The Science & Treatment of Obsessive Compulsive Disorder (OCD)
Date: 2022-06-27 | Duration: 02:33:35
Transcript
0:00 Welcome to the Huberman Lab podcast where we discuss science and science-based tools for everyday life. I’m Andrew Huberman, and I’m a professor of neurobiology and ophthalmology at Stanford School of Medicine. Today we are talking about obsessive-compulsive disorder or OCD. We are also going to talk about obsessive-compulsive personality disorder which, as you will soon learn, is distinct from obsessive-compulsive disorder. In fact, many people that refer to themselves or
0:30 others as obsessive or compulsive or quote-unquote “having OCD” or “OCD about this” or “OCD about that” do not have clinically diagnosable OCD. Rather, many people have obsessive-compulsive personality disorder. However, there are many people in the world that have actual OCD, and for those people there is a tremendous amount of suffering. In fact, OCD turns out to be number seven on the list of most debilitating illnesses—not just psychiatric illnesses, but of all
1:00 illnesses—which is remarkable and somewhat frightening. The good news is, thanks to the fields of psychiatry, psychology, and science in general, there are now excellent treatments for OCD, and we’re going to talk about those treatments today. Those treatments range from behavioral therapies to drug therapies and brain stimulation, and even some of the more holistic or natural therapies. As you’ll soon learn, for certain people they may want to focus more on the behavioral therapies, whereas
1:30 for others, more on the drug-based therapies, and so on and so forth. One extremely interesting and important thing I learned from this episode is that the particular sequence that behavioral and/or drug and/or holistic therapies are applied is extremely important. In fact, the outcomes of studies often depend on whether or not people start on drug treatment and then follow with cognitive behavioral treatment, or vice versa. We’re going to go into all those details and how they relate to different types of OCD, because it turns out there are indeed different
2:00 types of obsessions and compulsions, and the age of onset for OCD, and so on and so forth. What I can assure you is, by the end of this episode, you’ll have a much greater understanding of what OCD is and what it isn’t, and what obsessive-compulsive personality disorder is and what it is not. You’ll have a rich array of different therapy options to explore in yourself or in others that are suffering from OCD. And if neither you nor others that you know suffer from OCD or obsessive-compulsive personality
2:30 disorder, the information covered in today’s episode will also provide insight into how the brain and nervous system translate thought into action generally, and also you’re going to learn a lot about goal-directed behavior generally. My hope is that by the end of the episode, you will both understand a lot about this disease state that we call OCD, you will have access to information that will allow you to direct treatments to yourself or others in better ways, and that you will gain greater insight into how you function and how human beings function in general.
3:00 The Huberman Lab podcast is proud to announce that we’ve partnered with Momentous supplements. We’ve done that for several reasons. First of all, the quality of their supplements is exceedingly high. Second of all, we wanted to have a location where you could find all of the supplements discussed on the Huberman Lab podcast in one easy-to-find place. You can now find that place at livemomentous.com/huberman. In addition, Momentous supplements ship internationally, something that a lot of other supplement companies simply do not do. So that’s terrific, whether or not you live in the
3:30 US or you live abroad. Right now, not all of the supplements that we discuss on the Huberman Lab podcast are listed, but that catalog of supplements is being expanded very rapidly, and a good number of them that we’ve talked about—some of the more prominent ones for sleep and focus and other aspects of mental and physical health—are already there. Again, you can find them at livemomentous.com/huberman. Before we begin, I’d like to emphasize that this podcast is separate from my teaching and research roles at Stanford. It is, however, part of my desire and effort to bring zero-cost-to-consumer information about science and science-related tools to the general
4:00 public. In keeping with that theme, I’d like to thank the sponsors of today’s podcast. Our first sponsor is Athletic Greens. Athletic Greens is an all-in-one vitamin, mineral, probiotic drink that also has adaptogens and digestive enzymes. I started taking Athletic Greens way back in 2012, and I’ve taken it every day since, so I’m delighted that they’re sponsoring the podcast. The reason I started taking Athletic Greens, and the reason I still take Athletic Greens once or twice a day, is that it covers all of my foundational nutritional needs. In fact, when people ask me, “What’s the one supplement I should take?” I always say
4:30 Athletic Greens, because by taking Athletic Greens, you give support to your immune system, to your endocrine system, to your nervous system, and to the so-called gut-brain axis and the gut microbiome. As many of you have probably heard, our gut—meaning everywhere from our mouth down all the way through our intestine—is populated by trillions of little microbacteria that support the different systems of our body. Athletic Greens has the probiotics that support the microbiome and in turn support things like mood, endocrine function, immune system, and so on. If you’d like to
5:00 try Athletic Greens, you can go to athleticgreens.com/huberman and claim their special offer. They’ll give you five free travel packs plus a year’s supply of vitamin D3-K2. Many people are deficient in vitamin D3, and in general, vitamin D3 and K2 support a huge number of factors in your brain and body that support your immediate and long-term health. Again, that’s athleticgreens.com/huberman to claim their special offer. Today’s episode is also brought to us by Thesis. Thesis makes custom nootropics, and frankly, I’m not a big fan of the word “nootropics.” I’ve said that on
5:30 various podcasts and on social media posts. The reason I’m not a fan of the word “nootropics” is it means “smart drugs,” but as a neuroscientist, I know that we don’t have circuits in the brain or chemicals in the brain for being smart. We have circuits in the brain for focus, and for task switching, and for creativity, and oftentimes those circuits differ from one another, although they collaborate to create things that we think of as intelligence or focus or creativity, etc. Thesis understands this and for that reason has developed custom nootropics that are matched to your particular goals and to
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6:30 focused cognitive work or I’m going to exercise. I also like their Energy formula prior to exercise. To get your own personalized nootropic starter kit, go online to takethesis.com/huberman. You can take a three-minute quiz that will help match you to the best custom nootropics to start with, and Thesis will send you four different formulas to try in that first month. Again, that’s takethesis.com/huberman and use the code HUBERMAN at checkout to get 10% off your first order. Today’s episode is also brought to us by Eight Sleep. Eight Sleep makes smart mattress covers that have
7:00 cooling, heating, and sleep tracking capacity. I’ve talked many times on this podcast and on other podcasts and on social media about the critical relationship between temperature and sleep. Generally speaking, your body temperature has to drop by about one to three degrees in order to get into and to stay in deep sleep, and waking up has a lot to do with an increase in body temperature of about one to three degrees. So for many people like myself who run warm during the night, I find myself waking up in the middle of the night. However, recently I started using an Eight Sleep
7:30 mattress cover, and by programming in the specific temperatures that work for me across the night, I’m staying asleep through the whole night. As a consequence, I’m feeling far better during the day—much more focus, alertness, etc.—all the great things that come from getting excellent sleep consistently. The Pod Pro cover by Eight Sleep is their most advanced solution on the market for thermoregulation during sleep. That’s the one I use. It pairs dynamic cooling and heating with biometric tracking. It also has this really nice feature where your mattress basically vibrates a little bit right upon waking; I like that as well. You can cover any mattress with
8:00 it. You can start sleeping as cool as 55 degrees Fahrenheit or as warm as 110 degrees Fahrenheit, and that range is available to you simply because Eight Sleep understands that people have a tremendous range in natural body temperatures and sleeping environments. If you want to try Eight Sleep, you can go to 8sleep.com/huberman and check out their Pod Pro cover and save 150 at checkout. Let’s talk about OCD, or obsessive-compulsive
8:30 disorder. First of all, as the name suggests, OCD includes thoughts, or obsessions, and compulsions, which are actions. The obsessions and the compulsions are often linked. In fact, most of the time, the obsessions and the compulsions are linked such that the compulsion—the behavior—is designed to relieve the obsession. However, one of the hallmark themes of obsessive-compulsive disorder is that the obsessions are intrusive. People don’t want to have them;
9:00 they don’t enjoy having them. They just seem to pop into people’s minds, and they seem to pop into their mind recurrently. And the compulsions, unlike other sorts of behaviors, provide brief relief to the obsession but then very quickly reinforce or strengthen the obsession. This is a very key theme to realize about obsessive-compulsive disorder, so I’m just going to repeat it again. These two features—first, the fact that the obsessions are intrusive and recurrent, as well as the fact that the compulsions,
9:30 the behaviors, provide, if anything, only brief relief for the obsessions, but in most cases simply serve to make the obsession stronger, are the hallmark features of obsessive-compulsive disorder. It turns out to be very important to keep these in mind as we go forward, not just because they define obsessive-compulsive disorder, but they also define the sorts of treatments that will and will not work for obsessive-compulsive disorder. And then once you understand a little bit about the neural circuitry underlying obsessive-compulsive disorder, which we’ll talk
10:00 about in a few moments, then you will clearly understand why being a quote-unquote “obsessive person” or having an obsessive-compulsive personality is not the same as OCD. In fact, we can leap ahead a little