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We have three neuroscientists...who are here.
We'll call the first one, Dr.
Judson Brewer of the Center of Mindfulness of UMass Medical. Judson...
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Welcome to Le Web...
Thank you. It's great to be here.
Let's get started. Now,
let's just think of the magnitude of the problem.
My lab studies addictions. And if you take two addictions,
smoking and behavioral overeating, this accounts in the US for
nearly half of the drivers of healthcare cost, half of them.
Now, you can't cure cancer with blood pressure medications, right?
You can't cure cancer with blood pressure medications, and
you can't fix behavioral addictions by holding hands and
singing Kumbaya. So [LAUGH]
what we're looking at is,
what's the root of the problem, what's the mechanism behind behavioral addictions,
and how can we use things like mindfulness to help treat them?
So let's go through this together.
I thought we could start with: Why Facebook is like crack cocaine...
Move on to McDonald's... Go on to how Lolo Jones could have won the gold medal...
And finish up with how we can all become a Buddha in nine minutes, and perhaps quit
smoking as well. All right, so that's a lot to do. Let's see what we can do.
So let's start with Facebook. How are you feeling? Now it turns out,
when neuroscientists at Harvard gave people the choice to self-disclose,
or to earn money, while they scanned their brains, guess what they chose to do?
That's right... Talk about themselves... And it turns out that when
people talk about themselves, it activates the reward parts of your brain.
The one that is arrow is pointed to is called the nucleus accumbens,
the same part of the brain that gets activated when you smoke crack cocaine.
And another study showed that you can actually predict the amount
of time that people spend on Facebook by the amount that the nucleus accumbens
gets activated when they self-disclose.
Okay, I took this picture at the Louvre a couple of days ago.
For those of you that aren't familiar with one of the top 25 inventions of 2014,
you can buy a selfie stick and take pictures of yourself. I love this picture
because the boyfriend is standing there, and he's been replaced by the selfie
stick. >> [AUDIENCE LAUGHTER] >> [LAUGH]
So, let's go through this together.
You're at the Louvre, you think, Oh, this is a great picture.
I'm going to take a picture of myself and post it to Facebook.
This is going to be great. And
you think about all the likes that you're going to get, and all the comments, and
how everybody's going to be jealous that you're in Paris. So you take a picture,
and you post it to Facebook, and you get all these likes. And it feels really good,
and your brain says, Yeah, do that again. [LAUGH]
Well, it turns out that this is one
of the most evolutionarily conserved brain processes. It turns out that if you go
back to the most primitive neuron system, the Aplysia, the sea slug,
with only 20,000 neurons, the sea slug learns the same way that people learn when
they're taking selfies at the Louvre. Basically, you do something,
it makes you feel good, you get an urge to make that good feeling continue, you lay
down a memory, and then this reinforces it. You probably all heard of positive and
negative reinforcement, because this same thing happens with negative reinforcement.
You do something unpleasant, you get yelled at by your boss, you have an urge
to make that go away... You go out for a smoke, or you eat a good snack or
some chocolate, you feel better and you learn, Oh, if I just eat chocolate,
I'll feel better. Now, typical treatments say, Well,
okay, you just avoid these things. So if you drink alcohol, avoid the bars.
And if you smoke cigarettes, maybe you should just eat carrot sticks instead.
So you can actually target these pathways. Well, it's interesting,
these don't work particularly well. 70% of smokers want to quit--it
takes up to six quit attempts, and only 5% stay abstinent at the end of a year.
So this is a very, very reinforced process that's very hard...
This behavior is very hard to change. Now, it turns out that 2,500
years ago the Buddhist psychologists described the exact same process, and
they described it this way. They said, Things get interpreted by the mind.
They're either pleasant or unpleasant. We have an urge for the pleasant to continue.
We want to hold on to that stuff. We want the unpleasant to go away.
We do a behavior to make those things happen. And then we lay down this self.
We get a self identity. And the problem is that this process reinforces itself. For
those of you that aren't familiar with it, it's described as samsara. The literal
translation of this is endless wandering, because it's just self-reinforcing, and
the problem is, with this skewed view, when we start seeing the world this way,
and we start getting attached to these things, it just goes on and on and
on. They described this, they said, Just as a tree, though cut down,
can grow again and again if its roots are undamaged and strong, in the same way,
if the roots of craving are not wholly uprooted, sorrows will come again and
again. I like this modern-day
interpretation a little bit more.
Now you get the idea. So, now on to our second one. Well, the food industry says,
Oh, evolutionary conserved process, we can make tons of money.
We're actually going to flaunt this. So McDonald's, they're after it...
They craft their food to your craving. Kellogg's cereal in the US now,
they now have Krave cereal. And if milk chocolate Krave isn't good enough,
don't worry, there's double chocolate Krave. And, of course,
we all know where this leads... Okay, so on
to how we can work with this problem. We start to understand what the mechanism is,
what can we do about it? Now, mindfulness has become much more popular over the last
couple of years. What actually is it? So you can think of this as paying attention.
Okay, we're paying attention, but we're bringing a quality of our
awareness to this experience. So we're bringing an openness, a curiosity...
We're not saying, Oh, I know how this is going to go, or I don't like this, or
I want this to go away... We're just going to see what we can do to work with
the situation. And mindfulness is at least theorized to come
in, and instead of helping people avoid things or
substitute, actually drive this wedge of awareness in-between the craving,
that urge to act, and the actual behavior. So let's see if this is actually true.
Now, it's been shown empirically to be helpful for
a number of conditions. Just listing a few here--anxiety, depression, pain...
My lab has done some work with addiction, even boosting of the immune system, and
helping people score better on their graduate record exams,
if you want to graduate school. But how does actually paying attention work?
Does it actually help you change these very
deep-seated behaviors? Does paying attention, just by itself,
actually do anything? So what we actually do in our smoking treatment is to
have people smoke mindfully. That's the first exercise that they get. And the idea
here is, when you really pay attention to what you're doing, you see what you get.
And if it's helpful, you keep doing it, and if you don't, you stop doing it.
Here's an example from somebody with her first mindful smoking exercise. She said,
Smells like stinky cheese. She's obviously not French. Smells like stinky cheese and
tastes like chemicals. Yuck!
And the idea here is, she starts to see what she's actually getting in this moment
from smoking. She doesn't have to think about it. She knows smoking's not good for
her. But in this moment, she sees, Oh, this isn't actually as good as I thought
it was. So we took this, we did some randomized clinical trials, and
found mindfulness training was actually twice as good as gold standard treatment
in the US for smoking cessation. We had twice as good. This is on the level
with some of the best medications out there. And the effects lasted.
At our four-month follow-up, they were still largely, they had maintained their
abstinence. So this was pretty good. We're seeing a behavioral signal that you can't
argue with, they either have quit or they haven't quit. So we ask ourselves, Well,
what's actually going on mechanistically? And the hypothesis is, that if craving is
a fire and smoking is the fuel for that fire, if you stop adding the fuel,
that fire should be there for a bit but eventually die down. And
we studied this mathematically, I won't go through all the details... But, basically,
you get a strong correlation between craving and smoking at the beginning of
treatment. This is completely gone at the end of treatment.
And if you do all the fancy math, it has nothing to do with craving,
it has nothing to do with cigarette use... It's the amount of
informal mindfulness practice that people do that decouples craving and smoking, and
we can even see this in the raw data. If you look at the end of treatment,
same level of craving for the people that quit and the people that don't. And
for the people that quit, their craving dies off over time.
So that's really interesting.
It seems that mindfulness is actually driving this wedge in here.
We can see this mathematically. We can see this behaviorally, and importantly,
we can start to get it to psychological mechanisms of how it's working.
Okay, so then how do we disseminate this? So, training a lot of
people to facilitate mindfulness training is expensive, it's not scalable, so
we turn to the technology. And we said, Okay, let's develop an app that can
actually deliver this at the point of contact. And this is really important,
because context-dependent learning is where people learn to smoke.
They don't learn to smoke in their therapist's office.
They don't learn to smoke in the hospital. They learn to smoke in their car,
on their front porch, outside of work. And so, we put this manualized training
together in 21 days of modules, where they can get daily playlists.
They can have animations that help walk them through the core concepts.
They can pair this with in-the-moment exercises. And they can even...we
can collect data through experience sampling to make sure that it works.
We can also pair this with an online community where they have access to me
as the addiction psychiatrist, to peers, they can tell their stories,
they can learn from each other, we can crowdsource this... So
just to show you a quick video that kind of shows how this all fits together.
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>> Welcome to Craving to Quit, a three-week program that will help you quit
smoking. This training delivered live at Yale University has been shown to be
twice as effective as other quit smoking therapies.
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Now I'll walk you through the basic idea about how habits are formed.
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First, recognize that the wanting or craving is coming on, and relax into it.
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>> Now, it also turns out that sugar is more addictive than cocaine, and
so our next app is going to be an eating app that'll come out early next year.
More addictive than cocaine, which makes sense because that's how this process was
set up, so we'd remember where food is. Okay, so now let's get on to what's
actually going on in the brain, and I'll start with a story.
So Lolo Jones was an Olympic hurdler... She was favored to win the 2008 Olympics.
In fact, she was in the finals, in the lead at the ninth of ten hurdles. And
what she said in an interview with Time Magazine was, I was in the middle of
a race, and at one point I realized I was winning. And it wasn't like, Oh,
I'm about to win the Olympic gold medal--it just seemed like another race.
And then at a point after that, I started to notice that I was telling myself
to make sure my legs were snapping out. That's when I hit the hurdle. So
I overtried. Now, the idea here,
it wasn't that she had thoughts, it's that she got caught up in thinking, right?
She got caught up, she tripped herself up,
literally. And it turns out [LAUGH]
that this is a pretty common process.
About half the time of the day, we're actually spent either
daydreaming or getting caught up in our experience. And you can think of this as
a continuum--daydreaming, stress, and, of course, the far end is addiction. And
because we do this so much, we can actually study this in the brain, and it's
now aptly called the default mode network, because this is what we default to. And
I'm going to highlight a particular part of
the brain called the posterior cingulate,
which you can see here in the back of the brain... Which turns out,
when you look at all the data, there are a bunch of different things that will
activate the posterior cingulate--when we're thinking about ourselves,
when we're mind-wandering, when we're thinking about the past and future,
judging things... When we're thinking about ourselves in social situation,
liking choices that we've made, when it's involved in prevention goals,
immoral behavior... I'm just going through this large list...
And finally, of course, craving. What do all of these have in common?
What does this brain region actually do? The idea is that this brain region gets
activated when we get caught up in our experience. And, of course,
with mindfulness training, the idea is to notice what that feels like and to let go.
So let's see if this is actually true. We did a study a couple of years ago
where we took novice and experienced meditators, and we scanned their
brains while they were meditating. And we had them do a number of different types of
meditation to see what was common amongst all these different meditation practices.
And as you can see here, these two regions,
these two main regions of the default mode network,
are both deactivated in experienced meditators compared to novices. So
this was interesting, it was relatively novel. We didn't believe it.
We wanted to see if we could actually prove this more thoroughly.
So we followed... This is actually a technique that Christopher
deCharms really piloted, and he'll talk a little more about it in his talk, but
the idea is that we can take real time neural feedback to bring the subjective
experience together, with brain activity. And we can
give people feedback of their own brains while their meditating.
And this is what a typical graph looks like. And the idea is,
people can meditate with their eyes open, letting the graph rest in the background.
And then they can check in from time to time to see if it correlates with
their experience of getting in their own way, as well as when they're meditating,
when they're concentrating on their breath. And our studies show that we have
a very good correlation between this graph and people's subjective experience. Now,
that was a novice. Here's an experienced meditator.
Now, I'm not very good at statistics, [LAUGH]
but I can tell the difference between
these two people's brains. I'll just walk you through what this looks like.
Here's a novice. These are three minute runs, so
he says there's nothing special here. Nothing special here,
reporting that it was lining up with his experience. In his third run he said,
I don't think your feedback works, because I was thinking about my breath, and
it was going red. So there must be something wrong here.
And the very next run, his brain looked completely different, and he said, Oh,
I get it...feeling the physical sensation of my breath rather than thinking about
it. So he'd actually use this as neural feedback,
even though this wasn't the experiment. Now,
I'll just walk you through how we can take these data and bring them together so
we can learn even more about what these specific brain regions are doing.
Here's an experienced meditator going through the experiment.
And after each, these are one-minute runs now, they're describing their experience.
And he said, I caught myself. I was trying to guess when the words were going to end,
and when the meditation was going to begin.
So I was trying to be like, ready, set, go. And
then there was an additional word that popped up, and I was like, Oh, shit, and
there's that red spike you see there. And then I sort of immediately settled in and
I was really getting into it. And then I thought, Oh my gosh, this is amazing,
it's describing exactly what I'm saying, and
then you see this red spike. And I was like, Okay, don't get distracted,
and I got back into it and we got blue again. And I was like, Oh my gosh,
this is unbelievable! It's doing exactly [LAUGH]
what my mind's doing. So he was laughing
at this point, and he said, So I find it really funny because that's to the next
question. That's a perfect map, of what my mind was going through. That's a perfect
map of what my mind was going through. So, what exactly was his mind going through?
We can take all of these data from all these novice and
experienced meditators, and bring them together, and, in a data-driven fashion,
we can figure out what exactly this brain region is doing.
And we can confirm what other people have found. So, when you're distracted,
when you're thinking about yourself, the posterior cingulate gets activated.
And you can see that here in this whole line of distracted awareness. But
we also found a new category, where they were describing controlling things,
trying to, effort, or when they're discontent, there was something that we
hadn't noticed before. With deactivation of the posterior cingulate, again,
when people are concentrated, the posterior cingulate gets deactivated, we
know this already, but there's this whole other category that came out as well.
This effortless doing, when people weren't efforting...
I'll give you a couple of examples. So this person said,
I was worried that I wasn't using the graph as an object of meditation. So
I tried to look at it harder, and [LAUGH]
somehow pay attention more to it.
Of course, it went red. Harder, ahh, pay attention to it a little bit more...
So here's some examples of deactivation. The first one, Toward the middle,
I had some thoughts which I don't see in the graph, maybe because I just let
them flow by. The second person noticed that, The more I relaxed and
stopped even trying to do anything, the bluer it went. Stopped trying... Ahh,
Yoda... No, try not. Do or do not, there is no try. So we're
getting at this sense of flow. For those of you that aren't familiar with this,
Mihaly Csikszentmihalyi' described this several decades ago, as this mental state
where we're fully immersed in the present, totally energized, we're selfless,
it's effortless... We're just, we're just doing it. You can think of, you know,
sports figures like Michael Jordan or other folks that are just really in it,
and it just seems completely effortless. This is flow.
And we even [LAUGH] had some examples where experienced meditators were
reporting getting into flow in our scanner, and
that this was correlating with decreased activity in their
posterior cingulate cortex. So this is pretty interesting. Now,
just to finish, we can take what we know mechanistically,
we can think about what we know about the psychological mechanisms behind addiction.
We can look at the exact pathways, and we can take targeted
things like mindfulness that target the key components of the pathways, so
we can target craving. We can help people work through craving so
they can literally change these addictions that are so
hard to quit. We can take that, we can pair that with delivery platforms,
like I showed you with the app plus online community, in ways that are scalable,
that are cost effective, and can help reduce this healthcare burden
that the world is feeling more and more of. And eventually we can start to pair
these scalable technologies with neural feedback, where we can give people
specific feedback from their brain regions that are associated with mindfulness.
For example, we can give them this mental mirror. It's not going to meditate or
teach them, you know, for them, but it's going to show them whether they're doing
it correctly. And what we know as humans is that we learn the most, we learn most
effectively through feedback. So, these are just some examples of this new era,
at least that we're working in, in terms of craving and addiction treatment.
So I will stop there, and thank you very much for your attention.
>> [APPLAUSE]
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