Empowering physicians through mindfulness training
Recommended Book:
The Art of Racing in the Rain by Garth Stein
Best Way to Contact Judson:
: Hey Outcomes Rocket friends, thanks for tuning in to the podcast once again. As a leader in health care, you have big ideas, great products, a story to tell, and are looking for ways to improve your reach and scale your business. However there’s one tiny problem. Health care is tough to navigate and the typical sales cycle is slow. That’s why you should consider starting your own podcast as part of your sales and marketing strategy. At the Outcomes Rocket, I’ve been able to reach thousands of people every single month that I wouldn’t have otherwise been able to reach if I had not started my podcast. Having this organic reach enables me to get the feedback necessary to create a podcast that delivers value that you are looking for. And the same thing goes if you start a podcast for what you could learn from your customers. The best thing about podcasting in healthcare is that we are currently at the ground level, meaning that the number of people in healthcare listening to podcasts is small but growing rapidly. I put together a free checklist for you to check out the steps on what it takes to create your own podcast. You could find that at outcomesrocket.health/podcast. Check it out today and find a new way to leverage the sales, marketing and outcomes of your business. That’s outcomesrocket.health/podcast.
: Welcome back to the broadcast. Today I have an outstanding guest. His name is Dr. Judson Brewer. He’s the Founder at MindSciences. Judson’s a thought leader in the field of habit change and the “science of self-mastery”, having combined over 20 years of experience with mindfulness training and scientific research therein. He’s a Director of Research and Innovation at the Mindfulness Center and Associate Professor of Psychiatry at the School of Medicine at Brown University. He’s also a Research Affiliate at MIT. A psychiatrist an internationally known expert in mindfulness training for addictions. Brewer has developed and tested novel mindfulness programs for habit change including both in person and app based treatments for smoking, emotional eating, and anxiety. This gentleman has a ton of experience. He’s been featured on many media platforms like TED, Al Jazeera, NPR, the list is long. What I want to do is open up the microphone to Judson give his little introduction and I want to welcome you into the podcast.
: Thanks for having me.
: It’s a true pleasure. And so Judson just curious is there anything in that intro that I missed that you want to highlight to the listeners?
: Sounds great.
: Awesome man and guy like you you’re just like “Man how in the world that I do all that” right it’s like the time flies, you do amazing things and here you are but I’m curious what got you into the medical sector? What was that spark?
: It’s been a long and winding road. But it’s interesting I was an organic chemistry major in college and one that all of the premeds hated because I actually loved organic chemistry and wasn’t planning to go to medical school but was really fascinated by these molecules that made up life. And I remember learning about putrescine and cadaverine and things like that in my freshman chemistry class which you can guess where you know where those come from and just you know I started looking at some of the professors. I’m looking at the things you know they kind of, some of them had pigeonholed themselves to studying very small molecules for their entire lives and I was thinking yeah I had this itch to really make whatever I was doing relevant to helping people and so decided to do it MIT Ph.D. program where I could continue with my love of research but also do medical work at the same time and ideally dovetail that to and that’s that’s kind of what got me into the medical field and then and bringing out together with my own research field.
: Love that, love that. So you were the guy that screwed up the curve and made everybody else study harder.
: Maybe in one class.
: I love it man. You could definitely hear in your voice that you’re passionate about your work. And I think that tends to be the secret sauce to success. And anybody that has a meaningful and value adding career. In your perspective Judson, what would you say a hot topic that needs to be on every medical leaders agenda today?
: Burnout is just one that comes to mind. I could give you a list of five. But burnout and anxiety, big one.
: It’s a big issue. And so how and what should they be thinking about? How are you approaching this in your work? Give me some insights.
: My work focuses on behavior change and I was fascinated,first fascinated with these molecules that made up life and then started getting fascinated with like how stress affects the immune system and you know doing a bunch of molecular biology work in my Ph.D. program and then really got interested in how humans learn habits and how it can change them and as some of that work was progressing. You know we were doing work with smoking and with the emotional eating I started to see and learn in the literature that anxiety can actually be a learned behavior. You know certainly there are a lot of genetic influences that can predispose us to anxiety but we also can reinforce it in a way that I hadn’t really thought about before you know as an addiction psychiatrist I’ve certainly treated a lot of people’s anxiety and our treatments hadn’t really gotten really hit the mark. You know it seems like benzodiazepines can be helpful but they’re recommended to only be used for a short period of time because they can be addictive etc.. You know the SSRI’s aren’t showing to be particularly great. And so there really aren’t that many great medications that specifically target anxiety which actually makes sense. You know it goes back this learning system where we learn anxiety goes back all the way to the most basic process where we learn how to basically remember where food is now it’s called a reward based learning or operant conditioning. And so the anxiety piece is really interesting to see how that can contribute for example to physician burnout and what you can imagine if we’re anxious all day it consumes a huge amount of time and energy and our mental space we just don’t have that extra bandwidth to be able to be with our patients or to be leading our teams or to be working, working effectively in general. And so you know at the end of the day we go home exhausted and then just think “oh no I’ve got to do this again tomorrow”.
: Yeah. It’s a big deal. And I was just at a conference recently. Showing the stats on just job satisfaction, would you recommend this field to your kids? You know for physicians and yeah definitely glaring statistics that aren’t very encouraging for the future med student or even the clinician working in this space. Anxiety contributes to burnout. What would you say some things that you’ve been recommending or your research has been finding that helps not be as burnout.
: Well it’s a good question and we’ve been approaching this. You know if I put on my research I had.
I want to know why people get burned out and why they form anxiety habits and so have been approaching that from a translational perspective or we look at brain activity of folks to see if we can understand what brain networks are involved in these things and also have been doing intervention development where we can pair specific targeted treatments that actually focus on the payroll mechanisms underlying anxiety. So that’s how I’ve been approaching it and it’s been a really interesting journey. And I chronicled a bunch of this stuff in my book because it really talks about I should say that this premise underlying learning underlies a whole lot of things everything from being addicted to social media to distraction. It’s even getting caught up in anxiety and there’s a lot of neuroscience that’s now being discovered around this. So we’ve really taken a targeted approach where we can map out how excess habits are formed and then have been focusing actually specifically on mindfulness training and testing it to see if it can help people with anxiety. We actually just finished a large I should say a pilot study with a bunch of anxious stressed out physicians to see if you know one if we could give them a novel you know mindfulness training delivered through an app because physicians are pretty busy and we don’t want to give them more things to do and if we give them mindfulness training can we help them change their anxious habits. And does that even have a spillover effect on burnout like as like burnout inventory.
: Fascinating. A domino effect right.
: Well yeah well we found well first off it was one of ease. Unfortunately it was one of the easiest studies for me to recruit people to because there were so many stressed out physicians. And we’ve actually got about a 50% reduction in anxiety scores using this generalized anxiety measure and then more interest. Well that was great. But more interestingly we found that we got about the same level of reduction in burnout scores. So people were reporting that they were less calloused for their patients that were that callousness reduced by 50%. And these effects were lasting overtime even beyond when they were using our EP based mindfulness training. We developed this app called unwinding anxiety as a way to help them work with anxiety. So you know it really interesting just by helping people learn how their anxiety is formed that’s how we introduce the practices and then how they can use awareness or mindfulness practices to work with them helps them not only with the anxiety but also these other things that anxiety effects like burnout and callousness. So it’s a really interesting journey.
: That’s awesome yeah. And so folks Judson wrote the book, The Craving Mind. From cigarettes to smartphones to love, why we get hooked and how we could break bad habits. It’s a fascinating read. I’ll put a link to that book and the show notes so you could take a look for yourself. It’s one that is worth listening and watching his TED med talk to because he also dives into somebody’s concepts within his Ted med talk. I’ll put a link to that in the show notes as well. So without a doubt very interesting and timely Judson to be talking about this. Can you give the listeners an example of maybe a time when you had a setback or maybe some sort of learning that you learned from something not going well? And feel like we learned better from those examples and why that happened and how you are doing things differently as a result?
: How long do we have? Yeah I totally agree with you. I feel like falling on our faces really helps us learn more than succeeding at things especially if we can take every one of those incidents, incidences and instead of beat ourselves up for that which kids get to inhabit you kind of what am I. We can think of it as bowing to it as a teacher and asking “what can I learn from this?” and in that way instead of kind of closing down and walling often and thinking oh no we think wow that was crazy. What can I learn? So I’m just thinking recently you know when I’ve struggled with just even simple things because I’m trying to think of something particularly challenging that came up recently where there was a clear hard to even think of what I count as a failure because everything I’ve kind of started to look at everything is like wow it’s not really a failure. I learned more from that than anything else. So just learning how to work with a larger team for example. So moving from leading my research team to leading a center was has been really challenging and just looking at the importance of interpersonal dynamics and really taking the time to carefully interact with folks and make sure that everybody feels like they’re seen and heard. That was I’d say I can certainly say I’ve fallen down a number of times there where I tend to just go in my mom calls it business mode. Let’s get to the heart of the problem. Yeah that’s good. And it’s really especially for some people it’s really important to start with “hey you know how you doing?” Let’s check in. So I’ve certainly fallen down a number of times where it’s like wow you know this interaction just needed to start out differently because I didn’t know or hadn’t learned to really check in with that interpersonal piece first before we kind of rolled up our sleeves and got to business. So that’s one example on our personal level. And it’s something that I continue to learn from.
: Great example. Yeah yeah good yeah. And you know it’s one thing that all of us can do better. We recently had a HealthCare Thinkathon is our first annual meeting in Indianan Apolis and one of the speakers was Nick Atkins. He’s the pink socks movement guy. I’m not sure if you know who that is or not but he’s all about this experience that you’re just talking about you know that. This I see you, I see you before let’s get into it. And acknowledging people’s presence. We did a little exercise. And what was cool is that at the end of the meeting this is one exercise that was really so simple resonated with so many people and it’s because you know taking that extra moment to just make that personal connection really makes a huge difference in the overall relationship and then the result or seeking to drive through whatever projects were on. So I think it’s such a great example.
: That sounds wonderful and just to add to that that actually may fit within these forward based learning paradigms. So if we think of always looking to external things to make ourselves feel better whether it’s eating a cookie or doing whatever, we can actually turn toward these intrinsically rewarding things like just connecting with somebody because that’s always available we don’t need to go and buy connection at the store. And it feels really good so that can be reinforcing in itself that connection piece. That sounds wonderful.
: That’s a really great idea. Write that one down folks say as you know and we don’t realize how powerful are the things that we do are and how much of a habit they are on this topic of habits, are you grabbing a cookie, are you smoking, are you drinking to satisfy something and then all of a sudden it becomes a habit. And are the things that you doing on a day to day basis creating that anxiety and that burnout. Definitely something worth thinking about in your own mind. And big thanks to Judson for helping us think about this. So Judson what would you say is an exciting project or focus that you’re working on today?
: One of the exciting projects that we’re working on is really moving into the digital therapeutic sphere. So when I first started doing research on mindfulness training this is about about a decade ago we were delivering mindfulness in person and we were finding pretty good effects you know like actually we get five times the quit rates, gold standard treatment for smoking. Yeah. So we were like wow this is actually work. And we were looking to see how you could disseminate these types of things and it’s really challenging to have therapists follow him annualized treatment and about the time, this time iPhone’s were starting to come out that Android phones and we were thinking you know people don’t actually learn bad habits. In my office but so that context dependent memory actually loses some of its or the treatment loses some of its juice because it’s not really in context. So I started thinking well maybe we could deliver this in context and I could package my office and deliver it to them via their phone. So we started really exploring this and have subsequently developed apish training for smoke it’s called craving a quit for eating when called eat right now. And then one for anxiety. And just last year the first FDA approved digital therapeutic it came out. So this field just exploded with this new term digital therapeutics. And we’ve kind of been exploring…
: What therapeutic was that? Do you remember which one it was?
: I forget the name of it but it was put out by Pear therapeutics in Boston. Oh yeah. It really ushered in and is ushering in this new wave of treatment where you know called MHealth or mobile health where you can deliver high fidelity, scalable methodologies, and a lot of them don’t have good evidence yet but some are getting really good evidence bases to the point where you can get FDA approval. We’re seeing this type of stuff with our atbase training. So that’s probably the thing that I’m really excited about right now is to see you know how we can be part of the forefront of this movement and just can’t figure out the best ways to deliver training via digital therapeutic. And on top of that the best ways to deliver help people understand how their minds work and deliver mindfulness training is an effective therapeutic ranging for habits like smoking to eating to anxiety.
: You’re doing outstanding work Judson and you know I think that there’s definitely a lot of promise to the digital therapeutic. So keep doing what you’re doing man. It’s exciting. And again the promise on what’s on the other side of this is huge for the people that need it.
: Thank you.
: So getting close to the end here. Judson let’s pretend you and I are building a leadership course on what it takes to be successful in medicine. The one on one of Dr. Judson Brewer. So we’ve got a syllabus. We’re going to put together here with four questions on this lightning round followed by a book that you recommend to the listeners other than the Craving Mind.
: Okay.
: So question number one. What’s the best way to improve health care outcomes?
: Listen to our patients.
: And not. Totally agree. What is the biggest mistake or pitfall to avoid?
: Jumping to conclusions or making assumptions without looking at all of that information or taking a good history and getting a good differential diagnosis.
: How do you stay relevant as an organization despite constant change?
: Awareness is always relevant. Kindness is always relevant. The work that we’re doing is never gonna go away.
: I love that. What is one area of focus that should drive everything in a health organization?
: I’m going to say kindness and really supporting, creating a supportive environment.
: Wonderful. What book would you recommend to the listeners Judson?
: Oh man there’s so many great books. One that I particularly love is called The Art of Racing in the Rain and…
: Very cool.
: On the perspective of a dog.
: Really.
: Yes. For anybody that’s curious.
: I love this, I love this. Folks, The Art of Racing in the Rain. Check this one out. Obviously dovetails nicely into Judson’s work. This has been great for anybody that wants the show notes as well as links to the resources that we mentioned. Please visit outcomesrocket.health/brewer as in Dr. Judson Brewer you’ll find all of that here. Before I conclude Judson I’d love if you could just share a closing thought. And then the best place where the listeners could get in touch with you.
: Closing thoughts. Learn how your mind works. It will be very helpful. I certainly found that for myself and the folks can find me on judsonbrewer.com or at Brown University. But the judsonbrewer.com should have all of my contact information and some of the things we’ve been talking about.
: Outstanding. Judson, it’s been a pleasure. You’ve encouraged better habits more mindfulness and we’re excited to keep up with what you do in your latest work. So thanks for making the time for us now.
: Thanks for having me.
: Hey Outcomes Rocket friends, thanks for tuning in to the podcast once again. As a leader in health care, you have big ideas, great products, a story to tell, and are looking for ways to improve your reach and scale your business. However there’s one tiny problem. Health care is tough to navigate and the typical sales cycle is slow. That’s why you should consider starting your own podcast as part of your sales and marketing strategy. At the Outcomes Rocket, I’ve been able to reach thousands of people every single month that I wouldn’t have otherwise been able to reach if I had not started my podcast. Having this organic reach enables me to get the feedback necessary to create a podcast that delivers value that you are looking for. And the same thing goes if you start a podcast for what you could learn from your customers. The best thing about podcasting in healthcare is that we are currently at the ground level, meaning that the number of people in healthcare listening to podcasts is small but growing rapidly. I put together a free checklist for you to check out the steps on what it takes to create your own podcast. You could find that at outcomesrocket.health/podcast. Check it out today and find a new way to leverage the sales, marketing and outcomes of your business. That’s outcomesrocket.health/podcast.
