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Obsessive Compulsive Disorder (OCD) is a debilitating condition characterized by intrusive thoughts (obsessions) and repetitive behaviors (compulsions). The obsessions are unwanted and distressing thoughts, images, or impulses that frequently enter a person's mind, while the compulsions are behaviors or acts performed to alleviate the anxiety caused by the obsessions. OCD is different from Obsessive Compulsive Personality Disorder (OCPD), as OCPD primarily involves a sense of delayed gratification and a desire for perfection. OCD is an extremely common and profoundly debilitating condition, ranking as the seventh most disabling illness across all domains. The cortico-striato-thalamo-cortical circuit has been identified as a key neural pathway involved in OCD, and dysfunction in this circuit leads to the generation of obsessions and compulsions. Understanding these underlying mechanisms is essential for developing effective treatments for OCD.
The cortico-striato-thalamo-cortical circuit is a key neural pathway implicated in OCD. This circuit involves interconnected brain regions, including the cortex, striatum, and thalamus. The cortex is responsible for perception and understanding, while the striatum and basal ganglia are involved in generating and suppressing behaviors. The thalamus acts as a relay station, collecting sensory information and gating its passage to conscious awareness. Dysfunction in this circuit leads to obsessions and compulsions characteristic of OCD. Imaging studies have shown increased activity in this circuitry in individuals with OCD, while treatments that reduce OCD symptoms, such as selective serotonin reuptake inhibitors (SSRIs), also lead to decreased activity in this circuit.
The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) is a commonly used diagnostic tool for OCD. It involves a series of questions to assess the presence and severity of obsessions and compulsions. Patients are asked about various categories of obsessions and compulsions, such as aggressive thoughts, contamination fears, sexual obsessions, orderliness, and more. The Y-BOCS helps clinicians evaluate the specific fears underlying the obsessions and identify target symptoms for treatment.
Cognitive Behavioral Therapy (CBT) and Exposure Therapy are effective treatments for OCD. CBT for OCD involves identifying and challenging the irrational thoughts and beliefs that drive obsessions and compulsions. Exposure Therapy exposes individuals to their fears or triggers gradually, allowing them to confront and resist their compulsive behaviors. This process helps weaken the amygdala's (emotion center of the brain) response to the obsessions over time. By understanding the underlying neural circuitry of OCD, therapists can tailor CBT and Exposure Therapy to target specific components of the cortico-striato-thalamo-cortical loop involved in OCD symptoms.
Obsessive-compulsive disorder (OCD) is a mental health condition characterized by intrusive thoughts and repetitive behaviors. These obsessions, often disturbing and taboo, lead individuals to engage in compulsive actions in an attempt to relieve anxiety. The disordered thinking pattern prevents individuals from exploring the underlying fear or articulating it clearly, but therapy aims to encourage them to face their anxiety without resorting to compulsions. Cognitive-behavioral therapy (CBT) and exposure therapy are key treatment approaches for OCD, focusing on gradually exposing the person to their fears and interrupting the compulsion. The goal is not to eliminate anxiety but to increase anxiety tolerance and disrupt the neural circuit driving the compulsive behavior.
Cognitive-behavioral therapy (CBT) has shown to be highly effective in reducing OCD symptoms, primarily by increasing anxiety tolerance and challenging obsessive thoughts and compulsive behaviors. CBT is usually conducted twice a week for 10-12 weeks, with homework assignments to help individuals confront anxiety-inducing situations in their daily lives. Selective serotonin reuptake inhibitors (SSRIs), a type of medication, have also demonstrated effectiveness in reducing OCD symptoms. However, the exact mechanism of how these medications work in the brain is not fully understood. While drug treatments like SSRIs can provide relief, they are often more effective when combined with CBT. Other treatments, such as cannabis and CBD, have not shown significant improvement in OCD symptoms based on current research.
Transcranial magnetic stimulation (TMS) is a non-invasive procedure that uses magnetic fields to stimulate or suppress specific brain regions. TMS is being explored as a potential treatment for OCD, but further research is needed to establish its effectiveness. Ketamine therapy, known for its dissociative effects, is also being investigated for OCD treatment, especially when combined with other therapies. While initial results show promise, larger-scale studies are required for more conclusive findings. Other treatments, such as psychedelics and brain-machine interface technologies, are still in early stages of research and their use for OCD is yet to be fully understood.
One important aspect of OCD treatment is helping individuals recognize that thoughts are not equivalent to actions. Intrusive thoughts are a common occurrence in everyone's mind, and it is critical to understand that having these thoughts does not make a person bad or evil. Through therapy, individuals learn to separate thoughts from actions and reduce the need for compulsive behaviors. The goal is to increase cognitive flexibility and disrupt the automatic patterns of obsessions and compulsions.
One of the key themes in the treatment of OCD is the realization that thoughts are not as bad as actions. While thoughts can be troubling and time-consuming, it is important to understand that they are not inherently harmful like actions can be.
A study explored the hormone levels in people with OCD and found that females with OCD had significantly elevated cortisol and DHEA levels, both of which are associated with the stress system. In males with OCD, cortisol levels were increased, while testosterone levels were reduced. These hormonal differences may contribute to alterations in the GABA system, leading to increased excitation in certain brain networks implicated in OCD.
Superstitions, although not directly related to OCD, share similarities in the need for predictability and control. Superstitions can become compulsions if repeated often enough. Understanding the distinction between superstitions and the intrusive thoughts and compulsive behaviors of OCD is crucial to provide effective treatments for individuals with OCD.
In this episode, I explain the biology and psychology of obsessive-compulsive disorder (OCD)—a prevalent and debilitating condition. I also discuss the efficacy and mechanisms behind OCD treatments—both behavioral and pharmacologic as well as holistic and combination treatments and new emerging treatments, including directed brain stimulation. I explain the neural circuitry underlying repetitive “thought-action loops” and why in OCD, the compulsive actions merely make the obsessions even stronger. I review cognitive-behavioral therapies like exposure therapy and SSRIs, holistic approaches, and nutraceuticals, detailing the efficacy of each approach and what science says about how to combine and sequence treatments. I describe an often effective approach for treating OCD where clinicians use cognitive behavioral therapy (CBT) to deliberately bring patients into states of high anxiety while encouraging them to suppress compulsive actions in order to help them learn to overcome repetitious thought/action cycles. This episode should interest anyone with OCD, anyone who knows someone with OCD or OCPD, and more generally, those interested in how the brain works to control thoughts and actions, whether those thoughts are intrusive or not.
For the full show notes, visit hubermanlab.com.
AG1 (Athletic Greens): https://athleticgreens.com/huberman
LMNT: https://drinklmnt.com/huberman
https://www.livemomentous.com/huberman
(00:00:00) Obsessive-Compulsive Disorder (OCD)
(00:04:06) Sponsors: AG1, LMNT
(00:08:28) What is OCD and Obsessive-Compulsive Personality Disorder?
(00:11:18) OCD: Major Incidence & Severity
(00:15:10) Categories of OCD
(00:21:33) Anxiety: Linking Obsessions & Compulsions
(00:27:33) OCD & Familial Heredity
(00:29:10) Biological Mechanisms of OCD, Cortico-Striatal-Thalamic Loops
(00:39:36) Cortico-Striatal-Thalamic Loop & OCD
(00:46:39) Clinical OCD Diagnosis, Y-BOCS Index
(00:51:38) OCD & Fear, Cognitive Behavioral Therapy (CBT) & Exposure Therapy
(01:01:56) Unique Characteristics of CBT/Exposure Therapy in OCD Treatment
(01:10:18) CBT/Exposure Therapy & Selective Serotonin Reuptake Inhibitors (SSRIs)
(01:22:30) Considerations with SSRIs & Prescription Drug Treatments
(01:25:17) Serotonin & Cognitive Flexibility, Psilocybin Studies
(01:31:50) Neuroleptics & Neuromodulators
(01:36:09) OCD & Cannabis, THC & CBD
(01:39:29) Ketamine Treatment
(01:41:43) Transcranial Magnetic Stimulation (TMS)
(01:46:22) Cannabis CBD & Focus
(01:47:50) Thoughts Are Not Actions
(01:51:27) Hormones, Cortisol, DHEA, Testosterone & GABA
(02:00:55) Holistic Treatments: Mindfulness Meditation & OCD
(02:03:28) Nutraceuticals & Supplements: Myo-Inositol, Glycine
(02:09:45) OCD vs. Obsessive-Compulsive Personality Disorder
(02:20:53) Superstitions, Compulsions & Obsessions
(02:31:00) Zero-Cost Support, YouTube Feedback, Spotify & Apple Reviews, Sponsors, Momentous Supplements, Instagram, Twitter, Neural Network Newsletter
Title Card Photo Credit: Mike Blabac
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