The Science & Treatment of Obsessive Compulsive Disorder (OCD) | Huberman Lab Essentials • Podcast Notes
Skip to contentCurious about Andrew Huberman’s recipe for good sleep? Read morehereIntroHuberman (@hubermanlab) breaks down OCD from the brain circuitry up, explaining why it happens, how it’s diagnosed, and. . .
Skip to contentCurious about Andrew Huberman’s recipe for good sleep? Read morehereIntroHuberman (@hubermanlab) breaks down OCD from the brain circuitry up, explaining why it happens, how it’s diagnosed, and which treatments actually work versus which ones just sound good00:00:00 – Obsessive-Compulsive Disorder (OCD)OCD is made up of obsessions (thoughts) and compulsions (actions), and they’re usually linkedThe compulsion is basically designed to relieve the obsession, but it backfiresThe obsessions are intrusive, meaning people don’t want them, dont enjoy them, they just pop into their head over and overCompulsions give brief relief but then reinforce and strengthen the obsession really fast, so its this nasty loop00:00:11 – OCD Prevalence & Impact, Obsessions & CompulsionsCurrent estimates are anywhere from 2. 5% to as high as 3 or even 4% of people suffer from true OCD, which he calls an astonishingly high numberOCD is ranked number 7 in terms of most debilitating illnesses, not just mental illnesses, ALL illnesses, including stuff like asthma and cancerBecause of how frequent the intrusive thoughts are, tons of work hours, relationships, and just general functioning take a hitPeople end up spending so much time thinking about the compulsion and doing it that they can’t do normal life stuff like commuting, working, sports, working out00:01:54 – Categories: Checking, Repetition & Order; Contamination & DisgustOCD falls into 3 general bins: checking, repetition, and orderchecking is like checking the stove or the locks over and overrepetition is stuff like counting a certain sequence of numbers repeatedly, like 1, 2, 3, 4, 5, 6, 7, 6, 5, 4, 3, 2, 1…order can be about cleanliness and things being aligned perfectly, but it also includes incompleteness (c’ant walk away if somethings not “right”) and symmetryThere is a study example of kids who need their stuffed animals in the exact same order every day and will have an anxiety reaction if you move oneTheres also a disgust/contamination angle, where people feel something (a towel, a space, even someone elses hand) is contaminated and wont touch it or shake handsEvery time someone does the compulsion, the obsession gets stronger, so it’s a really powerful and debilitating loop00:04:30 – Anxiety, Fear; Genetic Component of OCDIf you drew a line between obsession and compulsion, that line is basically anxietyFear is heightened autonomic arousal (increased heart rate, breathing, sweating) in response to an immediate threat, while anxiety is the same body response but without a clear present dangerThere is a genetic component to OCD based on twin studies (identical vs fraternal, even twins sharing the same sac in utero)Roughly 40 to 50% of OCD cases have some genetic/inherited component, but he notes this isnt super useful info since you cant control your genes00:09:56 – Cortico-Striatal-Thalamic Loop; Imaging Studies, SSRIsThis corticostriatothalamic loop is thought to underlie OCD, and dysfunction in that loop is what generates itIn studies, people with germ/contamination obsessions were given a literal sweaty towel from someone elses hands while in a brain scanner, and it lit up this exact loopWhen people take SSRIs, they see suppression of the obsession/compulsion AND suppression of activity in these specific neural circuits, but he flags that SSRIs dont work for everyone with OCDDifferent treatments (drugs, behavioral, holistic) each tap into a different part of this same loop, which is why understanding the mechanism helps you pick the right treatment order00:11:02 – Diagnosis, Yale-Brown Obsessive Compulsive Scale (Y-BOCS)The most common diagnostic test for OCD is the Yale-Brown Obsessive Compulsive Scale, aka the Y-BOCS“Obsessions are unwelcome and distressing ideas, thoughts, images, or impulses that repeatedly enter your mind. ”Compulsions are behaviors you feel driven to perform even though you may recognize them as senseless, and resisting them is hardThe test has a checklist covering categories like aggressive obsessions, contamination obsessions, sexual obsessions, saving obsessions, moral obsessions, and need for symmetryThe test tries to get people to identify their EXACT obsessions, not just a general theme…This precision really matters for the therapies that work best, because you need to define the biggest, most catastrophic fear driving the obsessionThe deeper question isnt just “obsessed about germs, compelled to wash hands,” its figuring out what the actual fear is if the compulsion isnt performed00:16:30 – Tool: Cognitive Behavioral Therapy (CBT) & Exposure TherapyCBT, specifically exposure-based CBT, is a powerful category of treatment that doesnt work for everyone but works for many and directly targets that neural loopThe goal is to get people to tolerate anxiety, not relieve it, which is the opposite of typical anxiety treatmentnormally youd teach breathing or visualization to calm down, but here the goal is to feel the anxiety at max and then NOT do the compulsionPatients are gradually and progressively moved toward confronting exactly what they fear most, its not thrown at them all at onceThis is NOT something to do on your own or for a friend, it has to be trained licensed psychologists and psychiatrists doing itThe whole point is teaching the brain that anxiety can exist without needing to do the compulsion to relieve it00:20:46 – Dr. Helen Blair Simpson, Ritual Prevention, Exposure SessionsDr. Helen Blair Simpson at Columbia is one of the top few experts in the world on OCD mechanismsIn her research comparing CBT alone, placebo, and SSRIs: placebo did basically nothing for symptomsCBT had a dramatic effect, dropping severity scores from 25 down to about 11 within four weeksSSRIs helped some but symptom severity stayed much higher than with CBT alone, and combining CBT + SSRIs together didnt actually improve results beyond CBT alone00:24:12 – SSRIs & Serotonin System; Psychiatry & CausalityBig surprise reveal here: even though SSRIs can reduce OCD symptoms somewhat, there’s very little evidence the serotonin system is actually what’s disrupted in OCDHe points out this is a recurring theme in psychiatry, a drug can work to reduce symptoms without that system actually being the root cause of the disorder00:25:59 – Cannabis, CBD & OCD; Transcranial Magnetic Stimulation (TMS)A study by Dr. Blair Simpson on smoked cannabis (THC or CBD) found little acute impact on OCD symptoms and actually smaller anxiety reduction compared to placeboTMS uses a magnetic coil on the skull to suppress or activate specific brain regions, and when applied to motor areas while people have intrusive thoughts, it can interrupt the compulsive behaviorHe’s cautiously optimistic about TMS, especially combined with drugs or CBT, but says its not a magic bullet on its own00:27:53 – Mindfulness Meditation, Holistic Treatments, NIHDr. Blair Simpsons lab studied mindfulness meditation for OCD and the data is a bit complicated, it doesnt seem to directly relieve symptomsInstead, meditation seems to help by improving focus and engagement with CBT homework, so its an indirect benefitInositol (specifically myo-inositol) is worth looking at… 900mg can improve sleep and reduce anxietyHuberman Lab:anxiety,CBT,exposure therapy,fear,OCDNotes By DarioMore Notes on these topics