes, that they will go away on their own without us doing anything. And the less we feed them, the less they come back. So you've tried to operationalize this fundamental insight in a three-step process for dealing with our cravings. And the first of these is to apply kind curiosity

to the situations in which our cravings arise. What does this look like, Judd? Well, I'll give you, maybe we can start with a story that kind of highlights this. And I remember this patient coming into my office and the first thing he says is, hey doc, my head's going to explode if I don't smoke. And I'm thinking, oh crap,

I didn't learn this one in medical school, chief complaint, head exploding from craving. And so I had to improvise. And of course, my habit is to go to a whiteboard as a researcher and as a teacher. So I'm trying to buy time. So I fumble out a marker, a dry erase marker, and I say, okay, describe what head exploding feels like

and how intense it is. And so he was describing, you know, heat and burning and tightness and tension. And then he was describing that the intensity was going up and up and up and up. And so I was drawing this arrow and trying to capture some of the words along the way. And then at some point, the intensity peaked

and started to go back down. And he stopped at that moment. And I said, what's going on? And he said, you know, I've always smoked before the craving got this intense. But here it went down and I didn't smoke a cigarette. And it was this big aha moment for him where he realized that these cravings

were made up of thoughts and sensations, emotions, and that just by naming them, and even naming them out loud, it helped them see them for what they were. And in psychology, they describe this as the observer effect. By observing our thoughts, we cannot simultaneously be identified with them. And so this patient was observing his thoughts and body sensations instead of being consumed by them and identified with them. By doing that, he realized that he was not his thoughts,

he was not his body sensations, and that he had control by simply observing them. He could be with his body sensations rather than having to do something like resist a craving or smoke a cigarette. You had another patient whom you call Rob Judd, and you asked Rob why it was that he would compulsively overeat. And you asked him to pay very close attention

to his eating as he was compulsively overeating. What did he tell you? It's interesting. Rob first came to me for anxiety. He had panic disorder. He had generalized anxiety disorder for probably 30 years when he came to see me. And he, oh, and I should also mention he was 400 pounds.

He had clinically relevant obesity in the sense that he had obstructive sleep apnea affecting a lot of his body systems. He had hypertension, high blood pressure. He had basically a fatty liver, all of these related to his unhealthy weight. And so what he described to me was that as a kid, he started eating, so he had anxiety,

probably starting fifth grade or something like that, where he tried everything he could to help his panic and his anxiety. And the only thing at the time that seemed to help was him going home and eating a bunch of food. And for him, especially by the time he came to see me, it wasn't even a temptation, it was a drug. And he described fast food as his addiction.

He would secretly eat fast food in his car and throw out all the garbage to hide his behavior from everyone else. And then he would tell himself, just like I've had so many other people with addictions say, I'll be better tomorrow. I'm gonna start tomorrow. So when you asked him to do the same thing that you asked John to do, to pay very close attention

to what it felt like to indulge in the craving, what was his experience like, Chad? When he started paying attention as he ate, he realized that the fast food was actually giving him more health anxiety because he knew that he needed to lose weight because of all these clinical conditions. And so he started to realize, you know, eating was actually making things worse. The fast food wasn't helping.

And no kidding, between the first visit and his first follow-up visit, two weeks later, the first thing he says to me is, Hey doc, I lost 14 pounds. And I was stunned because we hadn't even really focused on his clinical obesity issue at that time. We were mainly just in this first visit focusing on anxiety, but he had started to realize he was starting to understand how his mind worked and he was starting to leverage his brain to help him change his eating habits without any willpower.

So what you're saying Judd is that many of our cravings involve behavior that is automatic and unthinking, but when we apply curiosity to our cravings, in some ways it allows us to take apart the sequence of the emotions that lead to the cravings and the cravings that lead to our behaviors. Absolutely. So I think of this first step of the three-step process is just mapping out your habit loops. And it can be as simple as just identifying the behavior. So like my patients in the binge-eating group, I had them start just recognizing, why is it that I'm reaching for food?

Am I hungry or am I X, Y, or Z? Lonely, bored, angry, frustrated, sleepy, whatever. And so just recognizing the eating habit is the first step. So you've evaluated smokers who have participated in your mindfulness program and you found that the urge to smoke and the act of smoking have become uncoupled. Tell me about that research. Yes, we did our first randomized controlled trial. We published this back in 2011.

So we had people, randomized people to get cognitive therapy and you know gold standard. This is the American loan association's freedom from smoking versus this mindfulness training that we had developed. And the mindfulness training was pretty much, you know, like, hey, let's help you explore these cravings, just like you and I've been talking about, you know, what is a craving, but they can also learn to write out cravings, just like I did with my patient whose head did not explode when we explored what head exploding could feel like. And what we found, first off, we found that we got five times the quit rates of gold standard treatment, which totally knocked

my socks off. We were just looking for a signal. Well, that was a signal. That was pretty striking. So in some ways, the first step of this approach is to make people aware of what the cravings are about, where they're coming from, what's driving them. But the next stage is to actually get people to think very closely about what happens when they're actually consuming the thing that they're craving. And you did this with gummy bears. And this is what you do when you tell smokers to go ahead and smoke, but to pay very close they're craving. And you did this with gummy bears, and this is what you do when you tell smokers to go ahead and smoke, but to pay very close attention to it.

And again, the idea is that paying very close attention to the eating of the food, to the smoking of the cigarette, to the drinking of the wine, it changes your experience of the thing that you were craving. Absolutely. So when we start looking at the core mechanism

and start asking, how can we leverage the strength of the brain, the way that works is that our brain is going to keep doing things that are rewarding, and it's going to stop doing things that are not rewarding. And the only variable that's needed for that is awareness. And this goes back to the 1970s, these two researchers, Rosquela and Wagner came up with these reinforcement learning models, And this goes back to the 1970s, these two researchers, Roscorla and Wagner came up with these

reinforcement learning models. And they're still at play today. We use these in our studies, where basically if you pay attention, you're gonna get an error term, meaning I learn, hey, these are not as good as expected, and I become disenchanted with that behavior. So it could be a type of food,

it could be an amount of food, it could be cigarettes, and food, it could be an amount of food, it could be cigarettes, and it takes only 10 to 15 times of somebody really paying attention when they do a behavior, if it's not rewarding, for that reward value to drop below zero. So that's the second step in this process.

We call this developing disenchantment. It doesn't change the taste of food, especially when we are eating in amounts that are not overindulging, but it can actually help us much more easily stop when we're full. The third step in Judd's process to address cravings is that the more you pay attention to your sensations, the more likely it is you will discover what he calls bigger and better alternatives to the things you crave.

That's what happened to Judd. Gummy worms have been replaced in his life by something better. I'm smiling just thinking about them. I had some this morning. They are blueberries. So for me, blueberries are the biggest, bestest offer in terms of like a sweet treat. They pop in your mouth.

They've got this, you know, a nice texture when you bite into them. They also have this intermittent reinforcement property. So you never know how sweet a blueberry is going to be, right? One might be slightly sweeter than another, another might be a little more tart. I like them both, but they kind of keep you constantly surprised when you're eating them. And the nice thing about blueberries is, for me,

they have this perfect amount of sweetness where I'm not craving the next one or the next pint. We actually, and this is true, we have some gummy things in our house right now that my wife's family member gave to us and I'm not even interested. She doesn't even ask me anymore. Yeah, do you want some? She knows the answer.

So let's return to the story of Jackie, your patient who wrestled for years with what she called the craving monster. She found that curiosity and kindness really did transform her eating habits. Tell me her story, Judd. Yes. So Jackie had a complicated relationship with her mom

and had learned some of these eating rules from her mom, in fact. And she had just come from visiting her mom, as she described it, yet another horrible trip. The two hadn't connected. And so she used to be in the habit of going to a certain grocery store and sitting in the parking lot, listening to loud music and just binging and binging. So she sat in her car and she said, it didn't make the upset go away. I still felt really upset and hurt with relation to her interaction with her mom. She said I just bawled my eyes out in the car Here's where it gets really interesting

She said she allowed the craving monster to get in the car with her instead of ignoring it or resisting it or fighting with it so she simply So she simply noticed what the craving for Chinese food felt like. She could already taste that magic combination of sweet and salty. And she investigated how it felt, how that craving felt in her body, asking exactly what she was feeling and noting the sensations. And then she had this moment of revelation. She put it, I went into the grocery store and each time I picked something up, I asked myself, how am I going to feel if I eat this?

And she gave herself permission to binge if she wanted to. And here's what she walked out of the store with, some avocados and spinach. So, and she said, she was laughing like a lunatic as she drove out of the parking lot because it was her first taste of freedom as an adult And she said I don't have to be scared of the craving the craving monster is so real for so many people But she said I see you. Yeah, you can't hurt me

You can't hurt me. There was a lot of fear with her with regard to the craving monster. And she said the fear wasn't there anymore. ["The Hunger Habit," by Justin Brewer, playing in background.] Justin Brewer works at the School of Public Health and Psychiatry in the medical school at Brown University. He's the author of The Hunger Habit, Why We Eat When We're Not Hungry and How to Stop, and The Craving Mind, From Cigarettes to Smartphones to Love, Why We Get Hooked and How We Can

Break Bad Habits. Judd, thank you so much for joining me today on Hidden Brain. My pleasure. Thanks for having me. Do you have follow-up questions for Judd Brewer about cravings and how to break them? If you'd be willing to share your question with a Hidden Brain audience, please record a voice memo on your phone and email it to us at ideas at hiddenbrain.org. 60 seconds is plenty.

That email address again is ideas at hiddenbrain.org. Please use the subject line, Cravings. Hidden Brain is produced by Hidden Brain Media. Our audio production team includes Annie Murphy-Paul, Kristen Wong, Laura Correll, Ryan Katz, Autumn Barnes, Andrew Chadwick, and Nick Woodbury. Tara Boyle is our executive producer. I'm Hidden Brain's executive editor. If you enjoy the show and would like to support our work, please consider becoming a member

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