← Huberman Lab

The Science & Treatment of Obsessive-Compulsive Disorder (OCD)

Episode 78 Jun 27, 2022 2h 31m 15 insights
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.
Actionable Insights

1. Seek Professional OCD Treatment

If you suspect you have persistent, intrusive obsessions and compulsions that cause distress or impair daily functioning, seek evidence-based treatment from a licensed clinician. This is crucial as most people with OCD do not seek treatment, leading to prolonged suffering.

2. Engage in Exposure-Based CBT

Work with a trained psychologist or psychiatrist in exposure-based cognitive behavioral therapy (CBT) for OCD. The therapy aims to progressively increase anxiety by confronting your deepest fears and then preventing the compulsive behavior, teaching you to tolerate anxiety without engaging in rituals.

3. Perform OCD Therapy Homework

Actively perform “homework” assigned by your clinician outside of therapy sessions. This is vital for challenging anxiety and interrupting compulsions in your home environment, as familiar surroundings can often trigger relapses.

4. Understand Thoughts Are Not Actions

Cultivate the understanding that intrusive thoughts are merely thoughts and not equivalent to actions. This realization is a fundamental step in OCD treatment, helping to reduce the urge to perform compulsions to suppress disturbing or taboo thoughts.

5. Avoid Substance Abuse for Anxiety

Do not use substances like alcohol or cannabis to suppress anxiety related to OCD. Suppressing anxiety is counterproductive to effective OCD treatment, which focuses on learning to tolerate and manage anxiety without compulsive behaviors.

6. Consult Physician for Drug Changes

Always consult with a licensed physician or psychiatrist before starting, stopping, or altering the dosage of any prescription drug for OCD. This ensures safety and appropriate management of complex drug interactions and side effects.

7. Add CBT to Existing SSRI Treatment

If you are currently taking an SSRI for OCD and experiencing some symptom reduction, consider adding cognitive behavioral therapy (CBT) to your regimen. Studies show that initiating CBT while on SSRIs can lead to further significant reductions in OCD symptoms.

8. Practice Yoga Nidra or NSDR

Engage in 10-minute sessions of Yoga Nidra or Non-Sleep Deep Rest (NSDR) to restore cognitive and physical energy. These practices involve lying still with an active mind and are supported by scientific data for their restorative benefits.

9. Consider Myo-Inositol Supplementation

Explore supplementing with 900 milligrams of myo-inositol, potentially in combination with other sleep aids. This dosage has been anecdotally reported to improve sleep quality, reduce anxiety, and enhance daytime focus and alertness.

10. Take Athletic Greens Daily

Consume Athletic Greens once or twice a day to cover basic nutritional needs, address potential deficiencies, and support microbiome health through its probiotic content. A special offer for five free travel packs and a year’s supply of Vitamin D3K2 is available at athleticgreens.com/Huberman.

11. Use Element Electrolytes Daily

Dissolve one packet of Element in 16 to 32 ounces of water first thing in the morning and during physical exercise. This practice ensures adequate hydration and electrolyte balance (sodium, magnesium, potassium) for optimal brain and body function.

12. Utilize Waking Up Meditation App

Access a free 30-day trial of the Waking Up meditation app at wakingup.com/Huberman. This app offers hundreds of meditation programs, mindfulness trainings, and NSDR protocols to help place the brain and body into different states.

13. Be Precise with Terminology

Use mental health terms like “OCD” and “trauma” carefully and precisely, understanding their clinical definitions. This avoids mislabeling and ensures that individuals receive appropriate understanding and treatment for their specific conditions.

14. Avoid High Glycine Dosages

Refrain from taking extremely high dosages of glycine, such as 60 grams per day, unless specifically instructed and supervised within a controlled research study. Such high amounts are not generally recommended for self-administration.

15. Explore Home Visits for OCD

If appropriate for your situation, discuss the possibility of home visits with your OCD clinician. This unique aspect of therapy allows the clinician to observe and address context-specific triggers and avoidance patterns in your natural environment.