My patient started our session by talking about how he’d failed with porn, again.

He had originally reached out to me because of an increasing spiral that looked something like this: he’d feel some type of frustration in life (e.g., not having a romantic partner, a setback at work, etc.), turn to porn, followed by compulsive masturbation, sometimes sex workers, and then feel ashamed of himself. This wasn’t just once a week. It had become a very regular habit.

When we started working together, I had introduced my Going Beyond Anxiety program’s method that leverages reinforcement learning (instead of willpower) to help him see and feel into the downsides of his habit. Over the past months, he had made really good progress, to the point where he was only “slipping up” a few times a month. He was also beginning to find the benefits of a life outside of porn, including dating.

In this session, after he talked about his slip-up and what he had learned from it, we mapped out another downside that we hadn’t explored much before: anger. It went something like this: trouble sleeping → porn → masturbation → anger → self-criticism. When I asked him to describe what he got from the anger, he reflected for a moment and then told me that anger was a strategy that he’d used his entire life (he was now in his 30’s). He’d get angry with himself when something didn’t go as planned (or he fell into an unwanted habit), which would then turn on the self-criticism voice in his head that would tell him that he’d never succeed or get anywhere in life. OK, I’d seen this quite a bit before with other patients.

He declared: “I get nothing from anger.”

When I asked him to back that up–he’s a scientist, so I asked him for some data–he continued: anger and self-criticism fueled other emotions, namely fear, anxiety and worry. And he had associated fear, anxiety, and worry as the things that helped him get going (“get off my ass” as he put it), to move and to change. So for his entire life, it seemed that he got a lot from anger. But that equation was changing.

I briefly asked him to provide some data for how fear and anxiety were actually causing change. While these can feel motivating, they can be correlated but not causal. He wasn’t interested in going there, so we bookmarked that for later. (For anyone reading this who is stuck in one of these loops: it is worth exploring whether it truly is causal. For example, is anxiety the only—or best—way to get something done? NO.)

Yet, he was still stuck. After we explored the anger cascade a bit more, he came to the realization that this extended habit loop was also keeping him in, as the Stanford psychologist Carol Dweck coined it, a fixed mindset: he wasn’t learning or growing in these moments.

He asked me how he could get out of these ruts and grow. Good question for him. Good question for any of us who have held onto ideas that fear, anxiety, and anger can help us grow (see my earlier article on anger for an in depth discussion).

About a month ago, I had given him a draft of a new book I had just completed (it will be published in April 2027) that takes a deep dive into how we can develop distress tolerance: the ability to be with, and not run or shrink away from discomfort. He pointed out something I hadn’t heard from him or other patients before: how porn had also made him more impatient, wanting things to happen immediately. I’ve seen a trend toward more and more instant gratification in society to the point where one advertisement boasted “instant gratification just got faster!”

Our computers booting up faster, faster internet, faster everything is training us not to be OK with something taking a minute, and when we do have to wait, we whip out our phones and mindlessly scroll to avoid that discomfort of being with ourselves in the moment. This is the opposite of distress tolerance. This also had the unintended consequence of making it hard for him to sit still when analyzing data or reading scientific papers. Science isn’t about instant gratification. Quite the opposite.

He wondered out loud how he might bring curiosity into the equation. We did the following thought experiment: when he felt the painful contraction of being stuck or frustrated with something at hand, could he bring curiosity to what that felt like in his body? He had done this before and could confidently report that it brought that tension down about 40%. He then realized that if he spent 1–2 hours on a problem and couldn’t solve it himself, that he could redirect that energy: instead of falling into an unhealthy habit like porn, which could derail his focus and concentration for the rest of the day, he could go and ask someone who might be more of an expert, who could help him get unstuck. Regardless of the outcome, he would learn something in the process. Yes, he’d move from Dweck’s fixed mindset to her more adaptive growth mindset.

We wrapped up the session with some practical steps: 1) notice when the painful contraction signals frustration or stuckness; 2) get curious about what it feels like right now [distress tolerance!]; 3) redirect that energy toward planning, problem solving or seeking help instead of wallowing or spiraling into old habits.

As we were about to finish up, he brought up one more thing. He had read something in my book that had helped him make sense of his world: uncertainty. Uncertainty is the only certain thing in life. He was exploring embracing it (he used the term acceptance), and that was helping him be OK with all of the uncertainty that came with science, and in his personal life. What a great note to end on!

Here are a few questions that we all can explore to check how strong our distress tolerance is:

1. How often do we get frustrated (or even angry) when we encounter friction in life?

2. What is our proverbial porn and how long does it mess up our focus and concentration (e.g., Zillow, which I’ve even heard referred to as “Zillow porn”)?

3. What is it like when we bring curiosity into the moment instead of turning to our phones to distract ourselves from life’s inevitable frictions?

Here’s to accepting the uncertainty of life, and building curiosity to run toward any associated fear.

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Judson Brewer MD PhD is a psychiatrist and neuroscientist and professor at Brown University. He is the author of Unwinding Anxiety (NYTimes bestseller), The Craving Mind, The Hunger Habit and The Unwinding Anxiety Workbook. His new book, Going Beyond Anxiety, is now available for pre-order. He co-founded MindshiftRecovery.org which provides free support for people with any type of addiction.

If you are struggling with anxiety, Dr. Brewer’s Going Beyond Anxiety program brings together his research and clinical experience to help people build effective skills to reduce anxiety and cultivate calm (www.goingbeyondanxiety.com).

Copyright © 2025, Judson Brewer, MD, PhD. All rights reserved.

You might have been able to come up with that number (as squishy as it feels) relatively quickly. Now check to see how you got to your answer. Did your brain do a quick recall of your life, checking your high points and low points? Did you think about how successful you’ve been in your career or personal life? Did you take stock of your mental and physical health as it stands right now?

That literal question is named Cantril’s ladder, after the psychologist Hadley Cantril, who wrote it in 1965, and if you’ve ever read a headline about which country is happiest in the world, there’s a good chance that the story is built on that single item. Gallup World Poll asks it, and it’s what the World Happiness Report rankings are calculated from. What country is at the top of the ladder? Finland, nine years running now, followed by Denmark and Iceland and Sweden.

But wait? Isn’t Bhutan considered happiest?

Bhutan coined the phrase Gross National Happiness back in the 1970s, wrote happiness into its constitution, and set up a commission to screen government policy against it. If you stopped ten people on the street and asked them to name the happiest country on earth, I’d guess several of them would say Bhutan. Yet the last time Bhutan appeared in the World Happiness Report, in 2019, it came in 95th, with a ladder score of 5.08 out of 10, and it hasn’t appeared in the report since. Over that same stretch, Bhutan’s own national survey found that the large majority of Bhutanese counted as happy, at a level that would have put the country somewhere around 20th.

So why such a big difference?

Bhutan’s index is a multidimensional measure that folds in ecological health, cultural preservation, community vitality and governance, so the two instruments are probably getting at related, but different things. And Bhutan is a lower income country, which, as we’re about to see, is much of what the ladder is sensitive to. So the country most famous on earth for happiness got that way by deciding the question everyone else was asking was the wrong one. A simple question about a ladder that can be answered very quickly works very well for quick polls, but may only be getting at a small slice of what contributes to happiness. So if we asked people about their happiness a different way, would we get different countries?

Tim Lomas and his colleagues did just this, and recently published what they found in Scientific Reports.

They used data from the Global Flourishing Study, a large panel study run out of Harvard and Baylor, which in its first wave surveyed 202,898 adults across 22 countries, from Sweden and Japan to Nigeria, Indonesia, Kenya and Brazil, with nationally representative samples in each. Usefully for our purposes, the survey asked three different wellbeing questions rather than one. The first was Cantril’s ladder. The second was “Overall, how satisfied are you with life as a whole these days?” The third was “In general, how happy or unhappy do you usually feel?”

Life satisfaction and happiness did line up closely, correlating at 0.69. Each of them tracked the ladder a little more more loosely, at 0.57, which already suggests the ladder is picking up something its two cousins are missing.

Now it gets a bit more interesting.

Then the researchers looked at what each measure tracked at the country level. Average ladder scores across the 22 countries correlated with national GDP per person at 0.58 (pretty strong for tracking with something like GDP that lumps a bunch of things together to get a single number). Ready for this? Life satisfaction correlated with GDP at 0.05. Happiness correlated at negative 0.08.

Hmmm.

The same people answered all three, in the same sitting, on the same zero to ten scale, and only Cantril’s ladder turned out to be correlated with how wealthy someone’s country is. You can see this play out in the rankings, too. In this dataset Indonesia came first on both life satisfaction and happiness while placing fifth on the ladder, whereas Sweden came second on the ladder and landed mid-pack on the other two. So the story the ladder tells may be largely a story about money.

Why is this the case?

The researchers point to the metaphor itself. A ladder has rungs, and rungs come in an order, so when we ask people to picture the best possible life and then place themselves somewhere on the steps below it, we’ve handed them a standard and asked them to report the distance between that standard and where they’re standing. That’s a comparison, and comparison is one of the more dependable ways to set wanting in motion (e.g. I wrote about what happens when we run this one on our own bodies in my earlier article, The Mountain Doesn’t Care How You Look).

Whereas “how happy do you usually feel” points us somewhere else. Instead of comparing ourselves to others, the only place to look for that answer is inside.

My lab has spent years measuring what different mental states actually feel like, and one finding has held up across hundreds of people: comparison feels closed and contracted in the body, while states like curiosity and connection feel open and expansive. That closed quality tracks with activity in a brain network tied to our self-focused, ruminating mode (which also happens to light up more consistently during craving than just about anything else we’ve measured, in case you needed another reason to be suspicious of comparison).

So when a survey asks two hundred thousand people to climb a ladder in their heads, it may be picking up, at least in part, the felt sense of, not climbing high enough, of falling short. And falling short is responsive to what others have, which may be why the ladder follows GDP, but the internal measures not so much.

Now let’s move from a Gallop poll to our own daily survey.

How many of us run the ladder question on ourselves all day long? It shows up when we open our social media feed and see someone’s smiling vacation pictures. It shows up in a meeting when someone says the smart thing that we wish we’d thought of. It shows up at three in the morning, when we can’t sleep, as some version of where should I be by now. No researcher asked us to imagine the best possible life, and we do it anyway, several times a day. Then we grade ourselves against it, which ironically, knocks us down a few rungs just by asking the question.

A seven still leaves three rungs that we haven’t yet achieved (but others on Tiktok surely have based on their videos!).

So in my clinical practice and in my Going Beyond Anxiety program, I have people run a small experiment. When they find themselves judging themselves (yet again), I have them ask themselves some version of the ladder question and then have them stop and feel what just happened in their body. Where did it land? Chest, jaw, stomach? Most people report some flavor of tightening. Yes, comparison in itself tightens us up.

Then, without fixing anything or talking themselves into feeling better, I have them ask a different question instead. How do I feel right now? And then feel what that feels like.

This helps them get a real sense of how the constant (and habitual) comparison may move us down on our happiness ladder. And at the same time, it can give us a realtime readout of what it feels like to simply be in the present moment. While this can sound like a cliche, it is one for a reason: not only do regretting where we could have been and worrying about the future make us less happy, so does comparison!

I’m not suggesting that we should all adopt some unrealistic and pollyanish “money doesn’t matter, so cheer up,” view of the world, because having enough money to meet our needs etc matters enormously (and the same dataset says so). People who were unemployed and looking for work scored lowest of any group on all three measures. People who grew up in households where things were financially very difficult were still carrying lower scores decades later, on every question asked. Security isn’t a mood, and telling someone who can’t make rent that they’re simply asking themselves the wrong question would be both insensitive and wrong.

Worth noting that John Helliwell, one of the authors on this paper, is a founding editor of the World Happiness Report. The people who built the rankings are among those pointing out that the rankings measure something narrower than the name promises, and I’d like to see more of that type of humility from all of us. (Scientists cash in their scientist card when they start defending their positions instead of following the data.)

Their own recommendation, incidentally, is that if you’re only going to ask one question, ask about life satisfaction rather than the ladder, since satisfaction lined up better with the broader flourishing measures. Better yet, ask all three.

None of us gets to choose which question the World Happiness Report asks. We do get to notice which question we just asked ourselves, and noticing is something we can learn, the way we learn anything else, by catching it a few hundred times. When we find ourselves reaching for the next rung, we can ask the other question instead. How do I feel right now?

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Judson Brewer MD PhD is a psychiatrist and neuroscientist and professor at Brown University. He is the author of Unwinding Anxiety (NYTimes bestseller), The Craving Mind, The Hunger Habit and The Unwinding Anxiety Workbook. He co-founded MindshiftRecovery.org which provides free support for people with any type of addiction.

If you are struggling with anxiety, Dr. Brewer’s Going Beyond Anxiety program brings together his research and clinical experience to help people build effective skills to reduce anxiety and cultivate calm (www.goingbeyondanxiety.com).

Copyright © 2025, Judson Brewer, MD, PhD. All rights reserved.

REFERENCES

Bhutan 2008 Constitution (Constitute Project) · Schroeder, Asian Affairs 47(1) · Masaki & Tshering, J. South Asian Development

Cantril, H. (1965). The pattern of human concerns. Rutgers University Press.

Helliwell, J. F., Layard, R., & Sachs, J. D. (Eds.). (2019). World happiness report 2019. Sustainable Development Solutions Network.

Lomas, T., Koga, H. K., Padgett, R. N., Pawelski, J. O., Kim, E. S., Makridis, C. A., Gundersen, C., Bradshaw, M., Le Pertel, N., Shiba, K., Felton, C., Helliwell, J. F., Johnson, B. R., & VanderWeele, T. J. (2026). Exploring associations of three evaluative subjective wellbeing measures (Cantril’s ladder, life satisfaction, happiness) with 15 childhood and demographic factors across 22 countries. Scientific Reports, 16, 8025. https://doi.org/10.1038/s41598-026-35777-y

Is this really the best we can do to conjure up creativity?

Now think about the rest of the advice we get for being more creative. We’re told to add constraints, to use prompts, to ask “how might we” questions, to set a deadline because nothing focuses the mind like a deadline! (Who came up with this? Deadlines create anxiety and kill creativity). All of these work the same way: by opening a gap and then pushing us to close it. The only thing worse would be standing us at the edge of a cliff and telling us that if we don’t come up with something creative, we’ll get pushed off of it.

Why is this the case? It may be because for forty years we have been focusing research efforts on one kind of curiosity.

In 1994, the economist George Loewenstein set the stage. His information-gap theory says curiosity shows up when we notice a gap between what we know and what we want to know. The gap captures our attention. It feels like deprivation. Like having an empty stomach, we have a natural hunger to fill that gap. We go get the information, the gap closes, and the feeling stops (we’re no longer hungry). Think of forgetting the name of the actress on screen and not being able to enjoy the rest of the movie until you’ve looked her up.

The information gap was the model everyone had, so it became the thing researchers built experiments around. They used trivia questions, where people rate how badly they want the answer, and blurred images that slowly sharpen into a recognizable object, and card games where you can pay to find out what you missed. Every one of them opens a gap and measures the itch. The blurry image whets our lips, gives us a taste, and then we have a thirst to know.

Marieke Jepma and her colleagues ran one of these in 2012 using ambiguous images. When their research team induced curiosity, brain regions associated with conflict and arousal lit up. When they relieved that curiosity by letting people finally see the image clearly, a reward region lit up. Here’s how the sequence goes: an uncomfortable state, then relief when it ends, and the relief is what registers as reward. Wait a minute! That’s a habit loop (textbook reinforcement learning), and it was published as the neural basis of human curiosity.

Yikes.

Why did the field go in this direction? I don’t think anybody sat down and decided deprivation was the important kind of curiosity. It may be a matter of simplicity, ease and pragmatics: A gap can be easily opened in seconds, rated on a scale, and closed on command. Which means you can line it up and study it with a brain scanner. (Oh, how we scientists love to isolate variables and make tidy experiments to the detriment of real-world applicability!) The other type of curiosity (interest curiosity), where we wonder and are simply exploring doesn’t work that way, since it has no tidy start and stop. So the field measured the type of curiosity that could be easily isolated and controlled.

Jordan Litman named the two flavors back in 2005. He called one D-curiosity, for deprivation, the restless, unpleasant, need-to-know state, and the other I-curiosity, for interest, the pleasurable side of exploring. I wrote about this at more length in an earlier article (The Curiosity Hijack), if you want more details.

Here’s something interesting about D and I types of curiosity: when you measure them using self-report questionnaires, they correlate at about .7, which is pretty high. People who score high on one tend to score high on the other, which makes sense, since curious people tend to be curious about a lot of things, and in different ways. Yet a correlation between traits doesn’t tell us the two states feel the same from the inside, and it doesn’t tell us they affect our thinking (and creativity) in the same way. Litman found that only some of his subscales separated them cleanly. The measures are muddy (like much of psychology that is dominated by questionnaire-driven science).

So what happens when researchers stop measuring brains and start watching what people actually make? Here the picture gets more interesting.

In 2019, Lisa Hagtvedt and colleagues had people read an article about Houdini’s Vanishing Elephant trick and then come up with their own ideas for magic tricks. The group whose curiosity had been piqued produced ideas rated about a third more creative. They followed this with a two-week diary study of working artisans, where the days someone got curious predicted better work the next day. They described the mechanism as idea linking, where a piece of one idea becomes the seed of the next one.

They call this specific curiosity, meaning curiosity aimed at one particular thing. It sits close to Litman’s deprivation curiosity (the itchy kind), but isn’t the same. They function differently: deprivation ends when we get the answer whereas idea linking keeps going, one idea seeding the next. And notice what they were curious about: a magic trick, not their own performance. Nobody was standing over them with a timer.

Here’s a deprivation curiosity itch of mine that hasn’t yet been scratched: why are there so many different definitions, models and scales for curiosity? My leading hypothesis: it’s hard to put related but different concepts and experiences into words. For my research and clinical programs, I’ve found Litman’s D- and I-type curiosity the most helpful handholds for people to use.

To wit: Todd Kashdan and colleagues built a five-dimensional curiosity scale that separates joyous exploration, deprivation sensitivity, social curiosity, thrill seeking and one more: stress tolerance, meaning the willingness to sit in the discomfort of not knowing. (See my previous article on distress tolerance for a related deep dive). A recent study using his scale looked at which dimensions predict creativity, and the two strongest were joyous exploration and stress tolerance.

Read that again: the facet that best predicts creative output isn’t how badly we want to know. It’s whether we can stay in the not-knowing without bailing out.

Ready for this? Last year Nan Li and colleagues had people breathe through a resistance device, which makes breathing effortful and the body distinctly uncomfortable. Then, they measured how much participants explored for information while making decisions. In healthy participants, exploration dropped. Make the body uneasy and we stop looking around.

When the body gets uncomfortable and we don’t know how to be with it, we stop exploring. We go get the answer, any answer, so the feeling will stop. The deadline, the timer, the edge of the cliff, all of these make the body uncomfortable, and then we wonder why we can’t be creative in those moments.

A bit more neuroscience while we’re here (sorry, can’t help it). The insula, one of the regions that lit up in Jepma’s curiosity induction, is an interoceptive region: it processes internal body signals, reads the body so to speak (e.g. hunger, heartbeat etc). The insula also activates in studies of anxiety. Is it possible that deprivation curiosity and anxiety are running through some of the same machinery? Nobody has tested this directly, but my hunch is yes.

How can we pull all of this together?

If the problem were simply that we need more curiosity, the advice would be to want to know things more badly, and we’re already doing plenty of that (we can thank the 24/7 availability of information via the internet for this!). Instead, if the problem is that discomfort collapses our exploring. As such, the skill to developl isn’t wanting more. It’s first, learning to stay in the space of not knowing, and then learn (or remember) to enjoy it.

In my Going Beyond Anxiety program and my clinical practice, I have people practice something that often comes across as goofy at first, until they try it and see how powerful it is.

I first have them feel into the itchy urge of D-curiosity, and note whatever their version of that “Oh, no, I need to get this information” voice is in their head. Then, I have them open their eyes really wide and say “Ohhh?!”, what does ‘Oh no!’ feel like in my body”? Sometimes I’ll even have them explore where they feel it more in their body: on the right side, or left side. Because there is no specific knowledge-based answer here, it helps them tap into genuine interest curiosity. They can learn to run straight toward the discomfort with a mental notebook to collect information and in the process discover that they can not only be with discomfort, but that curiosity helps them explore something that can feel uncomfortable at first, but when injected with interest, not only isn’t so bad, but helps us learn in the process.

After they get the hang of the flip from OH NO to Ohhh?!, they can start to bring interest curiosity into meetings and yes, creativity sessions. They can flip from time-bounded tasks to interest-induced curiosity fests (which may still end after an hour, but eyes are less on the clock and more on the process).

So try this the next time you are aiming to awaken your own curiosity. Take ten seconds first and check in with your body. Is there a tightness in your chest? Is your jaw set, are you leaning toward the screen? Is there a sense that there’s one specific thing you need and you need it right now? That’s deprivation, and you don’t have to scratch the itch. Instead, get interested in it. What does that restless energy actually feel like? Where is it? Does it have edges? Is it moving? Nothing needs to change for this to work.

And notice what happens next, because that’s the opening into interest curiosity.

Watch a four year old find a beetle on the sidewalk. They crouch down. Their eyes go wide. And out comes some version of “Ohhh?!” (usually followed by forty questions we can’t answer). They aren’t being creative on purpose, and nobody told them to do this. They simply haven’t learned yet that not knowing is something to hurry out of.

Somewhere along the way most of us did learn that, and as we “grew up”, we’ve been closing gaps ever since. Yet the capacity doesn’t go anywhere (but backwards).

So the next time someone hands out the sticky notes and starts the creativity timer, check in with your body before you look at the whiteboard. See if you can get curious about the tightness first, and then about the problem in front of you.

Judson Brewer MD PhD is a psychiatrist and neuroscientist and professor at Brown University. He is the author of Unwinding Anxiety (NYTimes bestseller), The Craving Mind, The Hunger Habit and The Unwinding Anxiety Workbook. He co-founded MindshiftRecovery.org which provides free support for people with any type of addiction.

If you are struggling with anxiety, Dr. Brewer’s Going Beyond Anxiety program brings together his research and clinical experience to help people build effective skills to reduce anxiety and cultivate calm (www.goingbeyondanxiety.com).

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Subscribe now

Copyright © 2025, Judson Brewer, MD, PhD. All rights reserved.

REFERENCES:

Hagtvedt, L. P., Dossinger, K., Harrison, S. H., & Huang, L. (2019). Curiosity made the cat more creative: Specific curiosity as a driver of creativity. Organizational Behavior and Human Decision Processes, 150, 1–13.

Jepma, M., Verdonschot, R. G., van Steenbergen, H., Rombouts, S. A. R. B., & Nieuwenhuis, S. (2012). Neural mechanisms underlying the induction and relief of perceptual curiosity. Frontiers in Behavioral Neuroscience, 6, 5.

Kashdan, T. B., Stiksma, M. C., Disabato, D. J., McKnight, P. E., Bekier, J., Kaji, J., & Lazarus, R. (2018). The five-dimensional curiosity scale: Capturing the bandwidth of curiosity and identifying four unique subgroups of curious people. Journal of Research in Personality, 73, 130–149.

Li, N., Lavalley, C. A., Chou, K. P., & Smith, R., et al. (2025). Directed exploration is reduced by an aversive interoceptive state induction in healthy individuals but not in those with affective disorders. Molecular Psychiatry.

Litman, J. A. (2005). Curiosity and the pleasures of learning: Wanting and liking new information. Cognition and Emotion, 19(6), 793–814.

Litman, J. A. (2010). Relationships between measures of I- and D-type curiosity, ambiguity tolerance, and need for closure: An initial test of the wanting-liking model of information-seeking. Personality and Individual Differences, 48(4), 397–402.

Liu, Longkun, Xingnan Cui, and Jiang Qiu. “Which type of curiosity promotes creativity? An investigation based on the five-dimensional curiosity construct.” Acta Psychologica 264 (2026): 106593.

Loewenstein, G. (1994). The psychology of curiosity: A review and reinterpretation. Psychological Bulletin, 116(1), 75–98.

What made the difference?

This is from a recent session in which one of my patients was detailing some progress she had made in working with her anxiety. When I asked her to add a bit of color to what had happened, she described it this way: “I was prepared, but much less prepared than last time, yet it went so much better because I didn’t feel stressed about the situation at all. I was not worried about messing something up, so I could just be normal.” She went on to point out that she’d been thrown many curve balls in the process, but found she could respond to them with remarkable ease, as though she were “in a normal conversation” with a colleague instead of batting practice.

How was she becoming a courtroom slugger despite only having played a little while in the major leagues? And how can we all learn some nuggets of wisdom from watching her at bat?

Let’s start with what was actually making her anxious that first time. It wasn’t the law (she knew her stuff). It was the audience. Am I making a good impression? Do I sound stupid? Am I about to be found out? And who’s the star of every one of those questions? Not the case. Her. That’s ego. We usually picture ego as someone strutting around sure they’re the smartest person in the room, but in a courtroom ego strikes out in two ways: thinking too highly of ourselves, and thinking too little of ourselves.

The anxious version of ego is something that she and I had been circling for months. Yet, for her, ego doesn’t only show up when she’s nervous. She’s navigating a high-powered job at a high-powered law firm that, let’s just say, didn’t have any ego vacancies. Her current case is set to go to trial in a few months, and lately the ego had been playing hardball on a different field: an associate senior to her who she worried was leading them the wrong way. How does she know this?

Based on her previous experience (she’s been down that road before), she can see where things are heading. As she put it, “I’m not right about everything, but fundamentally, I am [right] here.” She pointed out how she was getting frustrated in meetings, to the point where a partner checked in with her later to ask her what was going on. She knew that frustration wasn’t helping, yet didn’t know how to separate that from getting the task at hand done.

The easy thing here would be for me to tell her to check her swing; in this case check her ego. Take a breath, be more humble, let it go etc. This is pretty useless on several fronts: giving advice = lazy therapy, and telling someone to be humble doesn’t magically excise ego from the brain. Perhaps more importantly, she isn’t wrong. To mix metaphors here, the senior associate really may be steering the case toward a ditch, and she really has watched this movie before. If I’d said something like “sounds like a bit of ego talking there, huh?” she’d have been well within her rights to throw a legal pad at me (and I’d have deserved it).

So her accuracy isn’t the problem. As she walked me through the situation, “This approach is going to fail” showed up in the same breath as “and why am I the only one who can see it, and why do I always have to do everyone else’s job?” Get out your legal pad and make a note of this: One of those is a fact. The other is ego. And when the two ride together, when the ego is driving with the fact in the passenger seat, both get driven off the cliff (not exactly Thelma and Louise-style, but you can picture how this movie ends).

Why would that be? Here I’d point to some work from my lab. We’ve measured how different mental states actually feel to people, and a pattern shows up: states like anxiety, craving, and frustration feel closed and contracted, and worse, while states like curiosity and kindness feel open and expansive (and better). That closed, contracted feeling also tracks with a brain network tied to our self-focused, ego mode (all the “I, me, mine” activity). So when she’s in the grip of “I am right,” she isn’t only being hard to work with. She’s getting caught in the most closed, self-referential state her brain has on offer. Not a great place to argue a delicate point from, let alone have a collegial discussion (they are on the same team after all).

She and I walked through how these types of meetings play out. She tells the associate he’s wrong. He digs in. (Of course he does, who wouldn’t?). When we hear “that’s wrong,” most of us don’t hear a fact, we hear an attack, and the part of our brain that bristles isn’t the reasoning part, it’s the I am part. Her contracted ego wakes up his contracted ego, and now there are two closed systems defending themselves while the actual case sits on the table, untouched.

So we landed on an experiment (and I called it an experiment, because I honestly didn’t know if it would work). Play with the difference between “I am right” and “this is the right thing to do.” Say them a few times, and check your body as you do. Does one feel a little more open than the other? “I am right” plants you in the center of it. “This is the right thing to do” takes you out and lets the fact stand on its own. Same information, very different outcome. When we take ourselves out of the equation, the other person has nothing left to push against, because there’s no “me” for them to lose to. There’s just the problem, sitting where everyone can look at it together. Instead of us grabbing the steering wheel trying to force them to go with us, we let the facts drive, moving us toward the right destination (together) instead of off the cliff.

We then explored how to apply this practically. It turned into asking questions instead of making points. Instead of “that’s wrong,” something more like: “help me understand this, because I’m not following. I’ve seen this go sideways before, and I’m curious how this time is different. What am I missing here?” That shift does a few things at once. Maybe she’s missed something (it happens to everyone, even to her as she pointed out herself). She gets to understand more fully why he’s doing what he’s doing. This also helps them connect as people, on the same team, BUT this only works if she is truly curious, not fake curious. And it disarms him, because now he isn’t defending himself, he’s just explaining his thinking. Curiosity, it seems, can do what frustration keeps failing to do by force. It also happens to be that open, expansive state, which is a far better place to think from than a boiling one. A proverbial home run if not at least a triple.

Which points at the deeper thing, the one I warned her might be a year’s worth of work. Someone at a recent workshop I was co-leading asked me about ego and habits, and what came out of it was this: maybe anything that starts with “I am” is a habit. I am right. I am the only competent one here. I am the person who cleans up everyone else’s mess. Learned and reinforced a little more each time we feed them. The case doesn’t need her to be right. It needs the right thing to get done. Those are two different jobs, and only one of them makes it more likely that you strike out in the big game, leaves you frustrated and gets a “what’s up?” check from a worried partner.

At the end of the session, I didn’t hand her a summary. I asked her for hers. She said that over the next couple of weeks she’d try substituting out “this is right” for “I am right,” essentially taking herself out of the sentence. That simple single word substitution is more or less the way to keep her eye on the ball instead of herself. She could explore a way to let the fact do its job without dragging herself in behind it. And for all of us watching or playing the ego game, it may be an experiment worth doing ourselves: see if it is easier to keep your eye on the curve ball when the pitch was never aimed at or about you.

Judson Brewer MD PhD is a psychiatrist and neuroscientist and professor at Brown University. He is the author of Unwinding Anxiety (NYTimes bestseller), The Craving Mind, The Hunger Habit and The Unwinding Anxiety Workbook. He co-founded MindshiftRecovery.org which provides free support for people with any type of addiction.

If you are struggling with anxiety, Dr. Brewer’s Going Beyond Anxiety program brings together his research and clinical experience to help people build effective skills to reduce anxiety and cultivate calm (www.goingbeyondanxiety.com).

Subscribe now

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Copyright © 2025, Judson Brewer, MD, PhD. All rights reserved.

Then something unusual happened: the class ballooned from its usual 30 students to 86 the moment take-home got announced. Serrano specifically made the midterm harder than those that he had written in years past because students now had more time on their side. Historically, his midterm average ran 65 to 80 percent. This time it came in at an eye-popping 96. A much higher average on a much harder exam. Hmmm.

Something felt off, so Serrano and his graders ran the exam through ChatGPT themselves. The AI’s answers weren’t just similar to his students’. They were similar in a specific, telling way: on a proof that all but begs for a direct argument, the chatbot, and a suspicious number of his students, reached instead for a contorted, roundabout “contradiction” argument. So, he switched the final back to in-person. Eighteen students dropped the class. Nineteen failed. The final average landed at 48.6 percent, the lowest in the course’s history.

My first reaction when I read about this was surprise at the magnitude, and then wondering if this is an example of how pervasive this type of cheating is. Yet, as I sat with it more, this is less about the scandal of cheating (sadly Princeton recently revoked its time-honored honor code of 133 years in which students could take exams un-proctored and sign a pledge at the end that they didn’t cheat; cheating spiked and reporting by other students plummeted), and more about something that could slowly become insidious: students unknowingly cheating themselves out of the most important reason they are in college–to learn how to learn. And, this may be a window into our future if we don’t pay attention.

What happens when the discomfort of not knowing something has a frictionless and instant escape hatch sitting in everyone’s pocket? That doesn’t even require anyone to blatantly cheat on anything. It’s available for every assignment, every night, whether or not a professor ever finds out (though our sense of smell is generally good when something seems a little fishy). To be clear, what I’m talking about is different from other types of cognitive enhancement. To wit, drinking matcha tea helps my words emerge and flow, but the matcha itself doesn’t do the thinking for me. The matcha is helpful in two ways: it supports the work of thinking and writing without providing a substitute for the thinking itself.

Isn’t learning supposed to feel a little hard? When our brains don’t know the answer (aka we’re learning), the gap between not-knowing and knowing can produce a real, physical sense of discomfort. (I still remember the white-hot, twisting ball of dread that used to show up in my stomach before I sat down to write a paper I hadn’t researched enough. My instant distraction/fix: checking my favorite news website) Students who haven’t had much chance to build tolerance for that particular flavor of discomfort may also experience it as something to avoid or try to stop, rather than something to sit with or even lean in to. And AI is an extraordinarily good “make it stop” button. This fits well with my lab’s research on habit formation: The trigger is the blank page, or the equation that doesn’t have an obvious solution. The behavior is asking the chatbot du jour. The result is relief, and often a grade to go with it (but not the pride of ownership). That’s a habit loop (trigger, behavior, reward/result), the same wiring behind a cigarette craving, or my own old habit of checking the news the second a hard sentence needed writing. The reward of avoidance is real, and that’s the real problem, because it shunts us away from learning.

I don’t think that students are doing this on purpose. Just like any habit starts to form over time, they might be late on an assignment or overwhelmed by feeling that too much work is demanded of them (this is not unique to Ivy League institutions), and resort to having AI help a little here and there. If everyone else is using it, it gets normalized pretty quickly, and can also create some FOMO about falling behind or being at a disadvantage. Notice the irony here: they are inadvertently disadvantaging themselves over the long haul (not learning how to learn) by leaning on AI in the short term to give them an advantage.

Perhaps not the best analogy, but I have had a lot of patients over the years that start with a drink to take the edge off in social situations, which leads to two and then three and then way too much over time. Years later, they end up in my office when their drinking has taken over and ruined their lives. They wonder what happened and when things went south because the slope was slight enough at first that they didn’t notice that they were rolling until the momentum was so strong that they were out of control. In the same way, students may be blowing a huge and rare opportunity (and a lot of money) to specifically learn one (main) thing: how to learn and think. These are tangible, nonfungible skills that will increasingly be needed in a world where tasks that can be repeated will be increasingly automated. Once learned, repetition almost by definition is not learning. It’s habit. And if it can be programmed in our brains, it can be programmed into bots.

Fortunately, there may be a solution, but this is one that we have to learn as well (from our own experience): curiosity.

My own lab’s research on the felt sense of different mental states has found, again and again, that people prefer curious and kind states over anxious, craving ones, and that preference likely tracks with activity in a self-referential brain network that quiets down the moment we get genuinely interested in something (the default mode network). There seem to be two flavors of curiosity. One is the itchy, need-to-know kind: the movie star’s name you can’t place, the text you have to check mid-dinner. That is called deprivation curiosity, because we’re deprived of information. AI scratches that itch really well, almost instantly. The other is the open, wide-eyed kind, the joy of discovery, actually figuring something out. This is called interest curiosity because we’re, well, interested. Interest can’t be outsourced. Only this second kind seems to turbocharge real learning. And you can’t get to it without learning to tolerate the itchier kind for a little while first. (See my previous article on distress tolerance for more on this)

None of this makes AI the villain per se (with very real environmental and social concerns eg. data centers, the AI companies are already pretty villanous in many minds). AI isn’t going away, so we have to learn how to work with it without accidentally turning ourselves into unthinking automatons. In medical school we used to joke about “academic bulimia” (as someone who treats patients with bulimia nervosa, thankfully we’ve stopped using this term so casually): binge on an organ system’s worth of information for a few weeks, then purge it the moment the exam ended to make room for the next glut.

Human brains were never meant to be databases, and there is a very good argument for outsourcing the parts of thinking that were always going to fail us anyway (it would be malpractice to expect us to remember all combinations of drug-drug interactions). As physicians we’re not fully there yet, but I suspect a few years out we’ll lean on AI as something like an external hard drive for the facts, freeing up whatever’s left of us for human thinking, human creativity, human connection. BUT, that synergy only works if we already know how to think. Skip that step, and we’re not augmenting a mind. We’re just replacing a capacity that we never built. Yes, automaton.

This isn’t a new problem, even if it feels like an urgent one right now. Back in 2014, in his book “Excellent Sheep,” William Deresiewicz warned about students who treat college as a return on investment, a credential to be acquired rather than a self to be built (based on the joy of the struggle). This was a full decade before any of us had heard of ChatGPT. AI highlighted this by taking the friction out of the learning equation.

In my own seminar on addiction and habit change, I assign primary neuroscience papers, dense ones (some would be hard even for people with PhDs) to a room that’s mostly not neuroscience majors. And I actively encourage students to use AI to help them parse what they’re reading. (That’s the good kind of external hard drive, and it seems to work.) As my concerns for the slippery slope of help me, wow this is hard, ok go ahead and do the work for me grew, I started implementing an oral exam. At the end of the semester, students get twenty minutes alone with me, talking through their final paper: what they learned, how it applies to whatever they chose to write about (e.g. addiction, anxiety, social media). If they wrote the paper themselves, that conversation becomes an easy boost to their grade, and one of my favorite parts of the semester, because we usually end up learning something together. If they didn’t write it, twenty minutes is a very long time. This is much easier in a senior and graduate student seminar where I am scheduling twenty students and twenty minutes apiece, not eighty-six (or more).

So maybe the real question isn’t whether students should be allowed to use AI. It’s whether they’ve had the chance (and have been taught) to fall in love with the process (and discomfort) of learning in the first place. That was never really a technology problem. To be clear, higher education has a number of warts which are beyond the scope of this article (eg. the increasing cost of education which contributes to a shift toward the tangible, transactional what will I get from this approach that is often pressured by parents who are paying the bill etc). So it is incumbent upon all of us (professors, parents) to be yes, thinking through the nuances, catching our own habitual reactions, and modeling distress tolerance and most importantly, the love of learning itself. We can only learn how to learn if we love learning, and I doubt the faster escape hatch that AI has now provided is the thing standing between someone and that love. It just makes it a lot easier not to find out.

Judson Brewer MD PhD is a psychiatrist and neuroscientist and professor at Brown University. He is the author of Unwinding Anxiety (NYTimes bestseller), The Craving Mind, The Hunger Habit and The Unwinding Anxiety Workbook. He co-founded MindshiftRecovery.org which provides free support for people with any type of addiction.

If you are struggling with anxiety, Dr. Brewer’s Going Beyond Anxiety program brings together his research and clinical experience to help people build effective skills to reduce anxiety and cultivate calm (www.goingbeyondanxiety.com).

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Copyright © 2025, Judson Brewer, MD, PhD. All rights reserved.

REFERENCES

Brewer, J. A. (2021). Unwinding anxiety: New science shows how to break the cycles of worry and fear to heal your mind. Avery.

Deresiewicz, W. (2014). Excellent sheep: The miseducation of the American elite and the way to a meaningful life. Free Press.

Litman, J. A., & Silvia, P. J. (2006). The latent structure of trait curiosity: Evidence for interest and deprivation curiosity dimensions. Journal of Personality Assessment, 86(3), 318–328.

Princeton Alumni Weekly. (2026, May). After 133 years, Princeton is going back to proctoring exams. Princeton Alumni Weekly. https://paw.princeton.edu/article/after-133-years-princeton-going-back-proctoring-exams

Whitford, E. (2026, July 8). Brown professor suspects majority of his class used AI to cheat. Inside Higher Ed. https://www.insidehighered.com/news/faculty/learning-assessment/2026/07/08/brown-professor-suspects-most-his-class-used-ai-cheat

The study, published last month in the journal Environment International, pulled together survey responses from 50,363 people across 58 nations, speaking 36 languages. (Most “big” psychology studies that we read about ran a few hundred undergraduates through a questionnaire for course credit. This one literally spanned the planet.) The researchers, led by Viren Swami, who seems to have spent the better part of two decades studying how we relate to our bodies, were after a specific question: we already know that time in nature tends to make people feel better. But why? What is actually doing the work?

Their answer is more nuanced than “fresh air is nice.” People who spent more time in contact with the natural world tended to report more self-compassion and a greater sense of being restored by their surroundings. Those two things, in turn, were linked to a more positive relationship with their own bodies. And that, finally, was linked to greater satisfaction with life as a whole. Nature at one end, a more satisfying life at the other, and between them: how you feel about the body you inhabit.

The self-compassion piece is easy to skim past. It’s also the most human part of the paper.

We tend to imagine that liking our bodies is mostly a matter of the bodies cooperating: lose the weight, fix the thing, and the good feeling will follow. But the research on body image points somewhere stranger. “Positive body image,” as the field defines it, isn’t really about thinking you look good. It’s about relating to your body in terms of what it does rather than how it photographs. This means appreciating that it carries you up the stairs, lets you taste dinner, hugs the people you love, gets you from here to there. It’s a shift from the body as an object on display to the body as the thing through which you actually live. That is much closer to self-compassion than to self-improvement. We can think of it this way: it’s less “I look acceptable” and more “I’m on my own side.”

So why would a walk in the woods nudge anyone toward being on their own side?

The mechanism in the study focuses mostly on attention. Think about where most of us do our body-evaluating. It happens in mirrors, in photos, in the artificial glow of a social media feed engineered to show us other people’s curated highlight reels. Places that are built, more or less, to put the primary focus on appearance. Now think about a treeline at dusk, or the particular sound a creek makes, or the way light comes through leaves. Nature is one of the few places left that isn’t turning the lens on you, encouraging you to evaluate how you look (consciously or unconsciously through comparison etc). The mountain does not care about your waistline. The researchers describe nature as offering a kind of effortless, undemanding attention. This is about the gentle pull of a landscape that holds your focus without straining it. And in that unhurried peaceful quiet, people seem to find it easier to be kind to themselves.

In college, one of my sanity-savers was leading backpacking trips for our outdoor program. Every break that we got (fall, winter, spring), I was out in nature with a group of students, most of whom I had just met a few days before the trip began, as we planned our adventure. I can still vividly remember how the stress of school would just melt off with each step as we hiked deeper and deeper into the woods. Not only was there something magical about the smells and quiet beauty of nature, but we connected with each other on a very human level: no phones or social media, just us, sharing the same path, pitching tents and cooking a group meal together. As each day passed without mirrors or showers, the more we sank into our own and shared “stink” as we put t shirts back on that weren’t quite dry from the previous day’s sweat. And by the end of the trip, I had invariably made new friends, and a renewed appreciation for the power, beauty and wonder of nature.

This new study both fits with my own experience, and IMHO is needed in today’s world where we’re being conditioned to live in and for our screens. And of course, there are caveats:

This study is a snapshot, not a stopwatch. Everyone answered the questions at a single moment in time. That kind of design can tell you two things travel together (more nature, more body appreciation), but not which one is pushing the other. Correlation does not equal causation. It’s entirely possible that going outside softens how we see ourselves. It’s also possible that people who already feel at home in their bodies are the ones who head out the door in the first place, while the rest of us stay in. (Or that some third thing is driving all of it: living near a park, being healthy enough to hike, having the kind of life that leaves room for a Sunday walk.) The researchers know this; it’s a limitation and pretty normal for a study this size (which would be nearly impossible to do another way). You can’t exactly randomize fifty thousand people into “forest” and “no forest” for a decade.

But this particular caveat doesn’t tank the results. Especially if we focus on the risk/benefit ratio. Going outside has no side effects, no monthly fee, and no fine print. Even if the arrow points the other way, the worst case is that you spent an afternoon among trees (which is still a pretty good way to spend an afternoon!). That’s remarkably low stakes, especially compared to the medicine commercials that seem to spend more time on side effects than what the medicine is supposed to help you with.

It also helps that this study isn’t standing alone. Of course, the field has its junk, too: be wary of the breathless little papers clocking immune-cell counts in a dozen forest-walkers. But there are other studies that suggest similar benefits of being out in nature (“forest bathing” was trending for a while). For example, A British survey of nearly 20,000 people found that around two hours a week in nature was the threshold where good health and high wellbeing became markedly more likely. Here’s another example: Researchers at Stanford randomly assigned people to walk for ninety minutes through nature or through the city, and the nature group came back ruminating less, caught up less in the looping, self-critical thinking that feeds both depression and a bad morning in front of the mirror, and showed quieter activity in a brain region tied to exactly that kind of thought. And a Danish study that followed more than 900,000 people (!!) found that those who grew up with the least greenery nearby carried up to a 55% higher risk of a later psychiatric disorder, even after accounting for wealth, city living, and family history. None of these studies is perfect: the survey can’t prove which way the arrow points, the experiment was small and brief, the Danish data tracked green near your house rather than time you actually spent in it. But the imperfections sit in different places, and the results still line up.

So let’s say you throw caution to the wind, and go outside to feel the breeze and smell the trees. If you’re going to go outside buoyed by these results, it’s important to really be outside, not just walking somewhere in woods but still stuck in your head. Yes, there’s a difference between being in nature and being in nature while doomscrolling under a nice tree. The study measured contact with the natural world, but I’d add, from my own corner of the research, that how we pay attention probably matters as much as where we are.

You can stand in a grove of trees or a meadow and miss all of it because you’re three notifications deep or halfway through a podcast. The simplest antidote isn’t effort or willpower. Instead, it’s curiosity. Notice the actual texture of the bark. Listen to the birdsong and wonder what bird that is, without needing to look it up. Let yourself get a little interested in what’s in front of you instead of what’s on your screen. If you notice that you’re walking but stuck in your head worrying, you can simply get curious and notice, “I’m inside my head right now,” which can be a reminder bell that wakes you up and brings you back into your surroundings. Curiosity is one of the few states that reliably pulls us out of our heads and into the present moment. And the present moment is, conveniently, the only place the trees are. (Whether curiosity is part of or adds to why nature works the way this study suggests is a question I’d love to test, not one this study answered.)

None of this means the trees will fix you. Deep-rooted struggles with body image don’t dissolve because we took a walk. But the picture from fifty thousand people across fifty-eight countries is hopeful, and it points somewhere unfashionable. In a culture that keeps insisting the path to liking our body runs through changing it, here is a very large body of evidence suggesting that one of the better things we can do is step away from the mirrors entirely. To spend time somewhere that was never grading us to begin with, and to notice, with a little curiosity, that we were never required to play that game in the first place.

The mountain doesn’t care how we look. Go find out what that feels like.

Judson Brewer MD PhD is a psychiatrist and neuroscientist and professor at Brown University. He is the author of Unwinding Anxiety (NYTimes bestseller), The Craving Mind, The Hunger Habit and The Unwinding Anxiety Workbook. He co-founded MindshiftRecovery.org which provides free support for people with any type of addiction.

If you are struggling with anxiety, Dr. Brewer’s Going Beyond Anxiety program brings together his research and clinical experience to help people build effective skills to reduce anxiety and cultivate calm (www.goingbeyondanxiety.com).

Subscribe now

Share

Copyright © 2025, Judson Brewer, MD, PhD. All rights reserved.

REFERENCES

Swami, V., Voracek, M., Stieger, S., Tran, U. S., & the BINS Consortium. (2026). Positive body image is a pathway between nature contact and life satisfaction across 58 nations. *Environment International*, 110277. https://doi.org/10.1016/j.envint.2026.110277

Bratman, G. N., Hamilton, J. P., Hahn, K. S., Daily, G. C., & Gross, J. J. (2015). Nature experience reduces rumination and subgenual prefrontal cortex activation. *Proceedings of the National Academy of Sciences, 112*(28), 8567–8572. https://doi.org/10.1073/pnas.1510459112

Engemann, K., Pedersen, C. B., Arge, L., Tsirogiannis, C., Mortensen, P. B., & Svenning, J.-C. (2019). Residential green space in childhood is associated with lower risk of psychiatric disorders from adolescence into adulthood. *Proceedings of the National Academy of Sciences, 116*(11), 5188–5193. https://doi.org/10.1073/pnas.1807504116

White, M. P., Alcock, I., Grellier, J., Wheeler, B. W., Hartig, T., Warber, S. L., Bone, A., Depledge, M. H., & Fleming, L. E. (2019). Spending at least 120 minutes a week in nature is associated with good health and wellbeing. *Scientific Reports, 9*(1), 7730. https://doi.org/10.1038/s41598-019-44097-3

Guest: Not important.

Host: How come?

Guest: Well, because the amount of extra effort that’s required to do that is just not going to really have much R.O.I.

My wife and I were listening to Ezra Klein’s recent podcast when this clip came on. When we heard this, we looked at each other dumbfounded. Did we really hear that correctly? A young man, an influencer who goes by Clavicular, explaining to a streamer that a partner’s pleasure isn’t worth the ROI: Return on investment. And he deadpans this response as though actually pleasuring his partner is not even close in the calculation.

Klein’s episode is a conversation with the novelist Gary Shteyngart, who wrote a book back in 2010 called Super Sad True Love Story that seems to have called our current day with surprising accuracy. Of note, he wrote this novel before the iPhone had even been released, and nailed it: ubiquitous screens, everyone ranked, an obsession with looking a certain way and living forever, against the backdrop of a country that feels like it’s coming apart. The novel even included an invasion of Venezuela! The two of them spend an hour marveling at how a satire basically became a documentary.

I’ve been pondering the orgasm clip, because I don’t think it’s mostly about sex. (Whether Clavicular even means it, or is just feeding the camera the most outrageous line he can find, doesn’t really matter. The fact that this is the version of himself that gets rewarded is what is interesting enough for the two of us to be talking about it over breakfast. My wife pointed out that Clavicular is only twenty, and how many twenty-year-old “boys,” as she put it, who are actually having sex are focused on their partner? Probably very few.) It’s like he’s done the math, run a calculation, and the output is not worth it. Somewhere in there he has decided that the pleasure of another person, and his own pleasure in giving it, belongs in a spreadsheet which makes it easier to calculate and zero out losing propositions.

Has competition outcompeted joy?

I wonder if Clavicular might not know what he’s missing. And how could he know what he doesn’t know if his generation grew up with the constant comparison machine of social media?

Is maxxing the social media-determined metrics du jour what he (and others who are caught in the current trends) think happiness is?

Later in the same episode Klein and Shteyngart get to bone smashing, which is exactly what it sounds like: you take a hammer to your own cheekbone on the theory that the bone heals back denser, and a denser, sharper face scores higher on whatever scale these guys are using. Shteyngart, to his credit, doesn’t lecture about it. He just mentions, that the way to actually attract someone has always been to be an interesting person, to listen, to say something worth hearing and to want to hear what comes back, something he says he figured out as a small, unspectacular-looking, “furry” (his words), immigrant kid who had to be interesting because nothing else was going to do the work for him.

He says it lightly and moves on, but having worked the past couple of decades as a psychiatrist and neuroscientist watching what happens in people’s brains when they do the opposite of what Shteyngart is describing, this set my alarm bells off. The definition of addiction is continued use despite adverse consequences.

Let’s see, I keep smashing in my face (see the end of this article for my top 10 list of current maxxing trends that I hope don’t become addictions for too many people)...

There is a network in the brain, anchored in a region called the posterior cingulate cortex, that quiets down when we are focused or absorbed in something and lights up the moment we start getting caught up in the running commentary of how am I doing, am I enough, is my jaw sharp enough, what is the return on this. This is called the default mode network, but I think of it as the “me” network because it is all about the self.

In my own lab we have watched that region quiet down when people stop getting caught up in their experience (e.g. meditation), and activate when they get pulled back into the story of me. In a recent meta-analysis the default mode network is the most consistent network to light up during craving, which may be part of why the more time people spend measuring and improving themselves the worse they tend to feel, even while they are convinced they are getting closer to something. Craving never satisfies, it only intensifies. When we get addicted to ourselves, we lose sight of everything but the mirror (and the likes and the clicks and all of the other metrics). Hint: narcissism isn’t about generosity or connecting with others.

You can do the experiment yourself: check this in your own body, which is the most trustworthy evidence you can get. Bring to mind something you’re afraid you’re not good enough at or have compared yourself to someone else, and notice what happens. For most people there’s a tightening or contraction somewhere in their body (usually chest/stomach region). Then bring to mind a time when you were so absorbed in having a conversation or connecting with another person, a friend in the middle of a story, a kid showing you something they made, a stranger you just met and were actually curious about, that you forgot to check how you were doing. Notice how different that one feels. And what is the difference? Less contraction? More opening or even a loss of self-consciousness? Does the story of me fade into the background?

Our brains are really good at learning from how a state feels. And as a result of the burden of constant comparison, the story of me taking a lot of energy and feeling contracted, you would expect us to drift toward the open one on our own because it feels better. What keeps us from drifting is that the contracted state comes with a promise attached, the assurance that if I optimize a little more, sharpen the face, extend the lifespan, climb the ranking, then I will finally arrive somewhere and get to relax, and the promise is exactly what keeps the hammer swinging.

We get so caught up in the project of self-improvement that we lose sight of where we are going, and so busy doing it that we don’t stop to reflect on how (literally) miserable it is making us. The self we are optimizing turns out to be bottomless and there is always another millimeter. (Bryan Johnson, the longevity influencer who comes up in the episode, is trying very hard not to die, and Shteyngart’s line about him nails it: an obsession with living forever without enjoying life.)

So when I ask whether Clavicular knows what happiness is, I am genuinely curious because he has been handed an instrument for measuring himself and not one word of instruction on how to get outside himself. THe Zen Buddhist monk and peace activist Thich Nhat Hanh put it this way: “Many people think excitement is happiness... But when you are excited you are not peaceful.” Yes, mistaking excitement for happiness keeps us on the constant hunt for more, because it is all about anticipation and leaning into the future instead of enjoying what is right in front of us.

And of course under those conditions a partner’s orgasm doesn’t clear the bar, perhaps because it never was in the equation in the first place. Screen time has swamped out true face time, encouraging a metrics-based race away from true happiness. Without truly experiencing the reward that comes with true generosity, kindness and connection (which only happen in the present moment), one can’t include it in their formula or their ROI.

The most hopeful moment in the whole conversation isn’t about looks at all. Shteyngart starts describing men who collect watches, who gather and recite reference numbers and movement specifications at one another, and what he notices underneath all of it is that they are lonely, and so relieved to have found seven or eight other men who carry the same loneliness. He describes how one of them will sometimes bring a fifty-eight-dollar Casio instead of the Rolex and everyone loves it, and loves him, because geeking out on the specs was only ever the cover story for the thing they actually came for, which was each other.

He says something similar about a place. Go to the poorest part of Spain, he says, and life is somehow beautiful, the communal ties thick, the midday meal long, people having sex and then talking about it afterward and loving both halves of that, all of it on roughly half of what people earn in Mississippi. They are connecting and enjoying what they have right now.

As their conversation about Spain points out, it’s not that we can’t have authentic happiness in today’s world. It just got rerouted into the metrics (which are always pointed toward more), where it cannot be fed, because a number is not a person and was never going to love you back.

I don’t think the kids with the hammers are shallow. They seem to be very motivated and authentically trying to hack their way toward something. Unfortunately, I think they got pointed in the wrong direction, likely with the help of platforms that could be more aptly named social comparison than social media. Shteyngart said it at the end of the podcast, almost as a throwaway: be interesting, and listen. Yes, people are much more interesting than the competition to max something that isn’t authentically us.

So what it would take for a twenty-year-old with a hammer in his hand to believe him? It might have to start with modeling of kindness and connected behavior (instead of maxxing), which is hard to do on a screen...

P.S. For a little tongue-in-cheek relief, I asked Gemini to round up the ten most extreme looksmaxxing trends, just so you can get a sense of how far people will actually go. Jaw-dropping, in more ways than one (list below).

Judson Brewer MD PhD is a psychiatrist and neuroscientist and professor at Brown University. He is the author of Unwinding Anxiety (NYTimes bestseller), The Craving Mind, The Hunger Habit and The Unwinding Anxiety Workbook. He co-founded MindshiftRecovery.org which provides free support for people with any type of addiction.

If you are struggling with anxiety, Dr. Brewer’s Going Beyond Anxiety program brings together his research and clinical experience to help people build effective skills to reduce anxiety and cultivate calm (www.goingbeyondanxiety.com).

Subscribe now

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Copyright © 2025, Judson Brewer, MD, PhD. All rights reserved.

The Top 10 Most Extreme Looksmaxxing Trends

1. Bone Smashing

• The Logic (The Myth): Hitting facial bones (jaw, cheekbones) with hammers or blunt objects to trigger Wolff’s Law, theoretically making the bone grow back thicker and more chiseled.

• The Reality (The Truth): Causes severe facial asymmetry, nerve damage, and fractures that heal unevenly. Wolff’s Law applies to functional, gradual load—not traumatic DIY fractures.

2. Cosmetic Leg-Lengthening

• The Logic (The Myth): Undergoing an elective orthopedic procedure to break the leg bones and stretch them over months to gain a few inches of height.

• The Reality (The Truth): Extremely painful and expensive ($70k+). Requires a year of grueling rehab and carries high risks of chronic pain, nerve damage, and non-healing bone infections.

3. “Starvemaxxing”

• The Logic (The Myth): Severe calorie restriction or abusing extreme appetite suppressants to strip all facial fat and achieve “hollow cheeks.”

• The Reality (The Truth): Clinically mirrors severe eating disorders. Causes muscle wasting, dangerous nutritional deficiencies, long-term metabolic slowdown, and organ strain.

4. DIY Facial Injections

• The Logic (The Myth): Purchasing black-market dermal fillers or hyaluronic acid pens online to sculpt the jawline or nose at home on a budget.

• The Reality (The Truth): High risk of vascular occlusion (injecting into a blood vessel), which can block blood flow and lead to tissue necrosis (skin death), permanent scarring, or blindness.

5. Extreme “Hard Chewing”

• The Logic (The Myth): Chewing on high-resistance rubber blocks or tough resins (mastic gum) for hours daily to build massive, angular jaw muscles.

• The Reality (The Truth): Does not change adult bone structure. Frequently results in severe Temporomandibular Joint (TMJ) disorders, chronic jaw popping, migraines, and dental wear.

6. Orbital Massaging

• The Logic (The Myth): Aggressively pressing, rubbing, or pulling the eye sockets to force a transition from round “prey eyes” to deep-set “hunter eyes.”

• The Reality (The Truth): Adult skull bones cannot be manually reshaped. Instead, this breaks delicate capillaries and stretches skin, causing premature wrinkles, sagging, or hyperpigmentation.

7. Chemical Height Maxxing

• The Logic (The Myth): Sourcing unregulated cocktails of HGH (Human Growth Hormone), growth-factor peptides, and aromatase inhibitors online to force a growth spurt.

• The Reality (The Truth): Severely disrupts the endocrine system. Can cause abnormal internal organ enlargement (acromegaly), insulin resistance, joint pain, and lifelong hormonal imbalances.

8. Steroid / SARM Stacking

• The Logic (The Myth): Jumping directly into unprescribed anabolic steroid or SARM cycles to fast-track a hyper-masculine, idealized “V-taper” physique.

• The Reality (The Truth): Causes cardiovascular strain, liver toxicity, severe cystic acne, and natural hormone shutdown, while aggressively worsening muscle dysmorphia.

9. Face Taping & Diuretic Abuse

• The Logic (The Myth): Taping the face tightly overnight and abusing over-the-counter diuretics to flush water weight and eliminate “cortisol face” puffiness.

• The Reality (The Truth): Taping causes contact dermatitis and skin damage. Diuretic abuse risks chronic dehydration, dangerous electrolyte imbalances, and acute kidney strain.

10. High-Strength DIY Peels

• The Logic (The Myth): Buying industrial-strength acids (like high-concentration TCA) online to strip skin layers at home for a hyper-reflective “glass skin” look.

• The Reality (The Truth): Lacks professional timing and neutralizing agents. Frequently results in severe chemical burns, permanent hyperpigmentation, and irreversible facial scarring.

REFERENCES

Brewer, J. A., Worhunsky, P. D., Gray, J. R., Tang, Y.-Y., Weber, J., & Kober, H. (2011). Meditation experience is associated with differences in default mode network activity and connectivity. Proceedings of the National Academy of Sciences, 108(50), 20254-20259. https://doi.org/10.1073/pnas.1112029108

Evohr, Bryn, et al. “Cue-Elicited Brain Activity and Treatment Outcomes in Substance Use Disorders: A Meta-Analysis.” JAMA Network Open 8.12 (2025): e2548809.

Garrison, K. A., Zeffiro, T. A., Scheinost, D., Constable, R. T., & Brewer, J. A. (2015). Meditation leads to reduced default mode network activity beyond an active task. Cognitive, Affective, & Behavioral Neuroscience, 15(3), 712-720. https://doi.org/10.3758/s13415-015-0358-3

https://www.nytimes.com/2026/06/19/opinion/ezra-klein-podcast-gary-shteyngart.html

Looksmaxxing sources: Bone smashing (Healthline), Leg lengthening (Euronews), Filler vascular occlusion (PMC guideline), HGH/acromegaly (Cleveland Clinic), SARMs (FDA), Mastic gum/TMJ (Medical News Today), Diuretic abuse (ACUTE)

Still, when it comes to anxiety, talking it out can sometimes keep people stuck.

As a psychiatrist and neuroscientist who’s spent years watching anxious minds (including my own), I’ve started to see that traditional psychotherapy, especially the kind that centers on talking about worry, may not fit how anxiety actually works in the brain. The problem isn’t therapy itself. Ironically, it’s that the process of talking and analyzing often runs against the way anxiety keeps itself alive.

To be clear, psychotherapy helps a lot of people. For depression, trauma, and relationship struggles, it can be really helpful. For anxiety, especially generalized anxiety disorder (GAD), the results are less consistent.

A recent JAMA Psychiatry meta-analysis found that several psychotherapies, traditional CBT, “third wave” cognitive approaches (eg. Acceptance and Commitment Therapy), and relaxation, beat treatment-as-usual (TAU). TAU is basically whatever someone is already doing. Importantly, FIVE treatments, including psychodynamic psychotherapy, supportive psychotherapy, and cognitive restructuring were no better than TAU. In other words, it didn’t make a difference if someone with GAD would have gone to that type of therapy or saved their time and money for other things.

With the three treatments that were better than not going to therapy, another study showed that average remission rates for traditional CBT only hover around 50 percent. In other words, half of people still feel anxious after months of therapy.

That’s not half bad, as the saying goes. But, half also isn’t great.

Flip a coin to see if you are in the category that benefits. Does this make you worry a little? It has certainly kept me up at night, wondering what is missing in how we approach treating anxiety. To see what, it helps to look at how anxiety actually works.

Generalized Anxiety Disorder is fundamentally different from other anxiety disorders. No specific trauma causes it. No particular situation triggers it. In fact, it often triggers itself: my patients wake up feeling anxious for no particular reason, and then worry all day only to (try to) go to sleep and repeat the process the next day.

With GAD, what you see is chronic, uncontrollable worry that becomes self-perpetuating. The clinical challenge isn’t figuring out where it came from, but instead interrupting the ongoing process that keeps it going.

GAD is maintained by a learning mechanism in your brain. Specifically, negative reinforcement (one of the most powerful learning processes we have).

Think about how worry actually works. You’re sitting at home, and your mind starts spinning about something bad that might happen. Maybe it’s your job, your health, your relationships. The worry feels productive, like you’re preparing yourself, preventing disaster, at least doing something about the problem.

Then the feared outcome doesn’t happen. And here’s where your brain learns the wrong lesson: “See? The worry helped. It either prevented the bad thing or prepared me for it.” That moment of relief when the catastrophe doesn’t strike? That’s negative reinforcement in action. Your brain just got rewarded for worrying.

By the time someone comes to see me, they’ve often reinforced this cycle thousands of times. The worry has become automatic, habitual. It’s their brain’s go-to strategy for dealing with uncertainty.

But there’s a deeper mechanism at play. I’ve written about this in previous articles (see anxiety = habit), but here’s the skinny: research by Tom Borkovec and colleagues several decades ago revealed something crucial about worry: it’s not a passive symptom. It’s an active avoidance strategy.

People with GAD aren’t just anxious. They’re using worry to avoid something that feels even worse. When researchers ask GAD patients what they’re doing when they worry, they often say they’re trying not to think about “even more emotional things.” They’re using worry (which lives mostly in their heads as verbal, linguistic thought) to distract themselves from deeper, more visceral feelings of distress.

Think of it as an avoidance hierarchy. At the bottom is the sharp, somatic, gut-level feeling of vulnerability or dread. That can feel pretty unbearable. So instead, the person retreats into worry, which is uncomfortable, sure, but feels safer and more controllable than the raw emotional experience underneath.

There’s even a more refined model that adds to the picture called the Contrast Avoidance Model. It suggests that GAD patients are uniquely afraid of sudden negative emotional shifts. They don’t want to feel okay one moment and then get hit with bad news the next; that emotional whiplash feels dangerous. So they maintain a constant low level of negative affect through worry. They’re pre-loading the distress, staying perpetually braced, because it feels safer than being caught off guard.

This is why simply understanding where your anxiety comes from doesn’t fix it. The behavior is tied to a perceived survival function. Your brain thinks worry is keeping you safe.Not only is it not keeping you safe, it is making it harder for you to think and plan, let alone live a normal life.

Let’s use the example of traditional insight-oriented psychotherapy, which runs into trouble with GAD.

The foundation of insight therapy (whether psychodynamic or other exploratory approaches) is that if you understand the unconscious patterns and historical causes of your symptoms, you’ll be able to change them. You talk about your childhood, your relationships, your recurring patterns. You gain insight into why you are the way you are.

The problem? Gaining intellectual understanding (insight) doesn’t automatically give you the capacity to tolerate intense, present-moment emotional discomfort. And for GAD, that’s exactly what’s required.

Remember, GAD is maintained by avoidance. To break an avoidance behavior, you need to learn how to tolerate the uncomfortable feeling of anxiety, and relate to it differently.

What often happens instead? The GAD patient sits in the therapist’s office and does what they always do. Based on what I’ve seen over the past decades, here’s how this tends to go: They retreat into their head. They intellectualize. They analyze. They tell elaborate stories about their worry. They stay as far as possible away from their direct, embodied experience, because going there is uncomfortable. And if the therapist is trained to explore and validate and help the patient gain insight, they go along with this process.

The problem is that this extended verbal processing can function as a sophisticated form of the same avoidance the patient uses outside of therapy. The patient feels like they’re doing something productive (and they are, in terms of self-understanding), but they’re not actually confronting the visceral experience they’re avoiding. Worse, the therapeutic relationship (the caring, supportive presence of the therapist) can actually reinforce this cognitive retreat.

Ethan Kross, a researcher who studies what he calls “chatter” (that repetitive stream of anxious negative thoughts), has shown that when someone deeply describes a difficult experience to a caring listener, it can actually fuel the negative emotions rather than resolve them. He calls this “co-rumination”: you’re both tossing fresh logs onto the fire of an already burning internal monologue.

The therapeutic alliance feels supportive, and that’s valuable. But if all you’re doing is revisiting and rehashing the worry without learning concrete skills to interrupt it, you’re essentially practicing the problem. You’re getting better at the very thing that’s keeping you stuck.

Yikes.

We now know what works for GAD. The most effective treatments (enhanced Cognitive Behavioral Therapy, Acceptance and Commitment Therapy, mindfulness-based approaches) all share a common feature: they directly target the avoidance mechanism. They teach you skills to tolerate internal distress and actively interrupt the reinforcement loop.

Enhanced CBT doesn’t just challenge the content of your worried thoughts (though it does that too). It targets the process of worry itself—the generalized verbal thinking style, the cognitive biases that maintain it.

Acceptance and Commitment Therapy (ACT) takes a different angle but hits the same target. Instead of trying to change the thoughts, ACT teaches you to change your relationship with them. You learn to observe anxious thoughts without getting fused with them, to tolerate uncomfortable feelings without needing to fix them or make them go away. Research shows that increases in psychological flexibility, which is a fancy term for the ability to experience discomfort while still taking meaningful action, predict recovery from GAD, even when the frequency of worries doesn’t change much.

Let me translate this into the reward-based learning framework I use in my lab and clinic. Anxiety is a habit loop: trigger (uncertainty, stress) → behavior (worry) → reward (temporary relief from deeper distress). Like any habit, it’s maintained because the reward is immediate and the costs come later.

To break it, you need to update the reward value of the old behavior and find something that’s more rewarding than the habit you’re trying to change.

This is where mindfulness practices come in. Techniques like RAIN (Recognize, Allow, Investigate, Nurture with self-compassion) teach you to pause between the trigger and the automatic reaction. You learn to recognize the urge to worry, get curious about what anxiety actually feels like in your body (not what you think about it, but the raw sensations), and discover that you can tolerate it without needing to do anything about it.

When you bring awareness to the actual experience of anxiety (the tightness in your chest, the buzzing in your stomach, the contraction in your throat), you update the reward value in real time. You learn that the discomfort is tolerable. The sky doesn’t fall. And curiosity itself becomes rewarding, more rewarding than the temporary relief of worry.

My lab has studied this. We’ve found that when people get curious about cravings and urges instead of fighting them or giving in to them, they can decouple the trigger from the behavior. We’ve shown this works for smoking cessation (five times better than the current gold standard), for emotional eating (40% reduction in craving-related eating), and for anxiety, where we found a 67% reduction in symptoms in people with GAD.

The key here is that people are shifting from thinking and talking (and worrying) about their anxiety to learning skills that target the specific mechanism maintaining the disorder.

So why doesn’t everyone take one of these evidence-based (and theoretically aligned) approaches?

Things get even more frustrating now. I’ve just spent several hundred words explaining why you need evidence-based CBT or ACT instead of traditional talk therapy. But there’s a massive gap between knowing what works and actually getting it.

Let’s talk about cost first. A CBT session typically runs between $100 and $250 out of pocket in most of the U.S., with prices higher in major cities. If you have insurance, you might pay a copay of $20-$50 per session using an in-network provider, but many therapists don’t accept insurance at all. (Why? Because insurance companies can restrict treatment plans, limit the number of sessions, or require a diagnosis that not everyone is comfortable receiving. The very system designed to make treatment affordable can end up limiting access to the treatment you actually need. Thank the insurance industry for this monetary-forward instead of mental health-forward model.)

You can probably do the math yourself: Even at the lower end (let’s say $100 per session), you’re looking at $1,200-$1,500 just for the first three months of therapy. With insurance and a favorable copay, you might cut that to $240-$300. And that’s for only 3 months. And don’t forget, only 50% of people show significant benefit here.

Let’s say you can afford it. Now you need to actually find a therapist. I’m sorry to sound cynical, but good luck.

Over half (56%) of psychologists surveyed in 2023 reported having no openings for new patients. Among those who keep waitlists, average wait times were three months or longer, and nearly 40% said their waitlist had grown in the past year. Three months. That’s three months of continuing to reinforce your anxiety habit loop, three months of suffering, three months where, according to research, longer waits are associated with greater drop-out and disengagement once intervention begins.

The situation is even worse in rural areas. Seventy percent of rural counties don’t have a psychiatrist. Transportation becomes a major barrier when mental health providers are scarce and you have to drive an hour or more just to get to an appointment. Some areas report even more dire statistics. In Maine, preliminary survey results from 2024 showed clients waiting an average of 32 weeks (more than half a year) for mental health counseling services. Yes you read that correctly. More than HALF a YEAR.

Okay, so you’ve somehow found a therapist who says they do CBT, you can afford it, and they have an opening. Now you’re playing another lottery: will they actually deliver high-quality, evidence-based treatment?

This is where the gap between clinical trials and real-world practice becomes critical. Clinical trials of CBT use therapists who are extensively trained, closely supervised, and whose adherence to the treatment protocol is regularly monitored. In contrast, real-world therapists may experience “therapist drift:” the tendency to only partially adhere to established empirically supported practices.

This is important because therapist adherence to concrete CBT techniques predicts patient improvement and symptom change. If your therapist isn’t actually implementing the core components of CBT, you’re not getting the treatment that showed those impressive results in the research studies.

You often can’t tell the difference. A therapist can call what they’re doing “CBT” while spending most of the session in supportive conversation that looks a lot more like traditional talk therapy. Unless you know what to look for, you won’t know you’re not getting the real thing until months have passed without improvement.

I’m not telling you this to be discouraging. I’m telling you because it’s real, often not talked about, and pretending these barriers don’t exist doesn’t help anyone.

So what does all of this mean if you have GAD?

First: your brain isn’t broken. It learned a strategy (worry) that seemed protective at the time. That strategy is now causing more problems than it solves, but your brain keeps using it because of how reinforcement learning works.

Second: insight alone won’t fix this. Understanding why you’re anxious is interesting, and it might help in some ways. But it won’t give you the skills to tolerate distress or interrupt the habit loop. In fact, if therapy keeps you “in your head,” it might be inadvertently reinforcing the avoidance.

Third: you need skills training, not just support. The most effective GAD treatment teaches you to recognize when you’re using worry as avoidance, to get out of your head and into your body (where primary emotions actually live), to tolerate uncomfortable feelings without needing to fix them, to observe thoughts without getting fused with them, and to take meaningful action even when you feel anxious.

This has nothing to do with positive thinking or trying to convince yourself everything will be okay. You’re changing the underlying learning process. You’re teaching your brain that safety doesn’t come from worry; it comes from your capacity to handle whatever shows up.

[A note to therapists:] If you’re a therapist reading this, I’m not saying insight is worthless or that the therapeutic relationship doesn’t matter. Both can be valuable.

But if you’re treating GAD, watch for verbal processing that functions as a safety behavior. If your patient spends the entire session in intellectual analysis, gently redirect them to the somatic, emotional experience underneath. Remember that co-rumination, even in a supportive therapeutic context, can reinforce the problem. I don’t need to tell you that what we all signed up for isn’t just to help the patient feel heard, it’s to help them develop the skills to interrupt the cycle. And most importantly: exposure to emotional discomfort is necessary. One of the big and often uncomfortable tasks of therapists (especially those who haven’t nailed distress tolerance themselves) is to learn to stay with uncomfortable feelings in session, not just talk about them. Distress tolerance is where the real growth happens (for both patients and therapists).

I know this is harder to do when you’re seeing 30+ patients a week, when insurance is breathing down your neck about session limits, when you didn’t get training in these specific protocols. The system makes it hard to do excellent work. But understanding the mechanism—that GAD is maintained by negative reinforcement of avoidance—can help you recognize when you’re inadvertently enabling that avoidance, even with the best intentions.

If you’re struggling with chronic worry and traditional therapy hasn’t helped, it’s not your fault. The approach may simply be mismatched to the problem. And if you’re struggling to access any therapy at all, that’s not your fault either—it’s a systemic failure.

If you can access face-to-face therapy, look for therapists trained in evidence-based treatments for GAD (enhanced CBT, ACT, or mindfulness-based approaches). Ask explicitly whether the treatment will include skills training (not just insight or exploration), exposure to uncomfortable emotions (not just talking about them), homework and between-session practice, and concrete techniques to interrupt worry cycles. Ask about their training and supervision in these specific approaches. Don’t be shy about this; it’s your time and money.

If you can’t access or afford traditional therapy, consider digital therapeutics and app-based interventions that teach the same principles. Look for programs based on evidence-based approaches that specifically target anxiety as a habit loop. These aren’t perfect substitutes for skilled human guidance, but they can teach you the core skills you need. Consider group therapy if available (it’s usually more affordable and for GAD can be as effective as individual therapy). The connection with others struggling with similar issues can itself be therapeutic.

Regardless of your path, remember: anxiety is a habit. Like any habit, it can be unlearned. But you need the right tools for the job—tools that target the mechanism, not just the symptoms.

The goal isn’t to never feel anxious. Stop being afraid of your anxiety, stop feeding it with avoidance, and start living your life even when uncertainty is present.

The future is always uncertain. No amount of worry will change that. But you can change how you respond to uncertainty. And that changes everything.

Judson Brewer MD PhD is a psychiatrist and neuroscientist and professor at Brown University. He is the author of Unwinding Anxiety (NYTimes bestseller), The Craving Mind, The Hunger Habit and The Unwinding Anxiety Workbook. He co-founded MindshiftRecovery.org which provides free support for people with any type of addiction.

If you are struggling with anxiety, Dr. Brewer’s Going Beyond Anxiety program brings together his research and clinical experience to help people build effective skills to reduce anxiety and cultivate calm (www.goingbeyondanxiety.com).

Subscribe now

Share

Copyright © 2025, Judson Brewer, MD, PhD. All rights reserved.

REFERENCES

Borkovec, T. D., Alcaine, O. M., & Behar, E. (2004). Avoidance theory of worry and generalized anxiety disorder. In R. G. Heimberg, C. L. Turk, & D. S. Mennin (Eds.), Generalized anxiety disorder: Advances in research and practice (pp. 77–108). Guilford Press.

Brewer, J. A., Roy, A. H., (2021) “Can approaching anxiety like a habit lead to novel treatments?” American Journal of Lifestyle Medicine 15(5).

Gao, M., Roy, A., Deluty, A., Sharkey, K. M., Hoge, E. A., Liu, T., Brewer, J. A., (2022), “Targeting anxiety to improve sleep disturbance: a randomized clinical trial of app-based mindfulness training.” Psychosomatic Medicine 10-1097.

Kross, E. (2021). Chatter: The voice in our head, why it matters, and how to harness it. Crown.

Newman, M. G., & Llera, S. J. (2011). A novel theory of experiential avoidance in generalized anxiety disorder: A review and synthesis of research supporting the contrast avoidance model. Behavior Therapy, 42(3), 375–390. https://doi.org/10.1016/j.beth.2010.10.006

Papola, D., Gastaldon, C., Ostuzzi, G., Tedeschi, F., Purgato, M., & Barbui, C. (2024). Comparative efficacy and acceptability of psychotherapies for generalized anxiety disorder: A systematic review and network meta-analysis. JAMA Psychiatry. Advance online publication. https://doi.org/10.1001/jamapsychiatry.2024.

Roy, A. H., Hoge, E. A., Abrante, P., Druker, S., Liu, T., Brewer, J. A., (2021) “Clinical efficacy and psychological mechanisms of an app-based digital therapeutic for generalized anxiety disorder.” JMIR 23(12):e26987.

Springer, K. S., Levy, H. C., & Tolin, D. F. (2018). Remission in CBT for adult anxiety disorders: A meta-analysis. Clinical Psychology Review, 61, 1–8.

Stone, L. B., & Hankin, B. L. (2011). Correlates of co-rumination among children and adolescents: The role of emotional clarity, cognitive style, and friendship quality. Journal of Abnormal Child Psychology, 39(6), 921–933. https://doi.org/10.1007/s10802-011-9514-9

Association of American Medical Colleges. (2023). Exploring barriers to mental health care in the U.S. https://www.aamc.org/about-us/mission-areas/health-care/exploring-barriers-mental-health-care-us

Directions Counseling. (2023). How much does CBT cost? https://www.directionscounseling.com/how-much-does-cbt-cost/

Penn Center for Cognitive Therapy. (2024). Fees and insurance information. https://www.med.upenn.edu/cct/fees.html

Verywell Mind. (2024). How much does therapy cost? https://www.verywellmind.com/cost-of-therapy-survey-5271327

Make a quick list of the things you loved doing as a kid: drawing, building, roaming the neighborhood with your friends, asking “why” forty times a day (this one might be hardwired but you get the idea). Now ask how many of them you’d still do if nobody paid you, praised you, or gave you a grade for them.

Fast forward to adulthood. For me, when I check my calendar on Sunday night to plan for the upcoming week, there are the things I get to do and the things I have to do. The patients I’m curious to see, and the form that has to be filed. The paper I want to write, and the one that would be “good for my career.”

How are these childhood and adult “funs” (and chores) linked?

Back in the early 1970s, Edward Deci and later his longtime collaborator Richard Ryan built a whole framework, Self-Determination Theory, around the difference between intrinsic and extrinsic motivation. Here’s how they are defined. Intrinsic motivation is when the activity is its own reward: you do the thing because doing the thing feels good. Extrinsic motivation is when the reward sits somewhere outside the activity: you do the thing to get a paycheck, a grade, a gold star, a flat stomach. Carrots and sticks live in the extrinsic pile. Playing in the woods as a kid lives in the intrinsic one.

So far so good. Now let me complicate it, using my own dinner as an example.

For most of my life, eating healthy sat squarely in the have-to pile. I grew up in Indiana with a mom who made sure I ate my vegetables, so you’d think it would come naturally, but for years my reasons for eating well had very little to do with the food itself. Picture three versions of me at the dinner table.

There’s the version that eats the salad because he wants to look a certain way: lean, fit, the guy who has it together. The reward there is entirely outside the food. It lives in other people’s eyes, in the mirror, in comparison. Notice how that one feels. There’s a low hum of pressure to it, a sense of it could always be better because someone is judging you.

Then there’s the version that eats the salad to keep his energy up. This is the one I stumbled into when I started paying attention: what I ate at lunch ran a straight line to whether I crashed at three in the afternoon or made it through my last few patients on my clinic schedule intact. The reward is still outside the eating. It’s the energy, the not-crashing. But it’s my reward, tied to what I care about rather than borrowed from someone else’s approval.

A close cousin of this functional version of eat healthy = optimal energy is the eat well = self-care. When I think of the best ways to take care of myself, I show kindness to myself and my body by eating healthy food. Eating junk food falls more on the self-indulgence side of the spectrum than self-kindness. Fast food says convenience is more important than health.

At its extreme of these 2.5 versions is a relatively new term that was recently introduced to the mental health lexicon: orthorexia. Orthorexia is an unhealthy obsession with eating only foods that a person considers pure, clean, and perfectly healthy, to the point where it severely disrupts their daily life and emotional well-being. This could be driven both by the external rewards (e.g. social media likes when we post a picture of our meal), and the internal ones (e.g. higher energy levels).

And now, a third version: enjoying cooking and eating this food. The smell of garlic hitting the oil, the taste of a good meal made well. Here the reward isn’t downstream of anything. The food is the reward. That one took years to sneak up on me, and it’s the one that added to the eat healthy = sustained energy + better emotional balance made eating well feel like a no-brainer, because just doing the thing felt good.

So which of those is intrinsic and which are extrinsic? If we want to get technical, the textbook answer is that only the third is truly intrinsic (the food is its own reward) and the other two are extrinsic. But what happens to “wanting to keep my energy up” when we zoom in a little more. We tend to think of wanting to be healthy as one of the good, inside reasons. By the strict definition, it’s extrinsic: you’re eating one thing to get a separate outcome. Yet it feels pretty different than the wanting to impress others version feels (scenario #1), doesn’t it?

That’s because the intrinsic-versus-extrinsic line, useful as it is, hides a second distinction that may be what is important. Deci and Ryan saw this too, and stretched the binary into a spectrum that runs from motivation that’s fully controlled (I do it because I’d be ashamed not to, or because someone’s watching) all the way to motivation that’s fully autonomous (I do it because it matters to me, up to and including doing it for its own sake). Keeping up appearances and keeping my energy up are both technically extrinsic. But one is controlled and one is autonomous, and that difference tells you whether the behavior will last, and how you’ll feel while doing it, far better than the intrinsic-or-extrinsic label ever could.

Sorry, I know our brains don’t like nuance, but there it is. And it is kind of important.

Which means that sorting your life into two piles is likely missing something that helps us tap into motivation in a sustainable way. The more useful question then, is where the reward comes from, and whether it runs out.

If you’ve read my other work, you know I think most of what we do runs on one ancient piece of machinery: reward-based learning. Trigger, behavior, reward, repeat. Your brain — in particular a region behind your eyes called the orbitofrontal cortex — is constantly comparing the reward value of your options and steering you toward whatever paid off best last time. Same system whether you’re a sea slug learning where the food is or a person reaching for their phone out of boredom. Run motivation through that equation and the whole intrinsic-or-extrinsic question turns into something that may actually be useful: where does this reward come from, and does it wear off?

Extrinsic rewards come from outside, and outside rewards eventually wear off. Termed habituation, our brain adjusts to whatever it’s getting and then needs a little more to get the same hit. There’s an old image for this in some Buddhist texts, the hungry ghost: a creature with an enormous belly and a throat as narrow as a needle, eating forever and never full. Constantly hungry for more. You needed one compliment, now you need another, and another. The raise felt great for a month. You swapped in cute puppy videos for your old habit and pretty soon you needed more of them, and cuter ones (+ kittens!).

Intrinsic rewards work differently: they come from inside, and they don’t keep our bellies rumbling and growling for more. Being honest, living a life of integrity (see my previous articles on this), being kind. All of these are intrinsically rewarding and have a different quality to them. They don’t share that urgy “more” hunger that feels driven and contracted. Instead, they feel more open and expansive.

Curiosity is the cleanest example of an intrinsically rewarding motivation I know. You can’t get to the bottom of being curious. There’s always more to be interested in, and being interested feels good on its own, no delivery truck of more required. It’s the kind of reward your brain will keep choosing, because it doesn’t leave you hungrier than it found you.

One of my favorite quotes about curiosity: “Curiosity is the cure for boredom. There is no cure for curiosity.” Boom.

Which is what makes a relatively famous study in this corner of psychology very interesting (and somewhat unsettling). In 1971, Deci sat college students down with a puzzle called the Soma cube, an absorbing little three-dimensional brain-teaser that people tended to enjoy for its own sake. He paid one group a dollar for every shape they solved and left another group unpaid. Then came the critical part of the study: a “free choice” period, where the experimenter stepped out, the puzzles sat there next to some magazines, and nobody was paying or watching. The students who had been paid spent less of that free time on the puzzles than the ones who never were. The money had quietly moved the motivation for doing it from the inside to the outside, and once the money stopped, so did most of the interest.

There’s your answer to the question in the title, at least some of the time. You stopped doing the thing you loved because at some point an external reward got bolted onto it, your brain updated the reason from “because I love this” to “because I get paid for this,” and then the pay became the point.

As with most science that isn’t a slam dunk, the finding has been fought over (more nuance!): in the 1990s, Eisenberger and Cameron argued the effect had been overstated, yet a large 1999 meta-analysis from Deci and colleagues mostly held the line while spelling out the fine print. Where it nets out is this: the effect is real, but conditional. Unexpected rewards don’t seem to undermine motivation. Plain encouragement, a “nice work,” tends to boost it. It’s the expected, tangible, do-this-and-you-get-that kind of reward, dropped on top of something you already loved, that does the damage. So this isn’t a case against ever being paid. Instead, it’s a warning about one specific way the wiring gets crossed (and how we might accidentally be training ourselves and others away from doing things that we love).

I crossed that wiring myself once, on purpose, at a fork in my career, though I didn’t have the words for it then. When I was finishing my psychiatry residency and deciding what my first lab at Yale would study–mind you, a very important decision that I didn’t want to screw up because it would possibly set the stage for the trajectory of my career–I had a respectable path teed up: my PhD was in molecular biology, mouse models of stress, and the sensible (conservative) move was to keep building on it.

But I’d also started meditating to deal with my own stress and anxiety, found it really helpful, and gotten curious about whether the same thing could be studied scientifically. There was no career path there. When I floated the idea to a colleague, that I’d pivot to studying mindfulness and have to learn translational neuroscience, clinical trials to fMRI, more or less from scratch, he told me flatly that I’d “kill my career,” alluding to the perception that I was about to go off the deep end to study the mystical world of rainbows and unicorns.

I remember telling myself that I’d rather kill my career doing something that I was really interested in, than follow the established path and build on the research that I had already done.

That sentence is the whole point, but it would be easy to tell this as “follow your passion and you’ll be vindicated.” The field did blow up over the next decade, but that was as much luck and timing as passion and hard work (both are important). Plenty of people follow their curiosity straight off a cliff and the field never shows up to catch them. The point here isn’t the payoff. In fact, the payoff is beside the point, a side effect or side “benefit” that followed my path of following my passion. That’s what intrinsic motivation looks like: you’d make the call even if it never paid off, because the doing is the reward in itself.

Yes cliche for a reason: journey beats destination.

Curiosity is also what keeps my clinical work from going stale. I try to walk into each new patient, and each new session with someone I’ve seen a hundred times, with what Korean Zen calls “don’t-know mind”: a deliberate letting go of any assumptions that I already know what’s going on or how this will end. It keeps me curious and present, and it keeps me from treating a person as a problem to be solved, a box to be checked, or an encounter to be billed.

Do I think about money? Of course I think about money! Who doesn’t? But when those thoughts pop into my head, I can bring my own awareness to those moments and compare what I get from going down the money thought train vs. staying present with my patient. The money thought train takes me away from actually performing well at my job because I lose the connection, miss key insights, and generally give off a vibe of not being in the room (even if it’s over Zoom). Being present feels SO MUCH better: I’m not lost in the itchy never-enough money brain thinking which drives restlessness, and more importantly, it’s easier to truly sit and be curious when I’m present. Being constantly curious also keeps me from getting burned out, because I’m approaching each day fresh, instead of looking at my calendar and wondering how I am going to make it to the weekend.

To be clear, the trouble isn’t extrinsic motivation humming along in the background, quietly keeping the lights on. The trouble is when it takes center stage and hijacks a moment that was supposed to be about something else.

I’ll stop short of one tempting overclaim, though. Staying curious does seem to keep me from burning out. That’s legit. But curiosity is not armor against a broken system. You can be the most intrinsically motivated clinician alive and still get ground down by an impossible caseload. Intrinsic motivation lets good work nourish you. It can’t fix bad conditions on its own.

So what’s the point of pointing out any of these differences between different types of motivation? Try taking an inventory. It’s the same habit-mapping I teach for anxiety loops, just pointed at a new target. For a day or two, walk through your hours and notice, for each thing you do, where the reward is coming from. Not to grade yourself; there are no points for being more intrinsic. Just to see the shape of your days and how they are being driven.

The trick is to skip the labels and go to the felt sense, because “intrinsic or extrinsic” turns out to be too imprecise, a noisy way to sort things. Paying for groceries is extrinsic, necessary and feels fine. Creative work can feel terrible while you’re in the thick of it (especially if it is driven by a deadline or other extrinsic motivations). So don’t ask which pile it goes in. Ask the hungry-ghost question: does this feed me, or does it just feed the loop? Does the motivation feel driven, contracted, restless, never-enough, that narrow throat that never fills? Or does it feel nourishing, the kind of reward that leaves you steadier instead of itchier? My lab has spent years confirming what you can check in your own body in about thirty seconds: contracted states like frustration, impatience, craving and anxiety reliably feel worse, more closed-down, than open states like curiosity, kindness and connection.

And watch it run both ways, because you can tip too far in either direction. We love to talk about the people who are too extrinsically driven, chasing money or status until the thing they once loved curdles into a job (there are way too many movies about this). But you can lean too hard the other way too. The person who only does what interests them, and lets the dull-but-necessary things rot (taxes, etc.). I’ve seen too many patients find out the hard way that “I only do what fascinates me” is more akin to addiction than a formula for sustainable happiness. A life that runs purely on what feels good this minute isn’t free. It just sounds appealing at the moment.

You don’t have to burn the extrinsic out of your life and live on pure curiosity like some sort of motivational monk. Plenty of what you do for outside reasons is fine, even good; the rent gets paid, the dishes get done. All I’m suggesting is that you look, closely and from the inside, at where each reward is coming from, and whether it sustains you or just leaves you reaching for the next one. Most of us never have. So look. Hmmm — what’s really driving this one?

Judson Brewer MD PhD is a psychiatrist and neuroscientist and professor at Brown University. He is the author of Unwinding Anxiety (NYTimes bestseller), The Craving Mind, The Hunger Habit and The Unwinding Anxiety Workbook. He co-founded MindshiftRecovery.org which provides free support for people with any type of addiction.

If you are struggling with anxiety, Dr. Brewer’s Going Beyond Anxiety program brings together his research and clinical experience to help people build effective skills to reduce anxiety and cultivate calm (www.goingbeyondanxiety.com).

Subscribe now

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Copyright © 2025, Judson Brewer, MD, PhD. All rights reserved.

References

Deci, E. L. (1971). Effects of externally mediated rewards on intrinsic motivation. Journal of Personality and Social Psychology, 18(1), 105–115. [from memory — verify volume/pages]

Deci, E. L., Koestner, R., & Ryan, R. M. (1999). A meta-analytic review of experiments examining the effects of extrinsic rewards on intrinsic motivation. Psychological Bulletin, 125(6), 627–668. [verified]

Eisenberger, R., & Cameron, J. (1996). Detrimental effects of reward: Reality or myth? American Psychologist, 51(11), 1153–1166. [from memory — verify]

Ryan, R. M., & Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist, 55(1), 68–78. [from memory — verify; the standard one-stop cite for the framework]

Lepper, M. R., Greene, D., & Nisbett, R. E. (1973). Undermining children’s intrinsic interest with extrinsic reward. Journal of Personality and Social Psychology, 28(1), 129–137. [not used in this draft; on hand if you want the preschool/markers example — from memory, verify]

What is going on in our brains, when stress is getting in the way of learning? And perhaps more interesting: does stress affect our ability to fluidly associate things, connect dots and even be creative?

We all probably know the answer from our own experience. Yes. But how?

A new neuroimaging study might have some answers. First some background.

You see a friend’s new scooter, a particular shade of light blue, parked outside the university library, and without any effort at all you land on the thought that she is probably inside studying. Nobody handed you that fact. You stitched it together from two separate experiences (your friend with the scooter, and the scooter at the library) that happened to share an overlapping piece, and your brain wove them into a conclusion about a place you cannot even see. We do this constantly, so fluidly that it feels like nothing at all, and it is the difference between a mind that merely records and a mind that builds a working model of the world. The region doing most of that weaving is the hippocampus, and the process has a name: memory integration.

Neat trick!

This matters well beyond friends and scooters. Building cohesive structures out of related experiences is how a student turns scattered facts into understanding, how a witness assembles a coherent account from glimpses, and how any of us lean on the past to make sense of the present. When the weaving breaks down it tends to show up in places we care about a great deal, including psychosis and the anxiety disorders, where trouble linking related experiences is part of the clinical picture.

That leaves an obvious question, given how much of modern life is spent at least mildly stressed. We already know from decades of research that acute stress is a powerful editor of memory, reliably strengthening the laying-down of new memories while making it harder to retrieve old ones. And we know the hippocampus is studded with receptors for the very stress hormones that flood the system when we are under pressure (glucocorticoids such as cortisol). What we have understood far less well is what stress does to this more flexible, integrative work, the weaving itself. Does being stressed change our ability to braid separate experiences together and infer the things nobody ever told us directly?

That is the question a group led by Kai Schüren and Lars Schwabe in Hamburg set out to answer, and they just published their results in Science Advances. The design is clean enough to describe over coffee or tea. On day one, people learned a set of pairs (call them A and B, a face and an animal). The next day, half of them went through the Trier Social Stress Test, which is the gold-standard way researchers manufacture acute stress in a lab and is exactly as unpleasant as it sounds: an impromptu job-interview speech and some backward arithmetic, performed in front of a stone-faced panel in white coats while a camera films you. And don’t forget the bright lights shining in your face! Right afterward, everyone learned a second set of pairs that overlapped with the first (B and C, the same animal now linked to an object). Then, an hour later, came the twist nobody had warned them about: could they infer a link they had never been taught, the one between A and C?

So what happened?

Both groups learned the A-B pairs equally well, both learned the B-C pairs equally well, and both could recall those pairs on the final test with no group difference at all, so the raw material was plainly intact. What stress degraded was the inference, the capacity to put the pieces together into something larger than either piece alone (A linked to C). When the researchers used fMRI to look at participants related brain activity, they saw why: during that second learning session, the stressed brains were reactivating the old, related memory far less than the unstressed brains were, and the less a given person’s hippocampus lit up with that old memory, the worse they did at the inference later. Nothing had been erased; what stress had done was stop the brain from holding the new experience and the old one in mind together long enough to associate them. In other words, stress impaired the spontaneous retrieval of prior, related memories during new encoding. During stress, those old memory pairs couldn’t be brought up to help connect the dots between A and C.

Now for the boring parts that remind us that science isn’t a slam dunk (as much as the popular press wants a clean story to report). These were a hundred and twenty-one healthy young adults, screened to exclude anyone with an anxiety or mood disorder, exposed to a single sharp jolt of laboratory stress, with these associations being studied in a brain scanner, which is a long way from a person who has been marinating in worry for years, and then asked to defend their decision during a presentation in front of a large group of coworkers. Where does that leave us (and why would I bother to write about this study)? What we have is a real, mechanistic, carefully done study (a really careful and thoughtful design), but one that doesn’t directly connect the dots to the real world, especially that of mental health like anxiety, where people are constantly jacking their cortisol levels by worrying.

With those caveats in hand, the work still hands anyone who treats anxiety a real problem, and I want to flag it as a problem rather than dress it up as an answer. Anxiety is usually described in terms of overgeneralization. The classic finding is that anxious brains spread fear too widely, treating a safe thing as dangerous because it faintly resembles something that once wasn’t. That looks like the mirror image of what this study found, where stress made the brain keep things too separate. How do those two live in the same head? My best guess (and it is a guess, the kind I would want to test before I would want to assert it) is that they are running on different systems pulling in opposite directions at once: the fear circuitry smears threat across everything that rhymes with danger, while the hippocampal machinery that would let you integrate the reassuring counter-evidence (”I have felt precisely this and been fine”) goes quiet at the very same moment. The frightening associations generalize while the comforting ones fail to connect. If that is even partly right, it is a fairly cruel evolutionary hiccup, and it lines up uncomfortably well with what I watch happen in my clinic.

All of which circles back to the people I work with in my clinic. The thing we most want an anxious person to be able to do in the moment, to reach back across a hundred prior waves of anxiety and worry to feel, not just recite, that this one will pass too (or whatever they’ve been told to do to relax), is itself an act of memory integration, and it likely leans on the hippocampal weaving that stress appears to dampen right when the stress is running highest. Telling someone to remember they have done this before is asking the overwhelmed part of the brain to do the one thing that it has been blocked from doing. The span between what they already know and the moment they are standing in is a bridge too far.

In my own lab’s work, the practices that seem to actually help in those moments tend not to route through that kind of retrieval at all: dropping into the raw sensation in the body, getting curious about what the anxiety honestly feels like rather than what it threatens for the next twenty-four hours, all of it works in the present tense and does not need to build some cognitive bridge. I have wondered for years why “just remember last time” lands so flatly with people who remember last time just fine. This study leaves me suspecting that part of the answer is that, in the moment we most need it, the wiring that turns memory into useful inference is the wiring that builds that bridges is momentarily washed out with stress.

This is why I have my clinic patients and the members in my Going Beyond Anxiety program start with a grounding practice so that they can get their inference brain bits back online, BEFORE trying to take that next step. (See my previous articles on Five Finger Breathing, and The Simple Eye Trick for more). And this new study suggests why that might be so important: stress and anxiety keep us locked into very concrete thinking (and learning) patterns so that we (figuratively and literally) can’t open our minds to make connections or solve problems, let alone tap into our more creative sides.

The work that helps with stress and anxiety is less about handing people new information and more about keeping the lights on in the part of the brain that already holds everything they need to know.

Judson Brewer MD PhD is a psychiatrist and neuroscientist and professor at Brown University. He is the author of Unwinding Anxiety (NYTimes bestseller), The Craving Mind, The Hunger Habit and The Unwinding Anxiety Workbook. He co-founded MindshiftRecovery.org which provides free support for people with any type of addiction.

If you are struggling with anxiety, Dr. Brewer’s Going Beyond Anxiety program brings together his research and clinical experience to help people build effective skills to reduce anxiety and cultivate calm (www.goingbeyondanxiety.com).

Subscribe now

Share

Copyright © 2025, Judson Brewer, MD, PhD. All rights reserved.

REFERENCES

Armstrong, K., Avery, S., Blackford, J. U., Woodward, N., & Heckers, S. (2018). Impaired associative inference in the early stage of psychosis. Schizophrenia Research, 202, 86–90.

Brewer, J. A. (2019). Mindfulness training for addictions: Has neuroscience revealed a brain hack by which awareness subverts the addictive process? Current Opinion in Psychology, 28, 198–203. https://doi.org/10.1016/j.copsyc.2019.01.014

Cahill, L., Gorski, L., & Le, K. (2003). Enhanced human memory consolidation with post-learning stress: Interaction with the degree of arousal at encoding. Learning & Memory, 10, 270–274.

de Quervain, D. J.-F., Roozendaal, B., & McGaugh, J. L. (1998). Stress and glucocorticoids impair retrieval of long-term spatial memory. Nature, 394, 787–790.

de Quervain, D. J.-F., Roozendaal, B., Nitsch, R. M., McGaugh, J. L., & Hock, C. (2000). Acute cortisone administration impairs retrieval of long-term declarative memory in humans. Nature Neuroscience, 3, 313–314.

Kirschbaum, C., Pirke, K.-M., & Hellhammer, D. H. (1993). The “Trier Social Stress Test”: A tool for investigating psychobiological stress responses in a laboratory setting. Neuropsychobiology, 28, 76–81.

Laufer, O., Israeli, D., & Paz, R. (2016). Behavioral and neural mechanisms of overgeneralization in anxiety. Current Biology, 26, 713–722.

Lissek, S., Kaczkurkin, A. N., Rabin, S., Geraci, M., Pine, D. S., & Grillon, C. (2014). Generalized anxiety disorder is associated with overgeneralization of classically conditioned fear. Biological Psychiatry, 75, 909–915.

Madan, C. R., Scott, S. M. E., & Kensinger, E. A. (2019). Positive emotion enhances association-memory. Emotion, 19, 733–740.

Roozendaal, B., Okuda, S., de Quervain, D. J.-F., & McGaugh, J. L. (2006). Glucocorticoids interact with emotion-induced noradrenergic activation in influencing different memory functions. Neuroscience, 138, 901–910.

Schüren, K. A., Varga, N. L., Heinbockel, H., Preston, A. R., Roozendaal, B., & Schwabe, L. (2026). Stress disrupts hippocampal integration of overlapping events and memory inference in humans. Science Advances, 12(21), eaea5496. https://doi.org/10.1126/sciadv.aea5496

Schwabe, L., Hermans, E. J., Joëls, M., & Roozendaal, B. (2022). Mechanisms of memory under stress. Neuron, 110, 1450–1467.

In Part 1 (last week), I left you with a paradox that one of my patients, Maya, named more clearly than I usually manage to: actively trying to let go of an experience is itself a form of resistance to it. The more you try to accept, the more you’re confirming there’s something here that needs to be gotten rid of. Acceptance isn’t and can’t be a form of effort. But then what is it and how can we make it happen?

But first, the pushback that I get from my patients, in case your brain is going or getting stuck there.

If acceptance means not resisting our experience, does that mean accepting an abusive partner? Accepting a cancer diagnosis as if it is not a big deal? Accepting injustice or harm? Of course not. Acceptance is about the internal experience of what is already happening, not the external situation that needs to change.

You can accept the fear in your chest about a diagnosis and also get aggressive treatment. You can accept the grief of losing someone and also keep functioning. You can accept the rage you feel about an injustice and also organize against the injustice (see my previous article on anger for more). The two are not in conflict, and in fact, tend to support each other, because trying to act from a place of unacknowledged feeling is exhausting in a way that acting from a place of acknowledged feeling isn’t. What often gets confused is the assumption that accepting how you feel about a situation means endorsing the situation. It doesn’t. Accepting that you are afraid is not the same as accepting whatever caused the fear. Accepting that something hurts is not the same as agreeing to be hurt.

Maya was not being asked to accept that she might have cancer (which she didn’t have). She had already done the right external things: seen her doctor, scheduled the tests, etc. What she was working with was something narrower and, in a way, more humbling: the experience of being afraid right now, in her body, on a Tuesday afternoon when she could not yet know the test results. That is what acceptance was being asked of, and it was the thing she could not get to with effort or aspirations.

So what is it, then?

Here is where I start with my patients: acceptance starts with an acknowledgment of what is happening. The thought, feeling or situation is here. Without that acknowledgment, every move we make is most likely to be a reaction against a reality we have not yet admitted is real, which is exhausting in the same way that arguing with a closed door is exhausting (the door is not going to argue back, and you are wasting your energy).

Notice that this first step has nothing to do with approval. Acknowledging that fear is in my chest is not the same as approving of the fear, or wanting it to stay, or being a good sport about it. It’s just looking at what is already true. The fear was there before I noticed it. It will be there whether I notice it or not. Noticing it doesn’t add anything. Refusing to notice it doesn’t take it away. Acknowledging what is, is. It’s a sober reckoning with reality.

Forcing acceptance is a contradiction, because the forcing is itself a refusal of what is. Maya’s affirmation was a beautifully constructed refusal: by repeating “I allow and accept these anxious feelings” with effort and intention, she was, underneath the words, telling herself that the anxious feelings were a problem she needed a tool to handle. Yet, her body knew what her head didn’t (her affirmation was a form of resistance). That’s why she described it as a head experience. Her shoulders weren’t dropping because the words she was saying didn’t match what she was actually doing.

Just like telling ourselves to relax tenses us up more. The act of relaxing tells our head everything that it needs to know (“Hey up their, you three-pound organ devoid of sensory neurons, all is good.”)

So how does the door open?

The thing I have found, over years of working with patients and watching them try to push that door open, is that acceptance doesn’t happen through trying. It happens through curiosity. Not the deprivation kind of curiosity (the closed, restless, need-to-know kind) but the interest kind, the open-ended one, the huh, what is this? feeling. And that’s exactly what I explored with Maya on that (non-cancerous) Tuesday afternoon. When Maya turned toward her anxiety with curiosity instead of with effort to push it away or accept it, something shifted that her affirmation could not manufacture.

I asked her to get curious, turn toward and feel into her feeling of anxiety. She paused for a moment, and then she said: “I felt my shoulders drop. I became more aware of my breath, deeper breathing. The constant whirlwind in here stops for a moment.”

That moment, the shoulders dropping, the breath deepening, was the body doing what the affirmation could not. It was not produced by trying harder. It was produced by paying attention to what the trying had been covering up or avoiding. Curiosity, in this context, isn’t a technique. It’s the absence of the thing that was blocking her: the absence of the wish that this experience were different.

This is the critical piece of acceptance. Once we acknowledge what is happening, we can then turn toward our experience with curiosity. Acceptance isn’t a thing you do. It’s what’s there when you stop doing the other thing. Stop pushing, stop forcing, stop running, and what remains is acceptance. Critically, this is not because you constructed it but because there was never anything else there. The mind was already looking at its experience. Curiosity helped it shift from looking through a layer of struggle to simply looking. That’s acceptance: being with what it without resisting or avoiding.

You can test this in your body the way I suggested to in Part 1. Bring something difficult to mind. Notice the contraction. Now, instead of trying to make the contraction go away or trying to accept the contraction, get curious about the contraction itself. What does this actually feel like? Where exactly is it? What’s its shape? Does it have an edge? Notice what happens when you do this. For most people, the contraction softens. Not because they fixed it. Because curiosity is not compatible with bracing. The body cannot, at the same time, close around something and open to and look at it with interest.

This is also what my lab has found in the imaging studies. The brain regions associated with the contracted, restless, self-referential states (the posterior cingulate cortex and other parts of the default mode network) quiet down when people drop into curious, present-moment awareness. The two states are, mechanistically opposed. You can’t be in both at once. Which is part of why curiosity works as a way out of resistance loops: it isn’t fighting the loop. It’s just incompatible with it.

And when we release that resistance, acceptance is there.

There’s a passage from a poem by Stephen Mitchell, that speaks to this beautifully. He’s writing about the myth of Sisyphus, the king condemned by the gods to push a boulder up a hill, only to have it roll down again, forever:

We tend to think of Sisyphus as a tragic hero, condemned by the gods to shoulder his rock sweatily up the mountain, and again up the mountain, forever. The truth is that Sisyphus is in love with the rock. He cherishes every roughness and every ounce of it. He talks to it, sings to it. It has become the mysterious Other... Life is unimaginable without it, looming always above him like a huge gray moon. He doesn’t realize that at any moment, he is permitted to step aside, let the rock hurtle to the bottom, and go home.

Mitchell is not saying we love our anxiety (or whatever we’re resisting) in any conscious way. He’s suggesting that we have built our lives so completely around the rock that we no longer notice we are pushing it. The pushing has become the shape of the day. We do not see the rock as a separate thing we are choosing to push. We see it as part of who we are.

That, I think, is the deepest version of resistance. Not the obvious bracing, not the forced affirmation, not the reach for distraction, but the slow accumulation of habit that makes the rock feel like part of us. By the time someone like Maya arrives in my office, she has been pushing some version of this rock for years. The act of pushing is so familiar that the question “what would it feel like not to push?” can sound almost meaningless. Push against what? There is no rock, there is just life.

Curiosity is what allows us to realize that we have fallen in love with our “burdens” and even resistance itself (ie. it has become a habit). Once we notice, we wake up to our infatuation, which helps us sober up and see much more clearly what we are holding (and how much of a burden it is).

At the end of Maya’s session, we had been talking about how she could practice all of this, and she was worried (surprise!) that she wouldn’t be able to capture the feeling of openness when she needed it. She wasn’t sure how to remember what it felt like.

I told her that it was simpler than she thought. The contraction-versus-expansion check, the shoulders-up-versus-shoulders-down check, was almost everything she needed. If she could remember to notice whether she was closed or open, the rest would tend to take care of itself, because closed and open are not states you have to think your way into. They are states you can feel, immediately, without consultation with the part of your mind that loves to argue..

That, in the end, is what I think acceptance is. Not a posture, an affirmation or a brave decision to stop fighting. Just looking at what is here, with enough curiosity that we stop adding anything to it. And then noticing, in our body, that something has loosened that we didn’t have to loosen.

Here are some questions I have my patients sit with:

What rock have you been pushing for so long that you’ve forgotten it’s a rock?

What would it feel like, just for a moment, to look at it with curiosity instead of effort?

And if you noticed something soften, in your shoulders or your chest or your breath, would you be willing to trust that as evidence?

Judson Brewer MD PhD is a psychiatrist and neuroscientist and professor at Brown University. He is the author of Unwinding Anxiety (NYTimes bestseller), The Craving Mind, The Hunger Habit and The Unwinding Anxiety Workbook. He co-founded MindshiftRecovery.org which provides free support for people with any type of addiction.

If you are struggling with anxiety, Dr. Brewer’s Going Beyond Anxiety program brings together his research and clinical experience to help people build effective skills to reduce anxiety and cultivate calm (www.goingbeyondanxiety.com).

Subscribe now

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Copyright © 2025, Judson Brewer, MD, PhD. All rights reserved.

“It’s mostly a head experience.” A patient said this to me recently, describing an affirmation she’d been using to try to accept her anxiety. She’d been repeating it to herself for weeks and could tell that there was something that wasn’t quite right; by the way it was landing in her body, it wasn’t reaching the part of her that needed it.

Acceptance is a word that gets used so often in clinics and meditation apps and self-help books that by the time it reaches a person who is actually struggling, it can land more like an instruction than an invitation (maybe even a command!). Just accept it. Anyone who has been told to just accept chronic pain, or grief, or a difficult diagnosis knows how that sentence feels.

I’ll get into what acceptance actually is in Part 2 of this series. But before I can do that, it’s important to spend some time with its opposite: resistance. Why? Because resistance turns out to be much more interesting/challenging/important than it seems on the surface. Most of us think we know what resisting our experience means. What I’ve found, working with patients over the years, is that a whole lot of everything that we do when we think we’re not resisting is, in fact, another version of resistance dressed up as something different so it can hide itself. My patient’s affirmation was one of those versions. She just hadn’t seen it yet.

Let me back up and show you what I mean.

A patient I’ll call Maya is the one I quoted above, and she had come into our session in a particular kind of spiral. She had returned from a trip with a body symptom that scared her, had gone to her doctor (who reassured her the symptom almost certainly wasn’t serious: “no it’s almost certainly not cancer”), had scheduled the appropriate follow-up test, and was now, by her own description, “completely bowled over.” Her thoughts had gone straight to the worst possible diagnosis (cancer). Should she start planning her funeral? Would her husband survive losing her? Would there be chemo? She knew, intellectually, that her doctor had already told her this was unlikely (really, it’s almost certainly not cancer), which her anxiety was getting in the way of her hearing and comprehending. She was getting the test anyway. The catastrophizing was happening on top of all that, in a layer of mind that the reassurance hadn’t reached.

When I asked her what was driving it, she answered: “When I feel okay,” she said, “my mind starts scanning for things to be anxious about.” She’d globbed onto the symptom because the symptom was available. If it hadn’t been there, she explained, her brain would have found something else.

This is what worry actually is, when you look at it without the content. It is not a response to a specific problem. It is a habit of the mind looking for problems to attach itself to (the way a cow chews on whatever happens to be in its mouth, which is in fact where the word rumination comes from). When I asked Maya what she got from running off into the future this way, planning her own funeral, she didn’t hesitate. “More distress. Extreme fatigue. Nausea. Depression. Just this crappy feeling.” She knew. She had known for a while.

And she couldn’t stop.

This is the part of the picture that most explanations of anxiety skip over. We tend to assume that if a person sees clearly that a behavior isn’t helping, they will stop. (This is, incidentally, the basic logic of most cognitive approaches to anxiety: you challenge the thought, you see it isn’t accurate, the thought stops having power.) But anyone who has actually tried to think their way out of a worry spiral knows this is not how the mind works. Maya could see the loop. She could even name what it was costing her. The seeing did not make it stop.

It did not make it stop because she was, the entire time, doing something other than what she thought she was doing.

Resistance shows up in at least three ways, and they all look and feel different. The first is the obvious one, the one we recognize: pushing away. Oh no, not this again. You feel the anxiety (or whatever unpleasant experience it is) rising and you brace against it, the way you might brace against a wave. There’s a tightness, a closing-down, a sense of “I do not want this in my body right now.” Most people, asked to point to resistance, point to this.

The second is sneakier, and it’s the one Maya was caught in. Forcing yourself to let go. Trying to actively accept. Repeating an affirmation about not resisting your feelings, with such effort that the effort itself becomes the resistance. Yes, note the irony here. We will return to this one because it’s the heart of what makes acceptance so paradoxical to teach (and to learn). For now, just notice that “trying to be okay with this” and “actually being okay with this” are not the same thing, and that the first one usually feels worse.

The third face of resistance is the one we rarely call resistance at all, because it doesn’t feel like fighting. It feels like coping. It’s a sort of running away to the land of avoidance. Maya described doing it most nights: she would watch a video, listen to a soothing meditation, hear a pep talk that told her she was going to be fine, and feel calmer. Then she would wake up the next morning and the anxiety would be there again, unencumbered, and she would feel guilty for having relying on the video in the first place. Was she doing something wrong by reaching for things outside herself to feel better?

She was not doing something wrong, exactly. The video probably did help her sleep. But she began to notice something important about her own pattern, which is that anything we use to make a feeling go away in the moment is, by definition, not engaging with the feeling. Avoidance is a workaround, temporary at best. The next morning the feeling is still there because nothing about the underlying loop has changed. We have just gotten better at distracting ourselves from it, which is not the same as moving through it. Distraction is the most socially acceptable form of resistance we have. We don’t think of it as fighting our experience, but if you watch what it actually does (it ushers us away from what we are feeling so we don’t have to feel it), it’s the same machinery wearing a friendlier outfit.

Push away, force away, run away. Those are the three. They are all powered by the same engine, which is the wish that this experience were not happening right now.

Here is something you can test in your own body, and I’d actually invite you to try it before you read on, because the point of this is not to take my word for it.

Think of something you’ve been resisting recently. It doesn’t have to be dramatic. A conversation you’ve been putting off. A feeling you keep pushing down. A piece of news you don’t want to deal with. Just bring it to mind for a moment and notice what happens in your body. Where do you feel it? What does it feel like? Most people, if they look honestly, find some version of the same thing: tightness somewhere, often in the shoulders or chest or stomach, a sense of closing or bracing or pulling in.

Now think of a recent moment when something opened up for you. A laugh you didn’t expect. Someone letting you go in front of them at the grocery store or in traffic. A small piece of good news. Where do you feel that? What does it feel like? For most people, this one is harder to locate at first, because we don’t usually pay attention to it, but when you do find it there’s a clear quality of opening. A deep breath, dropped shoulders, something settling inside.

Closed and open. Contraction and expansion. This is, as far as I can tell from years of doing this work with patients and from research my lab has done on the felt quality of different mental states, the most useful pair of markers we have for telling resistance from its opposite in real time. They are not subtle. They are not metaphorical. They show up in your body and have nothing to do with thinking your way into or out of them.

When Maya and I were talking, she mentioned that she had been working with an affirmation she’d written for herself: “I allow and accept these anxious feelings.” She would repeat it to herself when the worry rose up, sometimes several times in a row. I asked her how it landed in her body when she said it. She paused for a long moment, and then she said, with a kind of dry honesty I appreciated, “I think there’s a momentary shift. A light, brief shift. But it’s mostly a head experience.”

She was right, and she could feel that she was right, which was the important part.

A little later in the same conversation she pushed back gently. “Isn’t there something to be said,” she asked, “for reinforcing the ideas of non-resistance? I’ve heard it a thousand times, but sometimes I’ll hear it like I’ve heard it for the first time.”

There is something to be said for it, of course. Concepts matter. Concepts are what point us in the direction of wisdom. Reading about acceptance, hearing teachers describe it, watching another person work with their own anxiety, all of this can prime the soil. But Maya had already named the problem with relying on it: she had heard the idea a thousand times. The thousand times had not been enough. Something about hearing it as an idea, even hearing it well, did not translate into the thing itself.

Why not?

Why would a person who can perfectly articulate the concept of acceptance, who has an affirmation she repeats with sincere intent, who has done all the right external things and read all the right books, still wake up each morning at the bottom of the same hole?

Experience is how we walk our way into wisdom.

The answer is the thing we’ll work with in Part 2. It has to do with a paradox that Maya put more clearly than I usually manage to: that actively trying to let go of an experience is, itself, a kind of resistance to it. The more you try to accept, the more you’re confirming there’s something here that needs to be gotten rid of. Acceptance, if it means anything, can’t be a form of effort. But then how does it happen? What are you actually doing when you stop pushing, stop forcing, and stop running, given that “stopping” can’t itself be one more thing you’re doing?

That’s where we’ll pick up next week in part 2.

For now, if you find yourself in one of these three habit loops of resistance (push away, force away, run away), start by simply noticing which one you’re in. Not to fix or change. Just to see, over the next few days, how often you can catch yourself in one of the three faces. You don’t have to do anything with what you find. Noticing is, as it turns out, already doing most of the work for you.

Judson Brewer MD PhD is a psychiatrist and neuroscientist and professor at Brown University. He is the author of Unwinding Anxiety (NYTimes bestseller), The Craving Mind, The Hunger Habit and The Unwinding Anxiety Workbook. He co-founded MindshiftRecovery.org which provides free support for people with any type of addiction.

If you are struggling with anxiety, Dr. Brewer’s Going Beyond Anxiety program brings together his research and clinical experience to help people build effective skills to reduce anxiety and cultivate calm (www.goingbeyondanxiety.com).

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Copyright © 2025, Judson Brewer, MD, PhD. All rights reserved.

It’s the kind of quote that can sound folksy until you really let it sink in. To put it bluntly, Lincoln wasn’t a man with the luxury of easy moral choices. He suspended habeas corpus during the civil war, signing off on the imprisonment of citizens without trial, while working toward what most of us now consider one of the most just causes in American history.

So when Lincoln says his entire ethical framework comes down to noticing how good and bad actions actually feel, was he being naive? Falling back on what could sound like an overly simplistic version of morality because the more sophisticated versions were too complicated? Or was he doing something more sophisticated than the philosophers, something they had been circling for centuries without quite landing on?

Could less be more here? Perhaps we now have the science to explain why.

Aristotle was working on this same question almost twenty-three hundred years earlier, in the Nicomachean Ethics. He nailed a great deal (IMHO), more than most modern ethical frameworks give him credit for. But there’s a piece he may not have had the tools to explore and/or articulate. And the piece he missed is what Lincoln was pointing at, and exactly what shows up in my lab when we measure how different mental and emotional states feel in the body.

This convergence highlights the question of how we become good people. And that answer has very little to do with thinking or reasoning your way to the right principles, and a lot to do with how your nervous system actually responds when you’re paying attention to what you’re doing.

To get there, we have to start with what Aristotle called hexis.

Hexis is one of those Greek words that loses something in translation. Most English versions of Aristotle render it as “habit,” which isn’t wrong (and how I first learned it), but flattens it into something we’d recognize as a behavior loop. Looking more deeply, the translation may be something closer to a settled disposition. A way of being that has become so integrated into who you are that it shows up automatically, without internal negotiation. Distinction without a difference?

Aristotle is famous for suggesting that we become just by doing just acts, brave by doing brave acts. The action comes first; the character follows. He seemed pretty clear that you don’t reason your way into being a good person. You practice your way there.

What he was describing maps closely onto what we now call reward-based learning. He didn’t have the luxury of modern-day neuroscience that maps out how habits are formed. But he had the phenomenon. Reinforce a behavior enough times and it stops requiring deliberation. The trained person doesn’t have to white-knuckle their way through the right action. They see the situation and respond ethically.

Aristotle saw clearly that you cannot think your way out of a poorly trained disposition. He understood, more or less, what we now call weakness of will, and he understood that the cognitive solution to it is mostly, let’s call it, a fantasy. If your training points one direction and your reasoning points another, your training wins.

Aristotle also went somewhere that most pop treatments of his work skip over. He held that pleasure and pain are the real guides to virtue, not abstract principles. The truly virtuous person, he says, takes pleasure in virtuous action. The person who has to grit their teeth and force themselves to do the right thing isn’t yet virtuous in his sense. They’re what he called enkratic, which usually gets translated as “continent” or “self-controlled.” A continent person does the right thing while still wanting to do the wrong thing. Then they can’t hold it in any longer, and poop their pants. A virtuous person doesn’t have the wrong-thing wanting in the first place, because their training has reshaped what feels rewarding.

This is a remarkably embodied account of ethics. Aristotle is already partway to where my lab studies were going. He understood that the felt sense of an action matters more than the rule about it. He understood that the body has to be on board, and that knowing the right thing in your head while your gut wants something else is a state of moral childhood (not yet potty trained so to speak), not moral maturity.

What Aristotle didn’t focus on, was a way of studying that felt sense directly. He built on the training as a given. The polis, the family, the teachers shaped you, and reason supervised the result. Whether the training was pointing in a good direction was a question he could answer only by appealing back to reason, or to the consensus of virtuous men, which is a much shakier foundation than it sounds. We’ll come to why that matters in a moment.

Here’s where Aristotle’s account starts to wobble.

His framework rests on the assumption that the training you receive is pointed in roughly the right direction. The polis shapes you, the family reinforces it, your teachers refine it, and reason supervises the whole process. If everything goes well, you end up with a settled disposition that takes pleasure in genuinely virtuous action. The pleasure becomes the confirmation that the training worked.

But what happens when the training is wrong?

Aristotle has a hard time answering this. His own moral perception, which he treated as a reliable guide, missed on some of the central questions of his era. He defended slavery as natural in the Politics, arguing that some humans were suited by nature to be ruled rather than to rule themselves. His views on women look, from a modern perspective, like pretty obvious moral failures rather than the careful conclusions of a careful thinker. The Spartans, whom Aristotle and his contemporaries looked to as a working model of civic virtue, trained boys in cruelty in the name of courage.

This points to a central problem with his account. If virtue is a trained disposition and the training comes from the surrounding culture, then your virtues are only as good as your culture’s. Reason was supposed to be the safeguard. Aristotle’s own reasoning didn’t save him from inheriting and defending the moral blind spots of his era. We are no different now; it rarely saves any of us from ours.

The deeper issue is one I’ve spent a bit of time on in my own clinic and research programs. The cognitive control regions of the brain, the parts we’d hope to recruit when reason needs to override a culturally trained disposition, are exactly the parts that go offline first when we’re under stress or duress. Reason turns out to be much better at justifying our existing dispositions than at correcting them. The slave-owner who reasons his way to a defense of slavery is not failing at reason. He’s using reason exactly the way reason usually gets used, to give shape and articulation to what the trained disposition already feels like the right answer.

So if Aristotle is right that virtue is hexis, and right that pleasure and pain are the guides, but a bit off the mark that the polis and reason can be trusted to point the training in a good direction, what’s left? Where would a more reliable signal come from?

His framework may benefit from something he didn’t have. The tools to study it weren’t available for another two and a half millennia.

A few years ago my lab ran a study that started as a side question and turned into something much bigger. We wanted to know how rewarding different mental and emotional states actually feel. Not what people say about them, not what they think they should feel, but what shows up when you ask them to compare states directly against each other.

The setup was simple. In the study, we took fourteen mental states, things like kindness, curiosity, connection, anger, anxiety, fear, and frustration, and asked hundreds of individuals to rank them by preference. Preference is a simple and useful proxy for reward value because the brain’s job, when choosing between behaviors, is to figure out which one feels better. Our orbitofrontal cortex is doing this kind of ranking constantly, mostly below the level of awareness. It’s how I know, without thinking about it, that I prefer seventy percent dark chocolate to milk chocolate.

The rankings were pretty clear. People consistently and significantly preferred kindness, curiosity, and connection over anger, fear, and meanness. Across hundreds of subjects, the pattern held.

On top of the rankings, the states people preferred had a particular quality to them. They felt open and expansive. Not in a metaphorical sense, but in the way subjects actually described what was happening in their bodies. The states they liked less felt closed or contracted. My lab has done imaging work showing that this contracted quality lines up with activation in default-mode network regions, including the posterior cingulate cortex, the same region that lights up when people are caught in craving and self-referential rumination. The expanded states show decreased activation in those same regions.

What these studies suggest is that our bodies have all of the data that they need. Real data about how different actions and states actually feel. When you act out of frustration or anger, something contracts. When you act with kindness, something opens. These signals are available to anyone paying close enough attention to notice them. Awareness is key here.

Aristotle didn’t talk about this. He understood that pleasure and pain were guides. He understood that the trained person takes pleasure in virtuous action. What he didn’t say, is that the felt sense itself can be studied, refined and used as an ethical guide or compass. You don’t have to inherit your training from the polis and hope it pointed in a good direction. You can pay attention to what your nervous system is reporting, in real time, and let that information be your guide.

Now you could take this in a direction I am not intending, so I’ll point this out now. The argument is not trust your gut. Your gut has been trained too. Saying “just notice how it feels” without qualification is the kind of advice that gets people walked on or worse.

My suggestion is a bit more specific. With sustained, curious awareness, the kind that takes practice to develop and that most of us have not been trained to bring to our own experience, the data start to converge. The closed quality of cruelty becomes recognizable as cruelty’s signature, separate from any momentary reward the cruel act provides. The open quality of kindness becomes recognizable too, separate from the social performance of being nice. The signal underneath the trained reaction begins to come through.

This is not a quick fix. As suggested by his pretty consistent wrestling with what is right throughout his life, Lincoln likely spent quite a bit of time paying that kind of attention.

The most common pushback I get when I talk about this work goes something like: I tried being kind and it felt terrible. People took advantage. I ended up resentful and depleted. So much for kindness feeling open.

In cases like this, what people are usually describing when they say this is not kindness in the sense I mean. They are describing a habit loop that looks like kindness from the outside. The trigger is something like discomfort with conflict, or fear of disapproval, or a long-trained sense that their job is to manage other people’s feelings. The behavior is accommodation, smoothing, soothing, agreeing, or giving in. The reward, in the short term, is relief from the discomfort. The longer-term result is exactly what they describe: resentment, depletion, the sense of being walked on. That’s a habit, not kindness.

If you actually pay attention to what’s happening in the body during one of these episodes, the felt sense is not open at all. There’s tension. There’s a tightness in the chest or the gut. There’s often a script running about what the other person needs and what will happen if you don’t provide it. Nothing about it feels expansive. Habits feel closed. In essence, they are a closed loop.

Most of what passes for kindness in everyday life is one of those loops, and it doesn’t feel open because it isn’t. Genuine kindness, the kind that shows up as actually rewarding in the lab data, has a different signature. It shows up when you’re present enough to notice what’s happening, including what you actually want and what the other person actually needs, and you act from that. Sometimes it means telling someone a hard truth they don’t want to hear. The defining quality is the state underneath the behavior, not the behavior itself.

The other objection worth taking seriously is harder. What about people whose felt sense really does report pleasure in cruelty? It seems to be the case that there are nervous systems that may not generate the contraction signal in response to harm, or that generate something like satisfaction instead (e.g. sociopathy).

The argument here is not that every human nervous system is exactly the same or reports the data accurately. It is that for most people, the pattern shows up reliably enough to be useful. And it might be even more accurate with a bit of awareness training. Aristotle likely would have recognized this. He acknowledged that some people are so badly trained, or so naturally disposed toward vice, that the framework of virtue ethics simply doesn’t reach them. My suggestion is similar, with the difference that I think the path is available without depending on the polis as the starting point and/or the guide.

Which brings us back to Lincoln.

The line about doing good and feeling good is easy to read as folk wisdom or even sentimentality. Sit with it longer, feel into it more deeply, and something more interesting starts to come through. Lincoln was making a simple statement about an internal signal he had learned to trust. Doing good felt one way in his body. Doing bad felt another way.

He could not have read or reasoned his way to that anchor. There was no philosophical text that would have given it to him, and reading the philosophical texts of his era would have given him plenty of material to argue himself out of it. What he had was decades of acting in morally weighted situations, paying attention to what those actions actually felt like afterward, and letting the data accumulate. The result was something like an evidence base, built one decision at a time.

This is why the quote holds up under pressure in a way that more elaborate ethical frameworks often don’t. Frameworks are vulnerable to clever reasoning. A sufficiently motivated person can argue their way to almost any conclusion if the only check is internal consistency. What’s much harder to argue your way out of is a felt sense that has been built up over years of careful observation. The body’s report is harder to gaslight than the mind’s.

I think this could have been what Aristotle was articulating when he said the truly virtuous person takes pleasure in virtuous action. He saw that the felt sense had to be on board, that white-knuckling your way through good behavior was a lower stage of moral development. What he didn’t have was a way of describing how someone could refine that felt sense directly, without depending on the surrounding culture to install it correctly. Lincoln, who was often pretty isolated in a country tearing itself apart, found his way to it anyway. Most of us are not Lincoln, but we all have that capacity.

What Lincoln called religion, I would call evidence-based faith. It is the same posture I have asked patients and program participants to adopt about their own habit change practice. You do not need to take my word that mindfulness will help. You do not need to take Aristotle’s word that virtue is hexis. You need to pay attention to your own experience, with enough sustained care that the patterns become visible, and then trust what you find.

This is how I explain it to my patients: I’m not asking you to adopt a position. I’m suggesting that you run an experiment.

Pick a moment in the next few days when you are about to do something you would call kind, or something you would call unkind, or something that falls in the murky territory between. Before the action, notice what is happening in your body. After the action, notice again. Not the story you tell about it. Not the justification or the regret. The actual felt sense.

Do this enough times and patterns will start to show up. The patterns are not subtle. The contracted feeling that comes with being mean or selfish is recognizable once you have seen it a few times. The open feeling that comes with genuine care is recognizable too. The datapoints accumulate pretty quickly. The only question is whether you are paying enough attention for them to register.

Aristotle thought we needed the polis to start this process for us. Lincoln found his way in a war-torn country. My patients find their way through a different route, working with their own habit loops one moment at a time. The mechanism underneath all three is the same. A nervous system, paying attention, learning what its actions actually feel like, and letting that information shape what it does next.

Whether the result counts as ethics in the philosopher’s sense, I will leave to the philosophers. What I can say is that it works the way Aristotle said virtue works, builds the way reward-based learning builds, and produces in people I have watched go through it the kind of ethical leaning that he was pointing at; acting from a place that does not require white-knuckling, reasoning or argument. A felt sense that the right action is also the one that feels open, and the wrong one is also the one that closes you down.

Lincoln called that his religion. I am content to call it paying attention.

Judson Brewer MD PhD is a psychiatrist and neuroscientist and professor at Brown University. He is the author of Unwinding Anxiety (NYTimes bestseller), The Craving Mind, The Hunger Habit and The Unwinding Anxiety Workbook. He co-founded MindshiftRecovery.org which provides free support for people with any type of addiction.

If you are struggling with anxiety, Dr. Brewer’s Going Beyond Anxiety program brings together his research and clinical experience to help people build effective skills to reduce anxiety and cultivate calm (www.goingbeyondanxiety.com).

Subscribe now

Share

Copyright © 2025, Judson Brewer, MD, PhD. All rights reserved.

References

Aristotle. (350 BCE/2009). Nicomachean Ethics (D. Ross, Trans.; L. Brown, Ed.). Oxford University Press.

Aristotle. (350 BCE/1998). Politics (C. D. C. Reeve, Trans.). Hackett Publishing.

Arnsten, A. F. T. (2009). Stress signalling pathways that impair prefrontal cortex structure and function. Nature Reviews Neuroscience, 10(6), 410–422. https://doi.org/10.1038/nrn2648

Arnsten, A. F. T. (2015). Stress weakens prefrontal networks: Molecular insults to higher cognition. Nature Neuroscience, 18(10), 1376–1385. https://doi.org/10.1038/nn.4087

Brewer, J. A. (2017). The craving mind: From cigarettes to smartphones to love—Why we get hooked and how we can break bad habits. Yale University Press.

Brewer, J. A. (2019). Mindfulness training for addictions: Has neuroscience revealed a brain hack by which awareness subverts the addictive process? Current Opinion in Psychology, 28, 198–203. https://doi.org/10.1016/j.copsyc.2019.01.014

Brewer, J. A. (2021). Unwinding anxiety: New science shows how to break the cycles of worry and fear to heal your mind. Avery.

Brewer, J. A., & Garrison, K. A. (2014). The posterior cingulate cortex as a plausible mechanistic target of meditation: Findings from neuroimaging. Annals of the New York Academy of Sciences, 1307(1), 19–27. https://doi.org/10.1111/nyas.12246

Brewer, J. A., Garrison, K. A., & Whitfield-Gabrieli, S. (2013). What about the “self” is processed in the posterior cingulate cortex? Frontiers in Human Neuroscience, 7, 647. https://doi.org/10.3389/fnhum.2013.00647

Garrison, K. A., Scheinost, D., Worhunsky, P. D., Elwafi, H. M., Thornhill, T. A., Thompson, E., Saron, C., Desbordes, G., Kober, H., Hampson, M., Gray, J. R., Constable, R. T., Papademetris, X., & Brewer, J. A. (2013). Real-time fMRI links subjective experience with brain activity during focused attention. NeuroImage, 81, 110–118. https://doi.org/10.1016/j.neuroimage.2013.05.030

Hare, R. D. (2003). The Hare Psychopathy Checklist–Revised (2nd ed.). Multi-Health Systems.

Herndon, W. H., & Weik, J. W. (1890). Herndon’s Lincoln: The true story of a great life (Vol. 3). Belford-Clarke Co.

She is also so anxious that she hasn’t been able to drive without raising her blood pressure and hasn’t gotten a good night’s sleep for several years.

Margaret has done everything right by the lifestyle medicine playbook, and she still spends a fair amount of her day rehearsing catastrophes. She echoes what a lot of patients have said over the years: “I don’t get it. I’m doing all the things you’re supposed to do.”

Yes, and... The playbook may be incomplete.

As a psychiatrist who has spent the past two decades studying how people get hooked on things, lately I’ve been thinking about some related subtleties and derivatives of that question. Not “why does anxiety persist,” which gets a lot of attention, but “why do the things we tell anxious people to do so often fail to stick?” Sleep more. Drink less. Move your body. Practice stress management. The advice is fine (and evidence-based). So why is Margaret, who follows it all, still white-knuckling her way through life?

I think part of the answer may be that lifestyle medicine may have a mechanism problem. We’ve built a generation of evidence around six pillars (nutrition, physical activity, restorative sleep, stress management, social connection, and avoiding risky substances) as a way to prevent and reverse chronic disease. I’m not here to argue with the pillars. And I’m a big fan of lifestyle medicine. I would go as far as saying that these pillars likely keep people healthier (in theory) than any combination of medications. Instead, I want to argue with the model we use to deliver them, which boils down to prescription + education + willpower. That’s roughly the same model that has failed addiction medicine for fifty years, and it fails for the same reason. It doesn’t account for how the brain actually learns.

Reward-based learning is older than humans. Eric Kandel won the Nobel Prize in 2000 for showing that this learning process operates in the sea slug, an organism with twenty thousand neurons in its entire nervous system. The basic structure is trigger, behavior, reward, and then repeat. Your brain encodes the reward value of each behavior in a region called the orbitofrontal cortex, where it gets compared against the reward value of other available behaviors and used to drive your future choices. This is how you learned to prefer dark chocolate to milk chocolate. It’s also how a forty-year patient of mine reinforced his smoking habit roughly 293,000 times before he walked into my clinic asking for help to quit.

Anxiety lives inside this same machinery. A trigger shows up. Maybe it’s an email, maybe it’s a tightness in your chest, maybe it’s a thought about tomorrow. Your brain reaches for whatever behavior has, in the past, made the discomfort go away even temporarily. Worry. A drink. An innocent scroll through your phone. A second helping of dessert. The behavior gets reinforced.

By the time someone like Margaret arrives at a clinic, her worry-and-avoid loop has been grooved thousands of times (or more), and her brain has stored that worrying has, paradoxically, some level of reward. Not because worry feels good. Because at some point it seemed to help her prepare for something bad, and her prefrontal cortex hasn’t been able to update that reward value since then.

There’s one more thing about this: the prefrontal cortex, which is where willpower-based interventions live, is the first brain region to go offline under stress. Amy Arnsten’s research at Yale has shown this in elegant detail. The very brain system we ask patients to use to implement our recommendations is the system that goes dark precisely when implementation is hardest. We hand people a flashlight and turn the lights out at the same time.

Substance use

The pillar I know best, and the one where the mechanism story is hardest to miss, is the avoidance of risky substances. Most clinicians treat substance use and anxiety as two conditions that travel together. The patient has anxiety and drinks, and we treat each in parallel. But for a big slice of patients, the substance isn’t the comorbidity. It’s the anxiety, in disguise.

I see this in my clinic pretty regularly. One patient stands out, a woman in her fifties whose anxiety was so severe in her twenties that she couldn’t make it to the grocery store without “pre-partying” first. A few decades of that, and by the time she walked into my office she had a textbook alcohol use disorder. The loop she described was almost too clean: drink to take the edge off the anxiety, drink past the edge because by then the off-switch was already underwater, wake up the next morning with anxiety worse than the one she had been trying to medicate. The substance wasn’t sitting next to her anxiety. It was the only tool she had ever found for it, and it was making the anxiety worse on a delay long enough that her brain never quite connected the two.

Alcohol is anxiety-relieving for an hour or two and anxiety-producing on the back end. The colloquial word “hangxiety” turns out to point at something real, with the day-after anxiety often hitting hardest in people who were already anxious to begin with. Nicotine is a stimulant that somehow reduces self-reported anxiety, because the withdrawal between cigarettes is itself anxiogenic, so each cigarette relieves a discomfort that the previous cigarette created. And when my patients and I examine this carefully, nicotine (a stimulant) isn’t the anxiety reliever; it’s the smoke BREAK that they take (which can be substituted by simply taking a break to stretch or go for a short walk, or to do a short mindfulness exercise).

Cannabis is more complicated, but for a lot of habitual users it follows the same arc. Benzodiazepines are the cleanest example, in a sad way: prescribed to treat anxiety, they generate, over time, a worse anxiety than the one they were prescribed for. And getting off of them is a bitch.

Telling these patients to “avoid risky substances” isn’t wrong. It’s just not a treatment. The substance is doing a job inside an anxiety habit loop, and unless we address the loop itself, the slot doesn’t stay empty. It gets filled by overeating, or doomscrolling, or, often enough, a new prescription.

Stress management

If risky substances is the pillar where the link to anxiety is most concrete, stress management is the pillar where I think the field has the thinnest mechanistic account. From my admittedly not complete read of the literature, most stress management content in lifestyle medicine boils down to a list. Diaphragmatic breathing. Progressive muscle relaxation. Yoga. Journaling. Time in nature. Good things, all of them, and not enough research on why they work or for whom.

Perhaps more importantly, anxiety and stress aren’t the same animal. Techniques that work for acute stress, like downregulating the sympathetic nervous system in the moment, often do nothing for the rumination loops that define generalized anxiety. I’ve talked to patients who diligently practiced box breathing for months and reported that it didn’t touch their 3 a.m. worry spirals.

The mechanism that does seem to address rumination is awareness applied to the loop itself. Noticing the trigger. Watching the behavior of worrying as it unfolds. Feeling clearly what the actual reward, or lack of reward, of worry is in the body. In trials from my lab and others, this kind of awareness training has produced clinically meaningful reductions in anxiety symptoms, and the proposed mechanism is exactly the one I’ve been describing: updating the reward value of worry in the orbitofrontal cortex so that your brain stops reaching for it. That’s a different approach that may get at the underlying driver of anxiety itself, and is quite different than being told to take a few deep breaths when you’re stressed.

Sleep

Sleep is the pillar where the two-way relationship with anxiety is best established. Anxious people sleep worse, and people who sleep worse become more anxious. A single night of sleep deprivation makes us (and our brains) more reactive (e.g. work that Yoo and colleagues laid out back in 2007 and that Goldstein and Walker have since built into a broader picture).

The lifestyle medicine teaching for patients is sleep hygiene. Consistent bedtime. Cool dark room. No screens before bed. Watch the caffeine. All sensible, and with quite a bit of evidence behind them. Unfortunately, none of what to do addresses the patient who already knows this stuff and still lies awake from 2:47 to 4:30 a.m. running through a list of things she can’t fix.

Insomnia, in a lot of these cases, is itself a habit loop. The bed becomes a conditioned anxiety cue. “Trying to sleep” becomes the failed control behavior, and lying awake feeling frustrated about lying awake gets reinforced as the actual behavior the brain practices, night after night. Cognitive Behavioral Therapy for Insomnia works partly by breaking this conditioned association, through techniques like stimulus control and sleep restriction.

In my own lab’s randomized trial of app-based mindfulness training for people whose worry was interfering with their sleep, we saw something pretty remarkable (yes I’m biased, but the data speak for themselves). In a randomized controlled trial, after two months, participants reported a 27% reduction in worry-related sleep disturbances, compared with 6% in the control group, and the mediation analysis pointed at a specific mechanism: their ability to not get hooked by their own anxious thoughts increased, which reduced their worrying, which reduced their perceived sleep problems. The part that complicates the story in an interesting and perhaps useful way is what didn’t change: their actual sleep duration, measured objectively, was about the same.

What changed was the loop. Their bedtime brains stopped being the same hyperaroused, ruminating brains they had brought into the bedroom for years, and the subjective experience of sleep improved even when the Fitbit data didn’t move. The thing that got better was the patient’s relationship with her own mind at 2 a.m. which is likely much better than your wearable telling you that you did/did not get a good night of sleep.

Exercise

I’m leaving exercise out of the main argument, but it deserves a paragraph, because it’s the pillar with arguably the strongest evidence for anxiety reduction (e.g. Stubbs and colleagues’ meta-analyses are reasonably solid), and it’s also the pillar that most clearly illustrates the limits of the prescription model. We can demonstrate in a trial that exercise reduces anxiety symptoms (and many have). We can also fail completely at getting an anxious patient to exercise, because the anxiety itself is what makes initiating and sustaining exercise hard. Even the pillar with the best evidence doesn’t implement itself. The implementation problem is the learning problem.

I’m not arguing that lifestyle medicine has the wrong pillars. The pillars are well-chosen and the evidence supporting them as targets is real. I’m suggesting that the model of how a patient gets from where they are to where the pillars say they should be is borrowed largely from a willpower-and-education tradition that hasn’t aged well in the addiction literature, and that anxiety is the cleanest place to see this, because anxiety renders willpower-based intervention nearly inert.

What might it look like to take learning seriously? Probably something like this. Clinical encounters that start not with “here’s what to do” but with “here’s the loop you’re already running.” Treatment plans that treat the OFC’s reward value as a thing to be updated, not a thing to be overridden. Time spent with patients in the actual texture of their behavior. What does that cigarette taste like? What does the worry feel like? What is the real reward of the second or third glass of wine? Sit with it long enough that your nervous system gets a chance to learn what it hasn’t yet had the chance to learn. That’s how reinforcement learning works (with a notable absence of the need for willpower).

I don’t think any of this is a departure from lifestyle medicine. Instead, I think it’s what lifestyle medicine gets up to date on the latest neuroscience about why so many of its prescriptions fail to stick.

A question worth sitting with, whether you’re a clinician or someone who has been on the receiving end of all this advice: when the change doesn’t happen, is the first instinct to ask for more education, more motivation, more discipline (or read another self-help book)? Or is it to ask what the loop is, and how to make it visible?

Those lead down completely different roads, and toward very different results.

Judson Brewer MD PhD is a psychiatrist and neuroscientist and professor at Brown University. He is the author of Unwinding Anxiety (NYTimes bestseller), The Craving Mind, The Hunger Habit and The Unwinding Anxiety Workbook. He co-founded MindshiftRecovery.org which provides free support for people with any type of addiction.

If you are struggling with anxiety, Dr. Brewer’s Going Beyond Anxiety program brings together his research and clinical experience to help people build effective skills to reduce anxiety and cultivate calm (www.goingbeyondanxiety.com).

Subscribe now

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Copyright © 2025, Judson Brewer, MD, PhD. All rights reserved.

REFERENCES

Arnsten, A. F. T. (2009). Stress signalling pathways that impair prefrontal cortex structure and function. *Nature Reviews Neuroscience, 10*(6), 410–422.

Arnsten, A. F. T. (2015). Stress weakens prefrontal networks: Molecular insults to higher cognition. *Nature Neuroscience, 18*(10), 1376–1385.

Brewer, J. A. (2019). Mindfulness training for addictions: Has neuroscience revealed a brain hack by which awareness subverts the addictive process? *Current Opinion in Psychology, 28*, 198–203.

Goldstein, A. N., & Walker, M. P. (2014). The role of sleep in emotional brain function. *Annual Review of Clinical Psychology, 10*, 679–708.

Kandel, E. R. (2001). The molecular biology of memory storage: A dialogue between genes and synapses. *Science, 294*(5544), 1030–1038.

Ong, J. C., Manber, R., Segal, Z., Xia, Y., Shapiro, S., & Wyatt, J. K. (2014). A randomized controlled trial of mindfulness meditation for chronic insomnia. *Sleep, 37*(9), 1553–1563.

Stubbs, B., Vancampfort, D., Rosenbaum, S., Firth, J., Cosco, T., Veronese, N., Salum, G. A., & Schuch, F. B. (2017). An examination of the anxiolytic effects of exercise for people with anxiety and stress-related disorders: A meta-analysis. *Psychiatry Research, 249*, 102–108.

Yoo, S. S., Gujar, N., Hu, P., Jolesz, F. A., & Walker, M. P. (2007). The human emotional brain without sleep: A prefrontal amygdala disconnect. *Current Biology, 17*(20), R877–R878.

Yet, he wasn’t talking about gambling. He was talking about what perfectionism actually does to his workday. Yes, not the inspirational poster version of perfectionism, but the other kind, the real kind, where an impossible standard sends us off to procrastination land: our social media feed, the news, the refrigerator, anywhere that creates the sensation of movement while the actual work sits there, gathering dread.

My patient knew he was doing it. He could watch himself do it in something close to real time, which made it worse, because now there were two things going wrong: the original task he wasn’t doing, and the watching-himself-not-do-it that he also wasn’t able to stop.

Perfectionism is its own kind of hell, and procrastination is one of its main manifestations. Another is getting stuck in the never-enough, never-good-enough cycle, which is a hell realm in itself.

After hearing versions of this story across the years, the self-tripping-over-the-self itself has stopped raising my eyebrows. Our brains are exquisitely good at it, and we’ll get to why in a moment. The even more interesting problem is the measuring issue underneath it.

When I ask patients what “good enough” would actually look like for the thing they’re avoiding, the answers tend to drift. The bar moves while they’re describing it. Meet it, and it was probably too easy, so it gets raised. Miss it, and that confirms you’re a failure, so it gets raised there too. After enough years of this, the ability to accurately perceive where the bar sits starts to degrade. That last part is the part worth sitting with.

The standard becomes what Hector Berlioz called an idée fixe in his Symphonie Fantastique — a fixed musical theme that recurs throughout the work, returning each time more distorted than the last. The term had already found a home in French psychiatry, where it described a fixed, dominating preoccupation that persists despite all evidence against it. The perfectionist’s standard works the same way. It returns, dominates, and distorts rather than resolves.

I’ve started thinking of this as a kind of “standards dysmorphia”. Body dysmorphic disorder is a serious diagnosis and I’d never want to flatten it into a metaphor. What I’m building on is the underlying idea: that the perceptual instrument itself can be miscalibrated. With perfectionism, what’s being misread is a threshold of acceptable performance. And because the instrument is broken (because we can’t see ourselves as ever being good enough), no amount of actual output corrects the reading.

Framing it this way may be helpful in changing how we view what kind of problem perfectionism is. Many people treat it as a motivation problem, or a standards problem, or, in the particularly brutal self-diagnosis I hear most often, a character flaw dressed up as some type of virtue. What neuroscience suggests is something more specific: a calibration failure in the brain’s reward system that traps people in habit loops which feel nothing like habits, precisely because the walls of the trap are built from something that looks, from the inside, a lot like caring deeply about your work.

The brain region most relevant here is the orbitofrontal cortex (OFC), which functions roughly as the brain’s comparison shopper. Every time you perform a behavior and experience an outcome, the OFC registers the reward value and stores it for future reference. The OFC keeps score so that future decisions can be made efficiently. I’ve written about this mechanism in the context of smoking and anxiety, but perfectionism puts a specific and underappreciated pressure on the system.

In most habit loops, the OFC is comparing real things, like the taste of a cigarette. The reward value is grounded in actual experience, which means the OFC can update its records accurately over time. Perfectionism runs the same circuitry with one complicating difference. The reward being sought is a mental image of a completed, flawless thing. The brain is running its standard cost-benefit analysis, measuring current performance against an ideal that exists only as a projection, and finding current performance perpetually wanting. The comparison target was never fixed to begin with, which is why the OFC can never get accurate information to work with.

Here’s where the popular story about perfectionism gets murkier than the version most of us have absorbed. The assumption has long been that perfectionism causes procrastination. That fear of not doing something perfectly leads people to avoid starting. The research picture is messier. Piers Steel’s 2007 meta-analysis found the direct link between perfectionism and procrastination to be surprisingly weak. Fear of failure predicts procrastination far more reliably, along with the negative affect that anticipates it. Fuschia Sirois and Timothy Pychyl have argued convincingly that procrastination is primarily a problem of emotion regulation.

The person who can’t start the report is more likely to be avoiding the feelings associated with attempting it: the anxiety of falling short, the anticipatory shame of producing something that doesn’t match the image in their head. The distraction behavior gets negatively reinforced because it provides temporary relief from that aversive state. Which means the habit loop running here isn’t really about the standard at all. The trigger is the bad feeling that arrives when current reality gets compared to the imagined ideal, and the behavior is whatever takes the edge off. Perfectionism is the engine generating the bad feeling, but the loop itself runs on emotion.

There’s also more of this loop running than there used to be. Thomas Curran and Andrew Hill published a large analysis in 2019 in Psychological Bulletin, pooling data from tens of thousands of college students over 25 years, and found that perfectionism has increased substantially across all three of its main varieties: self-oriented (holding yourself to impossible standards), other-oriented (holding everyone else to them), and socially prescribed (the sense that others are watching and evaluating, and the evaluation is never quite favorable). That last one showed the sharpest rise. It’s not hard to see why. Twenty years of being perceived through a quantifying looking glass, where the feedback comes back to you as numbers (likes, follows, view counts) and where the comparison to other people happens involuntarily every time you scroll, has done something to the experience of being a person trying to make something. The instrument was never well-calibrated and the surrounding conditions have been actively shaking it.

So what do we do with all of this?

The first step, which may sound obvious but isn’t, is recognizing that you’re working with a broken instrument. Most people carrying this kind of suffering have spent years treating their distorted standard as accurate (and helpful), which means treating the gap between their performance and their standard as meaningful information about their character. That gap is more accurately an artifact of a miscalibrated system, and recognizing this changes what the problem actually requires.

The same patient I mentioned earlier told me that the times when he felt most at ease with his performance was when he had a fitness coach. This wasn’t because the coach pushed him harder, but because having an external assessor meant that he didn’t have to trust his own instrument (himself). He admitted that his relief at handing that function over to someone else was a little embarrassing to acknowledge to himself. When his scale was “broken,” as in, miscalibrated from futzing with it and not trusting himself so much, he felt much better when handing that measurement off to someone else.

In my program, we focus less on destination-based goals and more on process metrics: how much time are you spending in a contracted, closed-down state versus an expanded, open one? My lab has studied this, and what we find, consistently, is that people prefer the open state, because it feels better. The reward value is higher, and the OFC can register that if you give it accurate information.

For readers who’ve been working with the three gears, this maps on in a specific way. First gear is mapping the loop, getting clear that for most people with this pattern, the actual trigger is the aversive feeling that arrives when current reality gets measured against the imagined standard. The distraction behavior is the analgesic. Seeing this clearly is more than it sounds like, because most people are so focused on the behavior (why do I keep checking my phone) that they never get curious about what it’s actually for.

Second gear gets tricky with perfectionism. The reason it works for smoking is that the reward, on close inspection, turns out to be underwhelming. People in our smoking cessation studies report things like “smells like stinky cheese, tastes like chemicals.” The OFC updates its records, and the behavior loses its grip. With perfectionism, the reward being chased is a mental image of a flawless completed thing, and you can’t taste a mental image and find it lacking. So second gear here means turning the same curious attention onto the distraction behavior itself: what relief it provides, how long that relief lasts, whether the trade is worth it. My patient noticed that thirty seconds of sitting with discomfort was almost always better than another hour of avoidance. He was running the experiment on himself.

Third gear is curiosity. I’ve written about this elsewhere at more length, so I’ll keep it brief here: the move is shifting from treating your inner experience as a problem to be solved to treating it as something interesting to investigate. The contraction you feel when you sit down to start the avoided task. That feeling has a location, a texture, something that changes when you actually pay attention to it. That quality of curiosity applied as an exploration of the moment feels better than dreading it, and the OFC can register that.

The hardest part of working with perfectionism is likely that the whole apparatus is powered by something real. Yes, caring about doing good work is genuine. The problem is that it has gotten hooked into a learning system running on distorted data, holding real performance up against a hypothetical that shifts every time you approach it.

My patient eventually said he wanted, above everything, to be at ease with his life. He said it somewhat sheepishly, as if ease were a small ambition. He had moments of it, he said. Now, it was about stringing those moments together, more and more.

He could already feel the difference between those moments and the rest. The work, as he saw it, was learning to string them together.

Essentially, the goal is not to dismantle high standards but to rebuild a measuring instrument that gives accurate readings, so that moments of genuine accomplishment can register as such. The OFC is doing its job. It just needs better information. This naturally comes from “working the gears” to recalibrate what we expect from ourselves, and how we relate to words like “perfect.”

So, if you are like my patient and find yourself in the perfectionism loop again (which you will, because that’s how loops work), see if you can get curious about it rather than immediately trying to escape it. Notice what the contraction feels like. Notice whether the standard you’re holding yourself to is the same one it was an hour ago, or whether it’s moved again while you weren’t watching.

It’s worth returning to Berlioz, because the full arc of the Symphonie Fantastique is more instructive than the idée fixe alone. The symphony tells the story of an artist consumed by an obsessive love. He poisons himself with opium and tumbles into a fever dream. He dreams he has murdered the woman he loves, is arrested, and marched to the scaffold; Berlioz writes the guillotine blade into the score, the head falling audible in the brass at the end of the fourth movement. In the fifth movement, his soul watches helplessly as his own funeral descends into a witches’ sabbath. The idée fixe returns one last time there, but she’s become a witch, the theme now grotesque and mocking, dancing over his grave. The obsession hasn’t resolved, but instead consumed him. In the Symphonie, he never wakes up.

Perfectionism, left unexamined, runs a similar program. The standard returns, dominates, distorts, and if you never stop to listen carefully to what it has actually become, you can end up marching toward a mental scaffold of your own making, guillotined by an instrument inside your own head. The work, such as it is, is hearing the theme accurately while there’s still room to do something with what you hear.

P.S. I still remember playing Symphonie Fantastique with my college orchestra. The music was, well, fantastic, but the story behind it is even more memorable. Our conductor explained that Berlioz had fallen madly in love with an Irish actress named Harriet Smithson after seeing her playing Ophelia in Paris in 1827. He fell madly in love, sent letters she never answered, rented rooms near her apartment, and when none of that worked, wrote the symphony as what one music historian generously called “the ultimate romantic gesture.” She didn’t attend the premiere or even hear it until two years later, at which point she apparently realized she was the idée fixe, agreed to meet him, and eventually married him, despite neither speaking the other’s language.

They separated eventually, as you might expect of a marriage that began this way, but are buried together in Montmartre Cemetery, which is either romantic or fitting depending on your disposition. I’m not sure this particular courtship strategy translates well to modern dating, but we all continue to benefit from an inspired piece of music.

Judson Brewer MD PhD is a psychiatrist and neuroscientist and professor at Brown University. He is the author of Unwinding Anxiety (NYTimes bestseller), The Craving Mind, The Hunger Habit and The Unwinding Anxiety Workbook. He co-founded MindshiftRecovery.org which provides free support for people with any type of addiction.

If you are struggling with anxiety, Dr. Brewer’s Going Beyond Anxiety program brings together his research and clinical experience to help people build effective skills to reduce anxiety and cultivate calm (www.goingbeyondanxiety.com).

Subscribe now

Share

Copyright © 2025, Judson Brewer, MD, PhD. All rights reserved.

REFERENCES

Brewer, J. A. (2019). Mindfulness training for addictions: Has neuroscience revealed a brain hack by which awareness subverts the addictive process? Current Opinion in Psychology, 28, 198–203. https://doi.org/10.1016/j.copsyc.2019.01.014

Brewer, J. A. (2021). Unwinding anxiety: New science shows how to break the cycles of worry and fear to heal your mind. Avery/Penguin Random House.

Curran, T., & Hill, A. P. (2019). Perfectionism is increasing over time: A meta-analysis of birth cohort differences from 1989 to 2016. Psychological Bulletin, 145(4), 410–429.

Kringelbach, M. L. (2005). The human orbitofrontal cortex: Linking reward to hedonic experience. Nature Reviews Neuroscience, 6, 691–702.

Sirois, F. M., & Pychyl, T. A. (2013). Procrastination and the priority of short-term mood regulation: Consequences for future self. Social and Personality Psychology Compass, 7(2), 115–127.

Steel, P. (2007). The nature of procrastination: A meta-analytic and theoretical review of quintessential self-regulatory failure. Psychological Bulletin, 133(1), 65–94.

There is a second dimension of burnout that gets much less airtime, for reasons that become obvious the moment you try to describe it out loud. The research literature calls it cynicism, which is a clinical-sounding word for something that feels considerably worse from the inside: you have started to not care about the people you are supposed to care for. The patient telling you about his back pain has become a problem to move through rather than a person to sit with, the colleague asking for a consult has become an imposition, and somewhere along the way the warmth went out of the room, except the room turns out to be the one inside your own chest.

This is the part of burnout that clinicians keep to themselves, and only talk about when they are exhausted and can’t hold it in anymore, because admitting it can feel like a moral failure. Exhaustion happens to you; cynicism feels like something you did. A character flaw or worry or that not-good-enough feeling dressed up as a work problem.

There may be a different way of looking at it, one that I think is both more accurate and more useful, and this is what I spend a good portion of my clinical and burnout research life on: cynicism is a habit loop. Once you can see the shape of the loop, you have more room to move than you thought you did.

This includes the relief that there isn’t something wrong with people who get burnt out, clinicians or otherwise. If it’s a habit, that means it was learned, and can be unlearned.

The setup is fairly straightforward, though the implications take some sitting with. You walk into a room with a patient who is suffering, and your nervous system (being a nervous system that senses) picks up on that suffering, because that is what empathy is at the neuronal level. Their distress becomes, briefly, your distress.

So maybe you do what brains do in that situation, which is to find something that helps with the (your) pain. Maybe you detach a little, stepping back from the feeling and going into checklist mode so that you can handle the encounter with technical competence but not much presence. Maybe you notice a flicker of irritation at the patient for being “difficult,” which is often code for “making me feel something I don’t have bandwidth for right now.” Maybe you make a dark joke with a colleague afterward. Whatever the specific move is, it works for a moment: the emotional temperature drops for the moment (or you’ve been distracted from it), and you can keep going.

That relief, right there, is the reward. Not pleasure, which is a different reward signal, but relief, which happens to be one of the most powerful reinforcers your brain has available. (This is why negative reinforcement is so sticky, and why people will do some remarkable things to avoid feelings they would rather not feel.) Now do this a few thousand times over the course of a career, and you have a very well-grooved loop. The trigger is someone else’s suffering arriving on top of your own overload, the behavior is emotional distancing in whatever flavor is yours, and the reward is a small hit of relief from empathic distress. The loop runs more and more efficiently over the years as it gets grooved into a habit, until eventually it runs without bothering to consult you, and one morning you notice that you do not feel much of anything about your patients anymore, and you find yourself wondering when that happened.

It did not happen in any single moment you could point to. It got trained, one encounter at a time, by a brain doing exactly what brains evolved to do. That’s how habits form.

Notice that your brain has learned (through thousands of repetitions) that detachment is what works when a patient’s suffering lands in your body. You cannot willpower your way out of a learned response, or at least you cannot do it for very long before the response wins. What you can do is give the brain better information about what is actually rewarding and what isn’t, which is a different kind of intervention altogether.

My lab recently published a study testing whether a short, pragmatic mindfulness training, designed with input from clinicians who told us what they actually had time for in their lives, and delivered as a podcast, could move the needle on physician burnout. Seven modules, each about fifteen minutes, with the aim that it was listenable on a commute, because most clinicians commute for at least 15 minutes and listen to podcasts. That was the entire intervention.

Ready for this? 7 x 15 minute modules led to the following results: Cynicism dropped by 33%, and the reduction was still there a month after the training ended. Anxiety dropped by 43%. Intolerance of uncertainty (which can be an indication of the not-knowing that drives a lot of the over-testing and defensive medicine we all complain about) dropped by 26%. We replicated the cynicism finding in a second study that delivered the same content via a smartphone app, with results in the same ballpark.

I want to be careful about what the study does and does not show, because the last thing I want to do is overclaim from pilot data. Both studies were single-arm with self-selected samples, which means we cannot yet make the kind of clean causal claims that a randomized controlled trial would allow us to make (stay tuned! We just finished data collection for that study). The effect sizes were large enough, though, and the replication was clean enough, that I think we are looking at a real signal rather than noise. The question I find more interesting is why something this short and this minimal would do anything measurable to cynicism, and the answer, I think, has to do with what mindfulness actually does to a habit loop when you apply it correctly.

Mindfulness does not make you care more, and it does not try to argue you out of the detachment you have been practicing. What it does is insert a small gap between the trigger and the behavior, perhaps just enough of a beat where you can notice what is actually happening in the moment. Oh. That patient’s story just landed in my chest. My shoulders are tight, my jaw is clenched, and I am about to go into efficiency mode to make this feeling go away.

The noticing, by itself, is an important move, because once the loop is visible to you while it is running, the reward value of detachment gets quietly updated. Detachment stops registering as relief and starts registering as what it actually is, which is a subtle kind of leaving. And the alternative (staying present with the patient and with your own reaction to the patient), turns out to be more rewarding than you would predict from the outside, not because it feels good in any conventional sense, but because it is the thing you actually came here to do in the first place.

I want to say something about the version of this objection that I know some readers are already forming, because I would be forming it too if I were reading this from the other side. And I’ve seen it come up over and over when I’m giving talks about my burnout research or working with clinicians who are struggling with burnout.

A significant portion of cynicism can feel and is, straightforwardly, earned. It is earned by systems that treat clinicians as interchangeable throughput units. (For those not in the profession, we are literally called “RVUs”: Relative Value Units based on how much we are billing for our services.) It is earned by electronic health records that appear to have been designed by people who have never actually used one in a clinical encounter. It is earned by insurance denials, by the moral injury of watching patients lose coverage they need for reasons that have nothing to do with medicine, by the slow accumulating recognition that the institution you work for has priorities that are not always aligned with yours. My colleagues and I didn’t go into medicine so we could spend time fighting with insurance companies and documenting our charts to de-risk lawsuits.

Nothing I am describing here is meant to suggest that the cynicism is a clinicians fault, or that we all should use mindfulness as a way out of a structurally broken system. That’s not how mindfulness or systems work. The objective read of the burnout literature is quite clear that individual-level interventions are not a substitute for organizational change. We need both, and anyone telling you otherwise is likely whitewashing something.

What I am pointing at is smaller and more personal than the structural question. Inside the broken system, there is still a version of you that has to walk into the next room, and then the room after that, and what I am asking is whether the habit of distancing (once it is running on autopilot, which it is) is costing you something you would rather not pay. For a lot of the clinicians I work with, the answer they arrive at, once they can actually see the loop running, is yes. They notice that they have become someone they don’t quite recognize anymore, and they want to know if there is a way back toward the person they were when they started.

There is, and the way back is not particularly dramatic. It begins with being able to see the loop while it is happening, which is a skill, and skills can be trained, which is ultimately what the data in our study are pointing toward.

The system is not going to fix itself this week, the patient load is not going to lighten, and the charting is not going to do itself no matter how long you wait. What can shift, in the next encounter, is whether we are able to notice the moment when our nervous system reaches for the usual move. That noticing does not require an app or a retreat or an extra hour carved out of a day that does not have an extra hour in it. What it requires is the recognition that the thing we had taken to be a fixed feature of who we have become is actually a loop that got trained, and that loops which got trained can also get retrained, slowly and patiently, one encounter at a time.

The burnout training that I mentioned in this article is freely available on The Dr. Jud Podcast, on any podcast player.

Judson Brewer MD PhD is a psychiatrist and neuroscientist and professor at Brown University. He is the author of Unwinding Anxiety (NYTimes bestseller), The Craving Mind, The Hunger Habit and The Unwinding Anxiety Workbook. He co-founded MindshiftRecovery.org which provides free support for people with any type of addiction.

If you are struggling with anxiety, Dr. Brewer’s Going Beyond Anxiety program brings together his research and clinical experience to help people build effective skills to reduce anxiety and cultivate calm (www.goingbeyondanxiety.com).

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Copyright © 2025, Judson Brewer, MD, PhD. All rights reserved.

REFERENCES

Antico, L., & Brewer, J. A. (2025). Digital mindfulness training for burnout reduction in physicians: Clinician-driven approach. *JMIR Formative Research*, *9*, e63197. https://doi.org/10.2196/63197

Brewer, J. A. (2019). Mindfulness training for addictions: Has neuroscience revealed a brain hack by which awareness subverts the addictive process? *Current Opinion in Psychology*, *28*, 198–203. https://doi.org/10.1016/j.copsyc.2019.01.014

Brewer, J. A., Mallik, S., Babuscio, T. A., Nich, C., Johnson, H. E., Deleone, C. M., Minnix-Cotton, C. A., Byrne, S. A., Kober, H., Weinstein, A. J., Carroll, K. M., & Rounsaville, B. J. (2011). Mindfulness training for smoking cessation: Results from a randomized controlled trial. *Drug and Alcohol Dependence*, *119*(1–2), 72–80. https://doi.org/10.1016/j.drugalcdep.2011.05.027

Roy, A., Druker, S., Hoge, E. A., & Brewer, J. A. (2020). Physician anxiety and burnout: Symptom correlates and a prospective pilot study of app-delivered mindfulness training. *JMIR mHealth and uHealth*, *8*(4), e15608. https://doi.org/10.2196/15608

Roy, A., Hoge, E. A., Abrante, P., Druker, S., Liu, T., & Brewer, J. A. (2021). Clinical efficacy and psychological mechanisms of an app-based digital therapeutic for generalized anxiety disorder: Randomized controlled trial. *Journal of Medical Internet Research*, *23*(12), e26987. https://doi.org/10.2196/26987

Maslach, C., & Leiter, M. P. (2017). New insights into burnout and health care: Strategies for improving civility and alleviating burnout. *Medical Teacher*, *39*(2), 160–163. https://doi.org/10.1080/0142159X.2016.1248918

Shanafelt, T. D., West, C. P., Dyrbye, L. N., Trockel, M., Tutty, M., Wang, H., Carlasare, L. E., & Sinsky, C. (2022). Changes in burnout and satisfaction with work-life integration in physicians during the first 2 years of the COVID-19 pandemic. *Mayo Clinic Proceedings*, *97*(12), 2248–2258. https://doi.org/10.1016/j.mayocp.2022.09.002

World Health Organization. (2019, May 28). *Burn-out an “occupational phenomenon”: International Classification of Diseases.* https://www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases

Cooke, G. P., Doust, J. A., & Steele, M. C. (2013). A survey of resilience, burnout, and tolerance of uncertainty in Australian general practice registrars. *BMC Medical Education*, *13*, 2. https://doi.org/10.1186/1472-6920-13-2

Strout, T. D., Hillen, M., Gutheil, C., Anderson, E., Hutchinson, R., Ward, H., Kay, H., Mills, G. J., & Han, P. K. J. (2018). Tolerance of uncertainty: A systematic review of health and healthcare-related outcomes. *Patient Education and Counseling*, *101*(9), 1518–1537. https://doi.org/10.1016/j.pec.2018.03.030

Gleichgerrcht, E., & Decety, J. (2013). Empathy in clinical practice: How individual dispositions, gender, and experience moderate empathic concern, burnout, and emotional distress in physicians. *PLOS ONE*, *8*(4), e61526. https://doi.org/10.1371/journal.pone.0061526

Klimecki, O., & Singer, T. (2012). Empathic distress fatigue rather than compassion fatigue? Integrating findings from empathy research in psychology and social neuroscience. In B. Oakley, A. Knafo, G. Madhavan, & D. S. Wilson (Eds.), *Pathological altruism* (pp. 368–384). Oxford University Press.

From a neuroscience standpoint, that initial dopamine hit reinforces the behavior and makes us more likely to return to it, and just like any other addiction, the reward diminishes while the harm compounds. Anger starts to own us, and we don’t notice because we’re too busy feeling righteous about it.

Several years ago, I went on a month-long silent retreat with the aim of developing a specific concentration meditation practice I’d been working toward for two years, under the guidance of my teacher Joseph Goldstein. All the physical conditions were perfect — quiet, beautiful setting, no distractions, nowhere to be. The mental conditions were a complete mess.

I had a colleague at work, let’s call her “Jane,” with whom I was having serious difficulty. Every time a thought of her arose during meditation, I’d spiral into elaborate mental simulations: what I should have said, what I’d say next time, how thoroughly justified I was in all of it. That’s exactly the problem. Remember that honeyed tip? Self-righteous anger is about as seductive as it gets. Here I was on a silent retreat, supposed to be developing deep concentration, and instead I was running the same mental courtroom drama on repeat, prosecuting Jane for the hundredth time. Which is what made Confucius’ observation land so hard when it finally hit me: “Before you embark on a journey of revenge, dig two graves.”

For most people, anger doesn’t just flare up randomly. It starts with expectations — we want something, or expect something not to happen, and when reality violates that expectation, the fuse gets lit. And the fuse has a spectrum to it. Something small happens and we get miffed, a little perturbed. It happens again, and now we’re frustrated. The next time we’re upset, then angry, then furious, then enraged. What looks like a sudden explosion is usually just the latest step in a progression that’s been building through dozens of small reinforcements, each one making the next a little easier to reach.

Here’s a concrete example, one that I suspect most of us have lived through. You order something online and it arrives broken. By the time you’ve hunted down the phone number (which the company has helpfully buried three pages deep on their website), you’re already a little annoyed. You get routed through a chatbot that asks the same four questions in different orders and resolves nothing. Now you’re frustrated. You finally reach a human being, the situation gets heated, and eventually — somehow, after all of that — you get what you wanted. Problem solved, call over, you move on. Or so you think.

Here’s what your brain quietly recorded during that interaction: anger worked.

But did it? This is the causation problem that sits at the heart of the whole thing. Two events can be true simultaneously without one causing the other. The situation would probably have resolved whether you got heated or not. The customer service rep may have given you what you wanted specifically to end the call, which means anger worked in the narrowest possible sense while actively harming another person who was just doing their job. And your brain, which is not particularly interested in philosophical nuance when there’s a reward on offer, filed this away under “anger = results.” The habit loop gets reinforced, and you walk away a little more primed to do it again next time. You repeat the process to yourself and to whoever happens to be on the receiving end.

So we learn three things from this loop: (1) We learn that anger is a reliable way to get what we want (or at least we think it does). (2) We learn to harm others in the process of getting it. AND (3) We slowly poison ourselves, because each time we complete that loop, we make the loop more likely to run again. The ancient texts weren’t being poetic when they called anger a poison.

But what if I was right, and I was wronged?

This is where most people push back, and reasonably so. What about genuine injustice to us, to our community, to the world? Doesn’t anger serve a purpose when someone has actually done something wrong?

It’s worth separating two things that often get conflated: the wrongdoing itself, and how we respond to it. When the prefrontal cortex goes offline in blind rage (and “blind rage” isn’t called that for nothing — this is a literal description of what happens in our brain when the cognitive control regions of the brain get overridden by the stress response), everyone gets hurt, including the person trying to address the injustice. The smoke from those fires makes it hard to see clearly, and clarity is exactly what you need when something genuinely important is at stake.

I also want to be clear that I’m not suggesting we wrap ourselves in some fireproof kindness blanket and let the world burn. Compassion isn’t passive. Compassion is actually the opposite of passive. Gandhi’s movement to win Indian independence from the British. The civil rights movement in the United States. The anti-Apartheid movement that led to Nelson Mandela’s election. These were not passive endeavors, and the people leading them understood something that rage-driven action tends to miss: you fight for change and justice more effectively when you can see.

Martin Luther King Jr., preaching in 1967 about the violence being done to Black Americans, famously said: “Bomb our homes and threaten our children, and, as difficult as it is, we will still love you.” That is the opposite of wrapping ourselves up, being passive or avoidant. That is a different quality of fuel, one that doesn’t consume the person holding it. See how much stronger love is than hate? The goal isn’t to extinguish the energy — it’s to repurpose it.

Back on my retreat.

By day three I had developed a phrase I’d say to myself when I felt the anger starting to spin up: “big, big, big.” For me, that meant opening my heart wide when I felt it beginning to close down. Predictably, mid-walking meditation, I got swept up in another elaborate Jane fantasy. The mindstate was extraordinarily seductive. And then I asked myself the question I ask my patients when we’re mapping out habit loops: “What am I getting from this?”

The answer came to me in a blaze. NOTHING. I was getting nothing. For the first time, I saw clearly that the self-righteous buzz of anger itself was the reward. It wasn’t resolution, not justice, not even relief. Just the sweet, seductive honeyed buzz, feeding itself, and keeping me far away from my actual goal of developing concentration. Like patients who after twenty or thirty years of smoking finally pay careful attention to what a cigarette actually tastes like and realize with some shock that it’s not good, I finally tasted the poison in the root. It was right there the whole time. Acrid. Bitter. Yuck.

Once I tasted anger that clearly, something lifted. Each time anger arose after that, letting go became less of a struggle, not because I was suppressing anything or forcing myself through it with willpower, but because the reward had lost its shine. The fire still flared up. It still flares up now. But I could catch it earlier, before it set the whole mind ablaze.

That’s disenchantment, and it’s worth understanding what it actually is and isn’t. It’s not a technique we apply. It’s not positive thinking or counting to ten. It’s the result of looking honestly at what we’re actually getting from a behavior — all of it, not just the honeyed tip — and letting that seeing do the work.

We have to taste the bitterness of poison to spit it out.

This is something all of us can practice. When anger has burned down, survey the scene before moving on. Have you burned a bridge? Scarred a relationship? Done damage you now have to repair? That retrospective, looking back and looking honestly at the results when the heat has died down, is what builds disenchantment over time, and disenchantment is what makes us less likely to reach for the match next time. We don’t need someone to tell us to stop getting angry. Simply seeing it clearly is enough.

From there, it becomes possible to start working with the earlier, smaller flares: the irritation, the frustration, the miffed, before they build into something harder to work with. Each time we catch it early and reach for something more rewarding than the loop (kindness to the situation, to the other person, to ourselves), we’re building a different habit, one whose rewards don’t leave a bitter aftertaste.

Ready for something really radical?

Here’s the Pali Canon text I quoted at the top, in full:

“Having slain what, does one sleep soundly? Having slain what, does one not sorrow? What is the one thing, O Gotama, Whose killing do you approve?”

[The Buddha replies:]

“Having slain anger, one sleeps soundly; Having slain anger, one does not sorrow; The killing of anger, O devatā, With its poisoned root and honeyed tip: This is the killing the noble ones praise, For having slain that, one does not sorrow.”

That’s right. An eye for an eye is way too much. The suggestion here is that the juice is not worth the squeeze. When anger only tastes bitter and we see how poisonous it is, we are moved to move beyond it. Radical indeed.

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Judson Brewer MD PhD is a psychiatrist and neuroscientist and professor at Brown University. He is the author of Unwinding Anxiety (NYTimes bestseller), The Craving Mind, The Hunger Habit and The Unwinding Anxiety Workbook. He co-founded MindshiftRecovery.org which provides free support for people with any type of addiction.

If you are struggling with anxiety, Dr. Brewer’s Going Beyond Anxiety program brings together his research and clinical experience to help people build effective skills to reduce anxiety and cultivate calm (www.goingbeyondanxiety.com).

Copyright © 2025, Judson Brewer, MD, PhD. All rights reserved.

REFERENCES

​​Bhikkhu Bodhi (Trans.). (n.d.). Sutta 1.71: Anger (SN 1.71). SuttaCentral. https://suttacentral.net/sn1.71/en/bodhi

King, M. L., Jr. (1967, December 24). A Christmas sermon on peace [Sermon]. Ebenezer Baptist Church, Atlanta, GA.

I’ve been sitting with that line, because it describes something I spent years learning the hard way in my own clinical training. Something that was intangible yet seemed important.

Let’s back up a bit in time.

Early in my psychotherapy training, I was taught the phrase “the less you know, the more you say.” The target of this little aphorism was therapist anxiety, specifically the way a trainee’s insecurity tends to spill out as verbosity. When you don’t know what you’re doing, you talk. You fill silence with theory, with interpretations, with carefully reasoned arguments that (you tell yourself) are serving the patient but are really serving your own need to feel competent. I understood this intellectually within about a week of starting my training. And it showed up big time.

Actually learning to keep my mouth shut took considerably longer.

I watched myself ramble on enough times to get embarrassed about it. I’d be sitting with a patient, they’d share something genuinely painful and complicated, and rather than following their thread with curiosity, I’d find myself mentally sprinting toward some theoretical framework that might “explain” what they were describing. I’d say whatever was running, or more accurately racing, through my mind (something appropriately clinical, I hoped) and then I’d watch their face. Their face would tell me, with remarkable consistency, that I had just taken a wrong turn. The session would flatten. The energy would drain out of it, the way a conversation does when someone realizes you’ve been half-listening. I would backpedal or check the clock, hoping that we were nearing the end of the session.

Apologies to all of my patients whom I worked with during residency. I look back on that time and try not to cringe too much.

What shifted things for me (not all at once, but gradually through growing pains, the way these things actually change) was noticing what happened when I stopped trying to demonstrate intellectual competence or lean too heavily on a particular theoretical orientation and instead started getting genuinely curious. Importantly, this was not about performing curiosity (and there is a difference, one your patient can feel from across the room), but actually wanting to know more about their experience, their story, what it felt like from the inside.

When I could settle into genuine curiosity, something different started happening in sessions. Patients would follow their own threads longer. Insights would surface that I never would or could have led them to. And (this is the part that still blows me away) they would often answer their own questions, resolve their own confusions, without my having to say much of anything. I found myself asking more and saying less, and the sessions felt qualitatively better for both of us, partly because patients were discovering that they were considerably wiser than they’d given themselves credit for. Instead of sweating and praying for the session to end, and feeling exhausted afterwards, I would finish up energized and surprised with how little I needed to say.

And critically, I started to gain confidence in something that might sound wild and even heretical: I really didn’t need to know much of anything theoretical to do good therapy. I only needed to be genuinely curious. Perhaps this is where the “dodo bird effect” comes in: the somewhat deflating finding (deflating, at least, if you’ve staked your identity on a particular theoretical orientation) that virtually all bona fide psychotherapies produce roughly equivalent outcomes across hundreds of trials. The name comes from the Dodo in Alice in Wonderland, who declares after a thoroughly chaotic race that “everybody has won and all must have prizes.” If CBT and psychodynamic therapy and interpersonal therapy all work about equally well, the obvious question is what they share rather than what distinguishes them. And what they share, it turns out, may not be a technique.

This is what Mahler was pointing at, I think. A pianist can master the score completely (every note, every dynamic marking, every tempo indication) and still walk onto the stage and produce something technically precise and utterly lifeless. What transforms precision into something that moves people is presence, not a technique for presence or a checklist of presence-adjacent behaviors, but the real thing: genuine attention to what’s unfolding right now, rather than to one’s own preparation for it. Therapy as music.

Again, this is not performative. True performers aren’t trying to perform. The performance is a result of curiosity, play and flow, which can’t be planned or prescribed. The more I tried to perform therapy the more I played out of tune. The more I simply let the sessions flow, the more musical they were.

The field has generated an enormous amount of technical knowledge over the past century (diagnostic frameworks, treatment protocols, intervention hierarchies) and the evidence suggests, somewhat uncomfortably, that it mostly doesn’t matter which one you use. Here’s where the dodo bird effect comes in again: what predicts whether therapy helps is the quality of the therapeutic relationship, regardless of theoretical orientation. The score is almost beside the point, and the essential is everything.

What creates that quality of relationship? The argument my colleague Fabio Giommi and I make in a paper we recently published in Frontiers in Psychology is that genuine curiosity sits at the heart of it, not what psychologists call deprivation curiosity (the anxious, contracted need to fill information gaps, to figure out what’s wrong and what to do about it) but interest curiosity, the kind that’s open and exploratory and feels, from the inside, more like wonder than like problem-solving. When a therapist is actually operating from that place, it tends to be contagious. Patients start exploring their experience more openly, rather than defending their story or performing their distress. Something in the room changes, and both people feel it.

In the paper, Dr. Giommi and I caution about synchopathy which is a form of reflexive (and even habitual) affirmation. The therapist who consistently validates, agrees, reflects back warmly, and never quite challenges, never sits with the patient in genuine uncertainty about whether the story they’re telling themselves actually holds up. It can look like empathy and feel like support, and in the short term patients often experience it as such. What it quietly forecloses and even trains both the therapist and patient out of (because it makes them both comfortable, and even comfortably numb over time) is challenge and growth, which requires someone willing to be honestly curious rather than reliably agreeable.

Curiosity, if it’s real, will more than occasionally take you somewhere uncomfortable. It will generate questions that don’t confirm the existing narrative, notice contradictions the patient has been carefully smoothing over, and follow threads the patient might prefer to leave alone. A therapist who is afraid of that territory (whether from their own conflict avoidance, or from a sincere but misapplied commitment to unconditional positive regard) isn’t being curious. They’re being careful, and their patients, on some level, tend to know it (unless they’ve learned to love coming to sessions to numb out over time).

What the neuroscience adds is that this isn’t just a vague interpersonal impression. The brain constructs its experience of the world by generating models and filtering incoming information through them, only updating when there’s a meaningful mismatch between what it predicts and what it actually receives. In neuroscience, these are literally called generative models. A simpler, more down to earth term is a world view. A therapist who has formed a confident model/world view of who a patient is, what’s wrong with them, and what they need, will be more likely to automatically filter that patient’s words through that model (filling in gaps, smoothing over contradictions) and in doing so, reliably miss the actual person sitting across from them. At the same time, patients develop their own world view (of themselves) and also filter their experience and what they hear in therapy through their own lens, which contributes to keeping them stuck but in familiar territory (familiar feels comforting). Curiosity disrupts this by keeping the model provisional, allowing new information to actually land.

Everything is written in the protocol except the essential. The essential (as far as I can tell from several decades of practice and more than a few embarrassing sessions early in my training) can’t be written down because it isn’t a technique. It’s a quality of attention, one that has to be cultivated, felt rather than performed, and that when it shows up in a room where someone is struggling, tends to make that room a safer place. Safety opens up the space for honesty (with themselves and their therapist), learning and growth.

Therapy as music = magic.

If you’re a therapist (early career)

When you notice yourself talking more than usual in a session (filling silence, reaching for theory, building an argument nobody asked for) what’s actually driving that? Is it that you have something genuinely useful to offer in that moment, or is sitting with not-knowing uncomfortable enough that talking has become how you manage it? And if it’s the latter, what would happen if you just didn’t? What might your patient say into that silence that they haven’t had room to say yet? And what happens when you bring curiosity into that space? This open space, imbued with curiosity, may be more useful than the theory.

If you’re a therapist (experienced)

The question I find more honestly difficult than anything I’d aim at a trainee is: how would you know if you were doing it? The brain builds models and filters incoming information through them, updating only when something surprising gets through. The more clinical experience you accumulate, the more refined and confident those models become, and the more seamlessly they sort incoming information into familiar categories before you’ve consciously registered what you just heard. This is confirmation bias operating at the level of expertise, and it’s more insidious than trainee anxiety precisely because it feels like competence rather than a problem. So the question worth sitting with (maybe after your next session rather than in the abstract) is how curious you were in session, whether you were genuinely surprised by your patient today, whether something they said landed in a way you didn’t expect, whether your model of them got updated, or whether everything more or less confirmed what you already thought.

If you’re a patient

The most useful thing therapy can offer (more than the “right” interpretation or the correct diagnosis or even particularly good advice) is a quality of attention that gives you enough space to hear yourself think, and let yourself feel. If your therapist’s questions are mostly opening things up rather than steering you somewhere, if you find yourself surprising yourself with what comes out of your mouth, if you leave sessions feeling more like a capable person and less like a problem to be solved, that’s the essential at work.

If that’s not what’s happening, it’s worth paying attention to that too. Therapy is not a situation that calls for politeness at the expense of honesty. You are allowed to notice if the curiosity mostly flows in one direction, if your therapist seems more interested in confirming their framework than in being surprised by you, and you are allowed to say so. “I feel like we keep coming back to the same explanation and I’m not sure it fits” is not a difficult patient being resistant; it’s useful clinical information, and any therapist worth their training will receive it as such. If they don’t, if what comes back is defensiveness or an escalation of the very certainty you were questioning, that’s worth making a note of. Finding a therapist who is curious about you specifically, rather than about the diagnostic category you happen to fit, is not a luxury. Any musician will tell you that the notes are the easy part. What you’re looking for is the person who can move beyond them.

PS. If this piece resonated and you’re a clinician looking to cultivate genuine curiosity as a clinical skill rather than just a concept, we’re offering a short training in exactly that: Cultivating Curiosity for Habit Change: Mindful Inquiry Training for Transformation.

Judson Brewer MD PhD is a psychiatrist and neuroscientist and professor at Brown University. He is the author of Unwinding Anxiety (NYTimes bestseller), The Craving Mind, The Hunger Habit and The Unwinding Anxiety Workbook. He co-founded MindshiftRecovery.org which provides free support for people with any type of addiction.

If you are struggling with anxiety, Dr. Brewer’s Going Beyond Anxiety program brings together his research and clinical experience to help people build effective skills to reduce anxiety and cultivate calm (www.goingbeyondanxiety.com).

Subscribe now

Share

Copyright © 2025, Judson Brewer, MD, PhD. All rights reserved.

REFERENCES

Brewer, J. A., & Giommi, F. (2025). Psychotherapy as investigation: cultivating curiosity and insight in the therapeutic process. Frontiers in Psychology, 16, 1603719. https://doi.org/10.3389/fpsyg.2025.1603719

Luborsky, L., Singer, B., & Luborsky, L. (1975). Comparative studies of psychotherapies: Is it true that “everyone has won and all must have prizes”? Archives of General Psychiatry, 32(8), 995–1008. https://doi.org/10.1001/archpsyc.1975.01760260059004

Wampold, B. E., Mondin, G. W., Moody, M., Stich, F., Benson, K., & Ahn, H. (1997). A meta-analysis of outcome studies comparing bona fide psychotherapies: Empirically, “all must have prizes.” Psychological Bulletin, 122(3), 203–215. https://doi.org/10.1037/0033-2909.122.3.203

“It’s food,” she said. “I’m either eating right or I’m not. If I’m not, what’s the point?”

I asked if anyone else in the meeting could relate to this and looked around the Zoom gallery. Hands were going up everywhere. She was speaking for the masses.

“I can’t eat perfectly every day,” she continued, “so I go to bed feeling like I failed again.”

I asked her how long she’d been doing this.

“Since I was seven. I’m turning fifty.”

Forty-three years. That’s a lot of nights going to bed feeling like a failure.

I wanted to understand what was happening in the moment when everything fell apart. “When a craving hits, what happens?” I asked.

“By the time it hits, I go do it.”

“Okay, but what about right before? That moment just before you eat?”

“It’s a war inside me. Will I, won’t I, should I, shouldn’t I? Then I do it.”

“Is that war in your body?”

“Yes. I’m tense just thinking about it.”

What she was describing, that tight warring feeling in the body before a craving lands, was contraction: that physical signature of resistance that shows up whether we’re fighting anxiety, cravings, or, as it turned out, something deeper.

We started exploring what happens in her body when this war begins. Just talking about it, she described how she could feel the tension (and I could see it in her face). I asked her to get curious about it, to simply ask herself: “What does this feel like?”

“Just thinking about it releases it a bit,” she said.

“What if that’s all you need?” I suggested.

She paused. “It can’t be that easy. There’s a voice saying I have to fight [the urges to eat].”

Of course there is, because for forty-three years, fighting had been the strategy. Diet plans, food rules, willpower, the whole battle. And where had it gotten her? Heartache and exhaustion, by her own account.

Then she said something that shifted the whole conversation: “I guess shame gets in the way too.”

Shame is that heavy, crushing feeling that shows up right after we “fail,” the voice insisting we’re not just doing something wrong but that we ARE wrong, broken, fundamentally flawed. Brené Brown, who has spent decades studying this, draws a sharp distinction: guilt circles around what you did; shame goes after who you are. Guilt can motivate change. Shame attacks the very sense of self that would need to be intact to make that change.

Ready for this? Most of us don’t realize that shame is a habit.

It starts with doing something we feel guilty about (“I shouldn’t have done that”). Guilt triggers rumination, where we dwell on the act. Over time, the focus shifts from what we did (“I ate too much”) to who we are (“I have no self-control”), and once we’ve made that leap, we start to believe we are the mistake (“I am a failure”) rather than that we made one. That’s how shame takes hold.

From a reinforcement learning standpoint, guilt functions as punishment: it feels bad, so any behavior that prevents it gets reinforced. Shame works similarly, and then it goes a step further.

At times, shame may even feel rewarding: a strange sense of agency, control, or predictability through self-criticism. That illusion of “doing something” provides a short-term payoff, even as it deepens the habit. Once rumination and self-criticism become grooved, the harsh inner critic predictably appears whenever shame is triggered. There’s a strange comfort in that, because doing something, even judging ourselves, feels better than doing nothing.

Our brains hate uncertainty and will choose painful certainty over the unknown. Yes, this sounds odd if not downright off, but that’s how our brains work. “At least I know I’m a failure” can feel more comfortable than the vulnerability of trying something new and risking disappointment again. Shame itself doesn’t feel good, but over the years it begins to feel like a trusty traveling companion, so familiar we forget to check whether it’s weighing us down.

From a functional standpoint, our brain is the perfect incubator for shame: our thoughts can repeat endlessly without anyone knowing we’re ruminating. Brown notes that silence and secrecy are precisely the conditions where shame thrives, which is one reason it gets so much uninterrupted practice.

Unfortunately, many people are raised in environments where caregivers or institutions use shaming techniques, explicitly or implicitly, to enforce social norms and obedience. This repeated exposure from a young age conditions the internal shame response, essentially wiring it as the default, if deeply unhelpful, mode of self-regulation later in life.

Shame also corrodes the very capacity to believe we can change. The more identified we become with it, the more our worldview shifts. Like glasses worn so long we forget they’re there, we start seeing everything through an “I’m broken” lens, interpreting new information to confirm what we already believe. By then, the idea of taking them off feels genuinely threatening.

This tends to produce the behaviors that keep the cycle running: hiding, withdrawing, giving up.

Shame is remarkably sticky for exactly this reason: it’s been reinforced thousands of times in the privacy of our own heads, and each repetition strengthens the pathway. So how do you take off those glasses?

Studies on shame show that it lights up a network of brain regions involved in self-referential processing. The medial prefrontal cortex and posterior cingulate cortex, core hubs of what is known as the default mode network, activate when people imagine shameful scenarios. This same network is what my lab has spent years studying in relation to craving, worry, and getting “caught up” in experience.

When you’re lost in shame (“I’m such a failure”), you’re activating the same brain regions that fire when you’re lost in a craving or stuck in anxious rumination. The posterior cingulate cortex, that brain region I’ve studied extensively in relation to addiction, doesn’t just light up when smokers crave a cigarette or when people anxiously spin out in cycles of worry; it also activates during shame.

When we identify with shame, we’re caught in the narrative, the story, the judgment. The prefrontal cortex spins stories about our character, our worth, our inability to change. Just as people who overidentify with anxiety come to believe they are an anxious person, we can get stuck in shame-as-identity (“I am no good”) rather than shame-as-experience.

Meanwhile, our older brain networks, including the insula, which processes both our body’s internal state and emotional salience, come online as well. The insula integrates signals from inside the body (that heavy, crushing sensation of shame) with our emotional state and sense of self, likely through links back to the posterior cingulate cortex.

The brain loops take hold fast. Shame activates the insula, processing those uncomfortable body sensations, while the medial prefrontal cortex and posterior cingulate cortex keep the shame story running (“this means something about WHO I AM”). And suddenly we’re reaching for food or another distraction to make it stop.

Ironically, we often reach for the very thing that triggered shame in the first place.

So how can we free ourselves from these shame spirals? The person in my Zoom call had been spinning for forty-three years, which is a long time to be dizzy.

“Can you feel into the shame?” I asked.

“It’s heavy.”

“Ask yourself: what does this feel like in my body?”

There was a shift in her face.

“That switches me from being the shame to simply feeling it.”

She’d found the doorway in.

When she turned curiosity toward the physical sensation of shame, something shifted: she created space between herself and the feeling, moving from “I am ashamed” to “I am experiencing shame.”

When we get curious about shame as a sensation (heavy, tight, crushing, whatever it feels like for us), we activate a different system altogether. We’re observing rather than being swallowed by the narrative, stepping outside the story long enough to actually look at it.

My lab has found that when experienced meditators practice mindfulness, activity in the posterior cingulate cortex decreases. We’ve even found that in people trying to quit smoking, reductions in these brain regions after mindfulness training predict reductions in cigarette smoking. The same region that lights up during craving, worry, and shame quiets down when we bring curious awareness to our experience.

Experientially, curiosity and shame can’t occupy the same moment. Curiosity feels open and expansive; shame contracts. You can’t be genuinely curious about what something feels like in your body while simultaneously being crushed by it.

Curiosity also shows us what shame actually gets us. When we pay attention to what shame feels like (heavy, crushing, contracting) and trace where it leads (more eating, more hiding, more exhaustion), we start updating the reward value in our brain. The orbitofrontal cortex, which is always running comparisons, starts getting accurate information. Shame, looked at clearly, stops justifying itself.

And once curiosity reveals that shame feels terrible and doesn’t actually help, it tends to call in its close cousin: self-compassion.

The next time shame shows up, about food or anything else, there’s a simple experiment worth running. Before you do anything about it, get curious: what does this actually feel like in my body right now? Then try talking to yourself the way you’d talk to a good friend who was struggling with the same thing. Something like: this is hard, I’m doing the best I can. Notice what shifts in your body between those two states. Your brain is always running a comparison, and it will move toward whatever feels more rewarding. For most people, the warmth of self-compassion is a pretty clear winner over shame’s cold contraction, once you can actually feel the difference.

This is how the habit loop itself becomes the path out.

She mentioned that voice, the one that says she has to fight, that it can’t be this easy, that letting go of the battle means losing control entirely.

I hear that voice all the time, and it makes a certain kind of sense: if you’ve been white-knuckling your way through life for decades, the idea of not fighting feels genuinely dangerous.

So I asked her to check: what had she actually gotten from listening to that voice for the past forty-three years?

The answer came quickly: heartache, exhaustion, forty-three years of going to bed feeling like a failure.

The leverage point is looking clearly at what the actual behavior produces, not the behavior we wish we were doing. In her case that meant tracing the real sequence: try to follow the rules, should all over herself, give up, feel shame, repeat. When we see clearly that the strategy isn’t working, really see it and feel it in our bodies, we create the conditions for something new.

Shame thrives in silence and secrecy, which is why compassion is so disruptive to it. This may be why the group setting, where others’ raised hands demonstrated “me too,” can be so useful for healing. By inviting curiosity and sharing the experience, we transform a private battle into something recognizably human, and remind ourselves that we are not alone in it.

We can also offer compassion to ourselves, and we can use the brain’s reinforcement learning system to make that a habit. When we actually compare what rumination and self-criticism feel like against self-compassion, the brain’s verdict tends to be pretty unambiguous. This helps us become disenchanted with the old habits because we see clearly that they’re not helping. We start recognizing the shame spirals whenever they arise and bring a moment or two of self-compassion in, as simple as reminding ourselves that we are worthy, that we’re doing the best we can. Short moments of self-compassion throughout the day are how we build it into a habit.

I gave her a mission (should she choose to accept it):

Any time those old habits come up (the voice of shame, the “I have to fight,” the “I am a failure”), ask: What did I get from listening to this last time?

Then drop into the body: What does this feel like right now?

No food rules, fighting with or blaming herself. Just curiosity about what’s actually happening. And perhaps a touch of compassion for good measure.

Why the 1-2 of curiosity followed by compassion? Curiosity creates the open space to step out of the old shame spiral, and compassion offers the rewarding alternative that helps you stay out.

As Rumi, the 13th century Sufi mystic wrote:

Be empty of worrying

Think of who created thought

Why do you stay in prison

When the door is wide open?

Move outside the tangle of fear thinking.

Live in silence.

Flow down and down in always

Widening rings of being.

(“A community of spirit,” Rumi)

Judson Brewer MD PhD is a psychiatrist and neuroscientist and professor at Brown University. He is the author of Unwinding Anxiety (NYTimes bestseller), The Craving Mind, The Hunger Habit and The Unwinding Anxiety Workbook. He co-founded MindshiftRecovery.org which provides free support for people with any type of addiction.

If you are struggling with anxiety, Dr. Brewer’s Going Beyond Anxiety program brings together his research and clinical experience to help people build effective skills to reduce anxiety and cultivate calm (www.goingbeyondanxiety.com).

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Copyright © 2025, Judson Brewer, MD, PhD. All rights reserved.

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