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  • [MUSIC]

  • We have three neuroscientists...who are here.

  • We'll call the first one, Dr.

  • Judson Brewer of the Center of Mindfulness of UMass Medical. Judson...

  • [MUSIC]

  • Welcome to Le Web...

  • Thank you. It's great to be here.

  • Let's get started. Now,

  • let's just think of the magnitude of the problem.

  • My lab studies addictions. And if you take two addictions,

  • smoking and behavioral overeating, this accounts in the US for

  • nearly half of the drivers of healthcare cost, half of them.

  • Now, you can't cure cancer with blood pressure medications, right?

  • You can't cure cancer with blood pressure medications, and

  • you can't fix behavioral addictions by holding hands and

  • singing Kumbaya. So [LAUGH]

  • what we're looking at is,

  • what's the root of the problem, what's the mechanism behind behavioral addictions,

  • and how can we use things like mindfulness to help treat them?

  • So let's go through this together.

  • I thought we could start with: Why Facebook is like crack cocaine...

  • Move on to McDonald's... Go on to how Lolo Jones could have won the gold medal...

  • And finish up with how we can all become a Buddha in nine minutes, and perhaps quit

  • smoking as well. All right, so that's a lot to do. Let's see what we can do.

  • So let's start with Facebook. How are you feeling? Now it turns out,

  • when neuroscientists at Harvard gave people the choice to self-disclose,

  • or to earn money, while they scanned their brains, guess what they chose to do?

  • That's right... Talk about themselves... And it turns out that when

  • people talk about themselves, it activates the reward parts of your brain.

  • The one that that is arrow is pointed to is called the nucleus accumbens,

  • the same part of the brain that gets activated when you smoke crack cocaine.

  • And another study showed that you can actually predict the amount

  • of time that people spend on Facebook by the amount that the nucleus accumbens

  • gets activated when they self-disclose.

  • Okay, I took this picture at the Louvre a couple of days ago.

  • For those of you that aren't familiar with one of the top 25 inventions of 2014,

  • you can buy a selfie stick and take pictures of yourself. I love this picture

  • because the boyfriend is standing there, and he's been replaced by the selfie

  • stick. >> [AUDIENCE LAUGHTER] >> [LAUGH]

  • So, let's go through this together.

  • You're at the Louvre, you think, Oh, this is a great picture.

  • I'm going to take a picture of myself and post it to Facebook.

  • This is going to be great. And

  • you think about all the likes that you're going to get, and all the comments, and

  • how everybody's going to be jealous that you're in Paris. So you take a picture,

  • and you post it to Facebook, and you get all these likes. And it feels really good,

  • and your brain says, Yeah, do that again. [LAUGH]

  • Well, it turns out that this is one

  • of the most evolutionarily conserved brain processes. It turns out that if you go

  • back to the most primitive neuron system, the Aplysia, the sea slug,

  • with only 20,000 neurons, the sea slug learns the same way that people learn when

  • they're taking selfies at the Louvre. Basically, you do something,

  • it makes you feel good, you get an urge to make that good feeling continue, you lay

  • down a memory, and then this reinforces it. You probably all heard of positive and

  • negative reinforcement, because this same thing happens with negative reinforcement.

  • You do something unpleasant, you get yelled at by your boss, you have an urge

  • to make that go away... You go out for a smoke, or you eat a good snack or

  • some chocolate, you feel better and you learn, Oh, if I just eat chocolate,

  • I'll feel better. Now, typical treatments say, Well,

  • okay, you just avoid these things. So if you drink alcohol, avoid the bars.

  • And if you smoke cigarettes, maybe you should just eat carrot sticks instead.

  • So you can actually target these pathways. Well, it's interesting,

  • these don't work particularly well. 70% of smokers want to quit--it

  • takes up to six quit attempts, and only 5% stay abstinent at the end of a year.

  • So this is a very, very reinforced process that's very hard...

  • This behavior is very hard to change. Now, it turns out that 2,500

  • years ago the Buddhist psychologists described the exact same process, and

  • they described it this way. They said, Things get interpreted by the mind.

  • They're either pleasant or unpleasant. We have an urge for the pleasant to continue.

  • We want to hold on to that stuff. We want the unpleasant to go away.

  • We do a behavior to make those things happen. And then we lay down this self.

  • We get a self identity. And the problem is that this process reinforces itself. For

  • those of you that aren't familiar with it, it's described as samsara. The literal

  • translation of this is endless wandering, because it's just self-reinforcing, and

  • the problem is, with this skewed view, when we start seeing the world this way,

  • and we start getting attached to these things, it just goes on and on and

  • on. They described this, they said, Just as a tree, though cut down,

  • can grow again and again if its roots are undamaged and strong, in the same way,

  • if the roots of craving are not wholly uprooted, sorrows will come again and

  • again. I like this modern-day

  • interpretation a little bit more.

  • Now you get the idea. So, now on to our second one. Well, the food industry says,

  • Oh, evolutionary conserved process, we can make tons of money.

  • We're actually going to flaunt this. So McDonald's, they're after it...

  • They craft their food to your craving. Kellogg's cereal in the US now,

  • they now have Krave cereal. And if milk chocolate Krave isn't good enough,

  • don't worry, there's double chocolate Krave. And, of course,

  • we all know where this leads... Okay, so on

  • to how we can work with this problem. We start to understand what the mechanism is,

  • what can we do about it? Now, mindfulness has become much more popular over the last

  • couple of years. What actually is it? So you can think of this as paying attention.

  • Okay, we're paying attention, but we're bringing a quality of our

  • awareness to this experience. So we're bringing an openness, a curiosity...

  • We're not saying, Oh, I know how this is going to go, or I don't like this, or

  • I want this to go away... We're just going to see what we can do to work with

  • the situation. And mindfulness is at least theorized to come

  • in, and instead of helping people avoid things or

  • substitute, actually drive this wedge of awareness in-between the craving,

  • that urge to act, and the actual behavior. So let's see if this is actually true.

  • Now, it's been shown empirically to be helpful for

  • a number of conditions. Just listing a few here--anxiety, depression, pain...

  • My lab has done some work with addiction, even boosting of the immune system, and

  • helping people score better on their graduate record exams,

  • if you want to graduate school. But how does actually paying attention work?

  • Does it actually help you change these very

  • deep-seated behaviors? Does paying attention, just by itself,

  • actually do anything? So what we actually do in our smoking treatment is to

  • have people smoke mindfully. That's the first exercise that they get. And the idea

  • here is, when you really pay attention to what you're doing, you see what you get.

  • And if it's helpful, you keep doing it, and if you don't, you stop doing it.

  • Here's an example from somebody with her first mindful smoking exercise. She said,

  • Smells like stinky cheese. She's obviously not French. Smells like stinky cheese and

  • tastes like chemicals. Yuck!

  • And the idea here is, she starts to see what she's actually getting in this moment

  • from smoking. She doesn't have to think about it. She knows smoking's not good for

  • her. But in this moment, she sees, Oh, this isn't actually as good as I thought

  • it was. So we took this, we did some randomized clinical trials, and

  • found mindfulness training was actually twice as good as gold standard treatment

  • in the US for smoking cessation. We had twice as good. This is on the level

  • with some of the best medications out there. And the effects lasted.

  • At our four-month follow-up, they were still largely, they had maintained their

  • abstinence. So this was pretty good. We're seeing a behavioral signal that you can't

  • argue with, they either have quit or they haven't quit. So we ask ourselves, Well,

  • what's actually going on mechanistically? And the hypothesis is, that if craving is

  • a fire and smoking is the fuel for that fire, if you stop adding the fuel,

  • that fire should be there for a bit but eventually die down. And

  • we studied this mathematically, I won't go through all the details... But, basically,

  • you get a strong correlation between craving and smoking at the beginning of

  • treatment. This is completely gone at the end of treatment.

  • And if you do all the fancy math, it has nothing to do with craving,

  • it has nothing to do with cigarette use... It's the amount of

  • informal mindfulness practice that people do that decouples craving and smoking, and

  • we can even see this in the raw data. If you look at the end of treatment,

  • same level of craving for the people that quit and the people that don't. And

  • for the people that quit, their craving dies off over time.

  • So that's really interesting.

  • It seems that mindfulness is actually driving this wedge in here.

  • We can see this mathematically. We can see this behaviorally, and importantly,

  • we can start to get it to psychological mechanisms of how it's working.

  • Okay, so then how do we disseminate this? So, training a lot of

  • people to facilitate mindfulness training is expensive, it's not scalable, so

  • we turn to the technology. And we said, Okay, let's develop an app that can

  • actually deliver this at the point of contact. And this is really important,

  • because context-dependent learning is where people learn to smoke.

  • They don't learn to smoke in their therapist's office.

  • They don't learn to smoke in the hospital. They learn to smoke in their car,

  • on their front porch, outside of work. And so, we put this manualized training

  • together in 21 days of modules, where they can get daily playlists.

  • They can have animations that help walk them through the core concepts.

  • They can pair this with in-the-moment exercises. And they can even...we

  • can collect data through experience sampling to make sure that it works.

  • We can also pair this with an online community where they have access to me

  • as the addiction psychiatrist, to peers, they can tell their stories,

  • they can learn from each other, we can crowdsource this... So

  • just to show you a quick video that kind of shows how this all fits together.

  • [MUSIC]

  • >> Welcome to Craving to Quit, a three-week program that will help you quit

  • smoking. This training delivered live at Yale University has been shown to be