Erasing Fears & Traumas Using Modern Neuroscience

00:00:00.000 | Welcome to Huberman Lab Essentials,

00:00:02.220 | where we revisit past episodes

00:00:04.040 | for the most potent and actionable science-based tools

00:00:07.220 | for mental health, physical health, and performance.

00:00:09.900 | I'm Andrew Huberman,

00:00:12.680 | and I'm a professor of neurobiology and ophthalmology

00:00:15.180 | at Stanford School of Medicine.

00:00:16.820 | Today, we're going to talk about the neuroscience of fear.

00:00:19.840 | We are also going to talk about trauma

00:00:22.440 | and post-traumatic stress disorders.

00:00:24.840 | I think it's fair to say that in the last 10 years,

00:00:27.960 | the field of neuroscience has shed light

00:00:30.120 | on not just the neural circuits,

00:00:32.360 | meaning the areas of the brain

00:00:34.240 | that control the fear response and the ways that it does it,

00:00:37.440 | but some important ways to extinguish fears

00:00:40.520 | using behavioral therapies, drug therapies,

00:00:43.560 | and what we call brain-machine interfaces.

00:00:45.680 | Today, we are going to talk about all of those,

00:00:48.260 | and you are going to come away

00:00:49.860 | with both an understanding of the biology of fear and trauma,

00:00:53.360 | as well as many practical tools to confront fear and trauma.

00:00:57.920 | To give you a sense of where we are going,

00:00:59.660 | I'll just lay out the framework for today's podcast.

00:01:02.400 | First, I'm going to teach you

00:01:04.480 | about the biology of fear and trauma,

00:01:06.480 | literally the cells and circuits

00:01:08.660 | and connections in the body and chemicals in the body

00:01:11.700 | that give rise to the so-called fear response,

00:01:14.720 | and why sometimes, but not always,

00:01:17.400 | fear can turn into trauma.

00:01:19.320 | I will also describe the biology of how fear is unlearned,

00:01:23.540 | or what we call extinguished.

00:01:25.360 | You're going to learn, for instance,

00:01:26.580 | that we can't just eliminate fears,

00:01:28.480 | we actually have to replace fears

00:01:30.240 | with a new positive event.

00:01:32.160 | So what is fear?

00:01:33.460 | Well, fear falls into a category

00:01:36.500 | of nervous system phenomenon

00:01:38.080 | that we can reliably call an emotion.

00:01:41.500 | I think it's fair to say

00:01:43.500 | that emotions include responses within our body,

00:01:47.380 | quickening of heart rate, changes in blood flow,

00:01:50.380 | things that we experience as a warming

00:01:52.040 | or a cooling of our skin,

00:01:53.280 | but that there's also a cognitive component.

00:01:55.600 | There are thoughts, there are memories.

00:01:57.620 | There's all sorts of stuff that goes on in our mind

00:02:00.360 | and in our body that together we call an emotion.

00:02:04.100 | So let's talk first about what fear isn't.

00:02:08.800 | Most people are familiar with stress,

00:02:11.660 | both as a concept and as an experience.

00:02:14.380 | Stress is a physiological response,

00:02:17.500 | and it is fair to say that we cannot have fear

00:02:20.760 | without having several,

00:02:23.060 | if not all of the elements of the stress response.

00:02:25.960 | However, we can have stress without having fear.

00:02:29.260 | Likewise, people are familiar with the phrase

00:02:33.100 | or the word rather, anxiety.

00:02:35.220 | Anxiety tends to be stress about some future event,

00:02:39.440 | although it can mean other things as well.

00:02:41.380 | We can't really have fear without seeing or observing

00:02:46.560 | or experiencing some of the elements of anxiety,

00:02:49.280 | but we can have anxiety without having fear.

00:02:52.240 | So what you're starting to realize

00:02:54.600 | is that fear is built up from certain basic elements

00:02:58.380 | that include stress and anxiety.

00:03:00.420 | And then there is trauma.

00:03:02.520 | The operational definition of trauma

00:03:05.000 | is that some fear took place,

00:03:09.560 | which of course includes stress and anxiety,

00:03:12.040 | and that fear somehow gets embedded

00:03:15.580 | or activated in our nervous system

00:03:17.840 | such that it shows up at times when it's maladaptive,

00:03:22.260 | meaning that fear doesn't serve us well

00:03:24.260 | and it gets reactivated at various times.

00:03:27.100 | The reason I'm putting all this word soup

00:03:29.040 | around fear out onto the table

00:03:31.320 | is not to complicate the issue.

00:03:33.400 | Rather, it is to simplify the issue

00:03:35.480 | because now that we acknowledge

00:03:36.800 | that there are many different phrases

00:03:38.760 | to describe this thing that we call fear

00:03:40.600 | and then related phenomenon,

00:03:41.740 | we can start to just focus on two of these issues,

00:03:45.420 | fear and trauma,

00:03:46.620 | as it relates to specific biological processes,

00:03:49.760 | specific cognitive processes,

00:03:51.920 | and we can start to dissect how fears are formed,

00:03:55.140 | how fears are unformed,

00:03:57.360 | and how new memories can come

00:03:59.780 | to replace previously fearful experiences.

00:04:02.780 | So in this effort to establish a common language

00:04:05.440 | around fear and trauma,

00:04:06.700 | I want to point out autonomic arousal.

00:04:10.080 | Autonomic arousal relates to this aspect

00:04:13.840 | of our nervous system

00:04:14.780 | that we call the autonomic nervous system.

00:04:16.440 | It basically has two branches to it,

00:04:18.700 | two branches meaning two different systems.

00:04:20.820 | One is the so-called sympathetic autonomic nervous system.

00:04:25.100 | It has nothing to do with sympathy.

00:04:26.420 | It has everything to do with increasing alertness.

00:04:29.080 | The other branch of the autonomic nervous system

00:04:31.040 | is the so-called parasympathetic branch

00:04:34.340 | of the autonomic nervous system.

00:04:35.640 | I know that's a mouthful.

00:04:36.540 | The parasympathetic branch of the autonomic nervous system

00:04:39.700 | are the cells and neurons and chemicals

00:04:42.920 | and other aspects of your brain and body

00:04:45.060 | that are involved in the calming nervous system.

00:04:47.460 | So sympathetic is alerting,

00:04:48.880 | parasympathetic is calming,

00:04:50.760 | and it acts as sort of a seesaw

00:04:52.380 | to adjust your overall level of alertness.

00:04:54.620 | There are many different aspects

00:04:55.880 | to the autonomic nervous system,

00:04:57.160 | but one of the main aspects

00:04:58.380 | is an aspect that's going to come up

00:05:00.080 | again and again and again today.

00:05:01.600 | It's called the HPA axis.

00:05:03.640 | The HPA axis stands

00:05:05.760 | for hypothalamic pituitary adrenal axis.

00:05:08.920 | The hypothalamus is a collection of neurons.

00:05:12.560 | It's an area of your brain,

00:05:13.940 | real estate that's deep in the brain,

00:05:16.120 | at the base of the brain,

00:05:17.020 | that contains many, many different areas

00:05:19.660 | that control things like temperature

00:05:21.120 | and desire to have sex,

00:05:22.920 | desire to eat, thirst.

00:05:25.200 | It also controls the desire to not mate,

00:05:29.500 | have sex, not eat, not drink more water

00:05:32.840 | or any other type of fluid.

00:05:34.660 | So it has accelerators and breaks in there as well.

00:05:37.940 | The hypothalamus connects to the so-called pituitary,

00:05:41.420 | the pituitary lives close to the roof of your mouth.

00:05:44.080 | It releases hormones into your bloodstream.

00:05:46.400 | And so the hypothalamus has this ability

00:05:49.240 | to trigger the release

00:05:50.980 | or prevent the release of particular hormones

00:05:53.480 | like cortisol

00:05:54.740 | or the hormones that go stimulate adrenals

00:05:58.560 | to produce adrenaline.

00:06:00.220 | And speaking of the adrenals,

00:06:02.020 | that A and the HPA are the adrenals.

00:06:04.620 | You have two glands that sit above your kidneys

00:06:07.280 | and your lower back.

00:06:08.200 | They release different hormones

00:06:09.880 | and other types of chemicals into the body.

00:06:12.700 | And the two main ones that you need to know about today

00:06:15.200 | are adrenaline, also called epinephrine, and cortisol.

00:06:19.100 | Both of those are so-called stress hormones,

00:06:21.440 | but they're not always involved in stress.

00:06:23.700 | They're also involved in waking up in the morning

00:06:25.720 | when you rise from sleep.

00:06:30.140 | And so this HPA axis should be thought of in the following way.

00:06:34.400 | The HPA axis includes a piece of the brain, the hypothalamus,

00:06:38.300 | the pituitary, and the adrenal.

00:06:40.840 | So it's a beautiful three-part system

00:06:43.120 | that can use your brain to alert or wake up your body

00:06:47.860 | and prepare it for action.

00:06:49.520 | And it can do that in the short term by triggering the release

00:06:53.100 | of hormones and chemicals that make you alert and ready

00:06:56.280 | to go right away, and by triggering the release

00:06:59.200 | of neurotransmitters and hormones and other chemicals

00:07:01.880 | that give that alertness a very long tail,

00:07:05.420 | a very long latency before it shuts off.

00:07:08.900 | And that's important because one of the hallmarks of fear

00:07:12.440 | and one of the hallmarks of trauma

00:07:14.700 | is that they involve fear responses that are long-lasting.

00:07:19.140 | Even if those fearful events, the events in the world

00:07:22.380 | that trigger the HPA axis can be very brief,

00:07:25.600 | the fear response can reverberate through your system

00:07:29.700 | because the chemicals that are involved in this HPA axis

00:07:33.200 | have a fast component and a longer-lasting component.

00:07:37.680 | And the longer-lasting component can actually feed back

00:07:40.640 | to the brain and literally control gene expression,

00:07:43.640 | which can take many days and build out new circuits

00:07:47.240 | and new chemicals that can embed fear in our brain and body.

00:07:51.360 | We can't really have a discussion about fear

00:07:53.740 | without discussing the famous amygdala.

00:07:56.380 | Famous because I think most people by now

00:07:59.320 | have heard of the amygdala.

00:08:00.560 | Amygdala means almond.

00:08:02.660 | It's an almond-shaped structure on both sides of the brain.

00:08:06.200 | The amygdala is part of what we can call the threat reflex.

00:08:09.640 | And this is very important to conceptualize fear

00:08:12.860 | as including a reflex.

00:08:14.740 | And that reflex involves things like quickening of your heart rate,

00:08:18.440 | hypervigilance, your attentional systems pop on,

00:08:21.640 | increased ability to access energy stores

00:08:26.680 | for movement and thought and so forth.

00:08:29.040 | And the amygdala is part of the threat reflex,

00:08:32.300 | so much so that we can really say

00:08:33.900 | that it's the final common pathway

00:08:36.260 | through which the threat reflex flows.

00:08:38.500 | In other words, the amygdala is essential for the threat response.

00:08:43.060 | So while the amygdala might look like an almond,

00:08:46.060 | it's actually part of a much bigger complex

00:08:48.920 | or collection of neurons called the amygdaloid complex.

00:08:52.600 | That complex has anywhere from 12 to 14 areas,

00:08:57.380 | depending on which neuroanatomist is naming things and carving it up.

00:09:00.580 | Why is that important to us?

00:09:01.900 | Well, it turns out that the amygdala is not just a area for threat.

00:09:06.460 | It's an area for generating threat reflexes

00:09:09.240 | that integrates lots of different types of information.

00:09:12.420 | Information from our memory systems, like the hippocampus,

00:09:16.180 | and from our sensory systems,

00:09:18.200 | our eyes, our ears, our nose, our mouth, etc.

00:09:21.560 | So taste information, vision, auditory information, touch, etc.,

00:09:25.880 | flow into the so-called lateral portion of the amygdala

00:09:29.380 | or the amygdaloid complex.

00:09:30.720 | And then there are multiple outputs from the amygdala.

00:09:33.200 | And this is where things get particularly interesting

00:09:35.700 | because the outputs of the amygdala

00:09:37.360 | have a lot of different areas,

00:09:38.760 | but there are two main pathways.

00:09:40.060 | One involves the hypothalamus,

00:09:43.960 | and it also feeds out to our adrenals

00:09:47.140 | to create a sense of alertness and action.

00:09:49.800 | The other pathway out of the amygdala

00:09:52.000 | is to a very interesting area

00:09:53.860 | that typically is associated with reward and even addiction.

00:09:56.740 | The amygdaloid complex actually projects

00:09:59.240 | to areas of the dopamine system,

00:10:01.240 | the so-called nucleus accumbens,

00:10:03.140 | the mesolimbic reward pathway.

00:10:04.780 | For those of you that want to look that up

00:10:07.460 | or that remember from the dopamine episodes,

00:10:09.500 | we have pathways in our brain

00:10:11.960 | that are associated with pursuit, motivation, and reward.

00:10:14.380 | And the neuromodulator dopamine

00:10:15.840 | is largely responsible for that feeling

00:10:17.540 | of craving, pursuit, and reward.

00:10:18.960 | And this threat center is actually able to communicate with

00:10:23.500 | and activate the dopamine system.

00:10:25.360 | And later you will realize why that is very important

00:10:28.160 | and why you can leverage the dopamine system

00:10:30.740 | in order to wire in new memories to replace fearful ones.

00:10:34.600 | There's a fourth component,

00:10:36.580 | and I promise this is the last component

00:10:38.160 | that we need to put into this picture

00:10:39.800 | of the neural circuits for fear.

00:10:41.140 | And this is a circuit that involves an area of the brain

00:10:44.240 | called the prefrontal cortex

00:10:45.500 | and some of it's subdivision,

00:10:47.120 | so literally in the front.

00:10:48.540 | And it's involved in what we call top-down processing.

00:10:52.880 | Top-down processing is the way

00:10:56.740 | that your prefrontal cortex and other areas of the brain

00:11:00.120 | can control or suppress a reflex.

00:11:03.700 | You tell yourself, I want to do this,

00:11:05.900 | or I should do this,

00:11:06.980 | or even though I don't want to,

00:11:08.840 | I'm going to do it anyway.

00:11:10.420 | So this fourth component of fear

00:11:13.340 | is really our ability to attach narrative,

00:11:16.240 | to attach meaning,

00:11:17.920 | and to attach purpose

00:11:19.460 | to what is by all accounts and purposes,

00:11:22.460 | a generic response.

00:11:24.340 | There's no negotiating what fear feels like.

00:11:27.120 | There's only negotiating what it means.

00:11:29.460 | There's only negotiating whether or not you persist,

00:11:32.020 | whether or not you pause,

00:11:33.360 | or whether or not you retreat.

00:11:34.420 | So this is usually the point in the podcast

00:11:36.660 | where I think people start asking,

00:11:37.980 | okay, well, there's the biology,

00:11:39.180 | there's the mechanism,

00:11:39.960 | there's the logic.

00:11:40.800 | How do I eliminate fear?

00:11:42.600 | Well, it's not quite that simple,

00:11:45.260 | although by understanding the logic

00:11:47.020 | and the mechanisms by which these circuits are built,

00:11:49.360 | we can eventually get to that place.

00:11:51.880 | I do want to plant a flag around a particular type of tool

00:11:56.020 | or a logical framework

00:11:57.960 | around a particular set of tools, rather,

00:12:00.200 | that we are going to build out through this episode.

00:12:02.920 | And based on what you now know,

00:12:06.180 | that the threat reflex gets input

00:12:09.420 | and it has outputs

00:12:11.100 | and it's subject to these top-down processing events,

00:12:15.340 | these narratives,

00:12:16.240 | you should be asking yourself,

00:12:19.220 | what sort of narrative should I apply to eliminate fear?

00:12:23.200 | Well, first, let's take a step back

00:12:25.580 | and just acknowledge the reality,

00:12:27.620 | which is that fear is, in some cases,

00:12:30.820 | an adaptive response.

00:12:32.080 | We don't want people eliminating fears

00:12:35.740 | that can get them injured or killed, right?

00:12:37.840 | The reason that the fear threat response

00:12:40.960 | and reflex exists at all

00:12:42.880 | is to help us from dying,

00:12:45.220 | to help us from making really bad decisions.

00:12:47.340 | So it's not just about a readiness

00:12:49.540 | for things that might injure us

00:12:51.740 | or kill us in the immediate circumstance,

00:12:54.180 | but also protecting us for the future

00:12:57.040 | because of our important need

00:12:58.760 | and ability to anticipate.

00:12:59.880 | Some memories,

00:13:01.060 | even if they evoke a sense of fear in us,

00:13:03.880 | are protective.

00:13:04.900 | They protect us from making bad mistakes

00:13:06.800 | that could get us injured or killed

00:13:08.200 | or put us into really horrible circumstances.

00:13:10.560 | Other memories are dangerous

00:13:13.000 | because they create a sense in us of discomfort

00:13:17.060 | and they tend to limit our behavior

00:13:19.220 | in ways that are maladaptive,

00:13:21.580 | that prevent us

00:13:22.420 | from having healthy relationships to others,

00:13:24.360 | healthy job relationships,

00:13:26.320 | healthy relationship to ourselves, frankly.

00:13:28.480 | So this language of memories as protective

00:13:31.180 | or memories as dangerous,

00:13:32.340 | it's an important aspect of fear

00:13:34.120 | because much of the fear system

00:13:36.520 | is a memory system.

00:13:38.420 | It's designed to embed a memory

00:13:41.080 | of certain previous experiences in us

00:13:44.260 | such that the threat reflex is activated

00:13:46.840 | in anticipation of what might happen.

00:13:50.140 | Okay?

00:13:50.800 | So let's talk for a second

00:13:52.040 | about how certain memories

00:13:52.860 | get attached to this fear system.

00:13:54.500 | and this brings us to a beautiful

00:13:56.380 | and indeed Nobel Prize winning aspect

00:13:58.720 | of biology and physiology,

00:14:00.720 | which is Pavlovian conditioning.

00:14:02.380 | Many of you are probably familiar

00:14:04.220 | with Pavlov's dogs

00:14:05.520 | and the famous Pavlovian conditioning experiments.

00:14:08.360 | They go something like this,

00:14:10.020 | ring a bell.

00:14:10.640 | A dog doesn't do much in response to a bell.

00:14:13.680 | It might attend to it,

00:14:14.500 | but it doesn't salivate typically

00:14:15.880 | in response to the bell.

00:14:17.020 | However,

00:14:17.280 | if you pair the ringing of a bell

00:14:18.640 | with a presentation of food enough times,

00:14:21.100 | the dog will salivate in response to the food.

00:14:23.480 | Eventually you take away the food,

00:14:25.180 | you just ring the bell

00:14:26.180 | and the dog will salivate

00:14:27.440 | in response to the bell.

00:14:28.300 | Okay?

00:14:28.800 | So in the context

00:14:30.420 | of so-called Pavlovian conditioning,

00:14:31.840 | these things have names

00:14:32.840 | like conditioned stimulus

00:14:33.880 | and unconditional stimulus

00:14:35.120 | and responses.

00:14:36.220 | the unconditioned stimulus

00:14:37.740 | is the thing

00:14:38.900 | that evokes a response unconditionally.

00:14:42.260 | So food is the unconditioned stimulus

00:14:44.840 | in the example I just gave.

00:14:46.060 | The bell in the previous example

00:14:48.400 | is what we call

00:14:50.660 | the conditioned stimulus

00:14:52.060 | or the conditioning stimulus.

00:14:53.960 | The conditioned stimulus

00:14:55.020 | is paired with the thing

00:14:58.080 | that naturally creates a response

00:14:59.780 | and then eventually

00:15:00.620 | the conditioned stimulus

00:15:01.640 | creates the response itself.

00:15:03.360 | You might think,

00:15:04.380 | well,

00:15:04.580 | that just seems,

00:15:05.700 | endlessly boring and simple,

00:15:07.860 | but this is actually

00:15:09.440 | the way that our fear systems work.

00:15:10.920 | Except unlike Pavlov's dogs,

00:15:13.740 | you don't need

00:15:15.140 | many, many pairings

00:15:17.220 | of a bell

00:15:19.000 | with some unconditioned stimulus

00:15:21.060 | in order to get a response.

00:15:22.320 | You can get what's called

00:15:23.380 | one trial learning.

00:15:24.360 | And in this circuit

00:15:25.600 | that involves the amygdala,

00:15:26.840 | the threat reflex

00:15:27.700 | and all this other

00:15:28.560 | stuff that I was talking about earlier,

00:15:31.560 | the system is set up for learning.

00:15:34.800 | It's set up to create memories

00:15:36.900 | and to anticipate problems.

00:15:38.700 | It's a very good system

00:15:40.260 | because it was designed

00:15:41.020 | to keep us safe.

00:15:42.240 | So now you should understand

00:15:43.700 | how classical conditioning

00:15:46.040 | as it's called occurs.

00:15:48.040 | you go to give a piano recital

00:15:51.060 | as a kid,

00:15:51.600 | you sit down and you freeze up

00:15:53.640 | and it's horribly embarrassing.

00:15:55.320 | And even if you just freeze up

00:15:57.760 | for a few seconds,

00:15:58.560 | the heart rate increase

00:16:00.140 | and the perspiring,

00:16:01.420 | the sweating

00:16:01.940 | and the shame that you feel

00:16:04.240 | leads you to want to avoid

00:16:06.300 | playing instruments

00:16:07.640 | or public displays

00:16:08.760 | of performances

00:16:10.900 | for a long period of time

00:16:13.220 | unless you do something

00:16:13.940 | to overcome it.

00:16:15.320 | some people,

00:16:16.160 | it tends to be more

00:16:17.800 | an accumulation of experiences.

00:16:19.300 | There's a key,

00:16:21.040 | what we call temporal component.

00:16:22.460 | There's a component

00:16:23.200 | of the fear system

00:16:24.880 | being able to batch

00:16:26.300 | many events in time

00:16:28.100 | and create one specific fear

00:16:30.500 | or take one very specific

00:16:32.860 | isolated incident

00:16:33.900 | that happened very briefly

00:16:35.000 | and create one very large

00:16:36.980 | general sense of fears.

00:16:38.020 | And I'll give an example

00:16:39.140 | of the latter

00:16:40.080 | just to kind of flesh

00:16:41.900 | this out a little bit.

00:16:42.760 | I had a friend come visit

00:16:45.140 | me in San Francisco

00:16:46.800 | some years ago

00:16:47.840 | and their car got broken into,

00:16:49.560 | unfortunately,

00:16:50.040 | a frequent occurrence

00:16:50.960 | in San Francisco

00:16:51.600 | even in the middle of the day.

00:16:52.480 | Never leave anything in your car

00:16:53.540 | in San Francisco.

00:16:54.080 | They'll break in

00:16:55.220 | in the middle of the day.

00:16:56.120 | Doesn't matter.

00:16:56.760 | Police can be having coffee

00:16:57.960 | right there in front of them.

00:16:58.760 | They'll still do it.

00:16:59.440 | They got their belongings taken

00:17:01.440 | and they decided

00:17:02.360 | they were never coming back

00:17:03.660 | to San Francisco.

00:17:04.720 | This was an isolated incident

00:17:06.320 | that forever colored

00:17:08.840 | their view of the city,

00:17:11.120 | which I, you know,

00:17:12.140 | frankly,

00:17:12.460 | understanding the fear system,

00:17:13.920 | I can understand.

00:17:14.640 | We can have isolated incidents

00:17:16.980 | that wick out

00:17:17.800 | to broad decisions

00:17:18.980 | about entire places

00:17:20.380 | or we can have many experiences

00:17:22.780 | that funnel into

00:17:24.160 | very specific isolated fears

00:17:26.300 | about particular circumstances,

00:17:27.640 | places, and things.

00:17:28.780 | So I like to think that by now

00:17:30.300 | you have a pretty good understanding

00:17:31.920 | of the circuits that underlie

00:17:33.920 | the threat reflex,

00:17:34.960 | the fear response,

00:17:36.580 | and how we have

00:17:37.700 | top-down control,

00:17:39.280 | meaning we can attach a narrative

00:17:41.100 | to the fear response

00:17:42.820 | and that the fear response

00:17:44.580 | can be learned

00:17:45.500 | in association

00:17:47.000 | with particular events.

00:17:48.100 | Okay?

00:17:49.100 | So now I'd like to talk about

00:17:51.220 | therapies that are carried out

00:17:53.200 | in humans

00:17:54.000 | that allow fears to be undone,

00:17:56.640 | that allow traumas

00:17:58.060 | to be reversed

00:17:59.060 | contrary to popular belief.

00:18:01.560 | it is not going to work

00:18:04.160 | to simply extinguish a fear.

00:18:06.140 | One needs to extinguish a fear

00:18:09.020 | and or trauma

00:18:10.540 | and replace that fearful

00:18:13.520 | or traumatic memory

00:18:15.100 | or idea or response

00:18:16.780 | with a positive response.

00:18:18.880 | And this is something

00:18:19.840 | that's rarely discussed

00:18:21.060 | both in the scientific literature,

00:18:23.200 | but certainly in the general discussion

00:18:25.660 | around fear and trauma.

00:18:27.220 | and so that brings us

00:18:28.140 | to which treatments

00:18:30.060 | are directly related

00:18:31.560 | to the fear circuitry

00:18:33.460 | and the circuitry related to trauma.

00:18:35.140 | And the primary one

00:18:37.180 | to begin with

00:18:37.860 | is the so-called

00:18:39.360 | behavioral therapies.

00:18:40.500 | There are three forms

00:18:41.680 | of therapy

00:18:42.260 | that purely

00:18:44.180 | through the use of language

00:18:45.260 | have been shown

00:18:45.840 | to have very strong

00:18:47.420 | positive impact,

00:18:48.600 | meaning reduce fears

00:18:50.200 | and traumas.

00:18:51.260 | and those three

00:18:52.180 | are prolonged exposure therapy,

00:18:53.920 | cognitive processing

00:18:55.840 | or CPT

00:18:56.840 | and cognitive behavioral therapy.

00:18:58.460 | It's very clear

00:19:00.720 | because it's been measured

00:19:01.980 | that if you look

00:19:04.800 | at the amount of anxiety,

00:19:06.260 | the pure physiological

00:19:07.740 | anxiety response

00:19:09.840 | of quickening of heart rate,

00:19:11.400 | flushing of the skin,

00:19:14.100 | sometimes quaking

00:19:15.340 | of the hands

00:19:16.320 | that the experience

00:19:17.220 | of fear

00:19:17.740 | over time

00:19:19.400 | when people recount

00:19:21.040 | or retell their trauma

00:19:22.720 | that the first time

00:19:24.520 | they do that,

00:19:25.220 | especially when it's recounted

00:19:27.260 | in a lot of detail,

00:19:28.840 | there's a tremendous

00:19:31.020 | anxiety response,

00:19:32.220 | sometimes even as great

00:19:34.420 | or greater

00:19:34.880 | than the actual exposure

00:19:36.220 | to the fearful event

00:19:37.240 | or trauma.

00:19:37.740 | And obviously

00:19:39.100 | this is something

00:19:39.680 | that is done

00:19:40.600 | with a clinician present

00:19:42.620 | because it is very traumatic

00:19:44.760 | to the person.

00:19:45.460 | They're literally reliving

00:19:46.720 | the trauma

00:19:47.240 | in full rich detail

00:19:48.740 | and they are encouraged

00:19:49.780 | to provide full rich detail.

00:19:51.920 | They're often encouraged

00:19:53.340 | to speak in complete sentences,

00:19:54.880 | to flesh out details

00:19:56.920 | about how they felt

00:19:57.980 | inside,

00:19:58.940 | to flesh out details

00:20:00.880 | about their memories

00:20:01.980 | going into this traumatic

00:20:03.840 | or fearful event,

00:20:04.880 | going through it

00:20:06.280 | and after really

00:20:08.000 | digging into

00:20:09.500 | all the nuance

00:20:10.660 | and contours

00:20:11.500 | of these horrible experiences.

00:20:12.980 | But what's remarkable

00:20:15.420 | is that in the second

00:20:17.740 | and the third

00:20:19.060 | and the fourth retelling

00:20:21.020 | of these traumatic

00:20:22.460 | or fearful events,

00:20:23.640 | that anxiety response

00:20:25.640 | and the amount

00:20:26.580 | of the physiological response,

00:20:28.220 | I should say

00:20:28.880 | that the amplitude

00:20:29.820 | of the physiological response

00:20:31.200 | becomes progressively diminished

00:20:33.280 | with each retelling.

00:20:34.380 | Every clinician

00:20:36.140 | I spoke to

00:20:36.920 | in anticipation

00:20:37.600 | of this episode

00:20:38.360 | said the exact same thing,

00:20:39.760 | which is that

00:20:40.260 | a detailed

00:20:41.480 | recounting

00:20:43.060 | of the traumatic

00:20:44.060 | and fearful events

00:20:45.300 | is absolutely essential

00:20:46.760 | in order to get

00:20:48.460 | the positive effects

00:20:50.000 | of prolonged exposure,

00:20:51.240 | cognitive processing

00:20:52.180 | and cognitive behavioral therapy.

00:20:53.580 | So the thing

00:20:54.500 | to embed in your mind

00:20:55.500 | is that recognition

00:20:57.620 | of the early traumatic

00:20:59.280 | or fearful event

00:21:00.420 | in detail

00:21:01.400 | over and over

00:21:02.860 | is key to forming

00:21:04.380 | a new non-traumatic

00:21:06.780 | association

00:21:08.180 | with that event

00:21:09.780 | or person.

00:21:11.060 | So that's part one.

00:21:12.620 | You need to diminish

00:21:14.860 | the old experience.

00:21:16.120 | And when I say diminish,

00:21:17.080 | I mean reduce

00:21:18.220 | the amplitude

00:21:19.380 | of the physiological response.

00:21:21.540 | but even after

00:21:23.980 | that's occurred,

00:21:24.700 | there's an essential need

00:21:26.860 | to relearn

00:21:27.920 | a new narrative.

00:21:28.960 | Why is there

00:21:30.400 | essential need

00:21:31.100 | to relearn

00:21:31.740 | a new narrative

00:21:32.620 | or create

00:21:33.220 | a new association?

00:21:34.560 | Well,

00:21:35.580 | that has to do

00:21:36.380 | with that fear

00:21:37.420 | reflex circuitry.

00:21:38.280 | As you recall,

00:21:38.960 | there are outputs

00:21:39.940 | to areas

00:21:41.120 | of the brain

00:21:41.940 | that are associated

00:21:42.560 | with dopamine release

00:21:43.900 | and reinforcement.

00:21:44.880 | And that,

00:21:46.000 | we now know,

00:21:46.780 | offers the capacity

00:21:47.860 | for these fear circuits

00:21:49.080 | and these circuits

00:21:49.720 | that underlie trauma

00:21:50.780 | to be mapped

00:21:51.880 | onto new experiences

00:21:53.340 | that are

00:21:55.060 | of positive association.

00:21:56.620 | That is all

00:21:58.120 | through narrative.

00:21:58.720 | It's all

00:21:59.360 | through cognition.

00:22:00.100 | And I think

00:22:00.840 | this is a very

00:22:01.460 | important point.

00:22:02.240 | Oftentimes,

00:22:02.980 | I think we tend

00:22:03.860 | to undervalue

00:22:05.540 | the importance

00:22:07.380 | of rationalization

00:22:08.500 | and of story

00:22:09.520 | and of narrative.

00:22:10.360 | But the prefrontal cortex

00:22:12.220 | is this amazing

00:22:13.560 | capacity of our brain

00:22:14.720 | real estate

00:22:15.280 | to create meaning,

00:22:17.220 | to attach meaning

00:22:18.260 | and purpose

00:22:18.940 | to things

00:22:19.740 | that otherwise

00:22:20.300 | are just reflexive.

00:22:21.380 | Now,

00:22:22.360 | I mentioned

00:22:22.880 | prolonged exposure therapy,

00:22:24.180 | cognitive processing

00:22:25.060 | and cognitive behavioral therapy.

00:22:26.480 | For those of you

00:22:27.660 | that are seeking relief

00:22:28.600 | from fear

00:22:30.340 | and traumatic events,

00:22:31.300 | you can look up

00:22:32.580 | licensed clinicians

00:22:33.560 | that can carry out

00:22:34.780 | those one

00:22:36.080 | or several

00:22:36.500 | of those types

00:22:37.160 | of therapies.

00:22:37.620 | There are many people,

00:22:40.560 | however,

00:22:40.920 | that don't have access

00:22:41.820 | to that

00:22:42.340 | or who are

00:22:43.540 | working through stuff.

00:22:45.000 | They have things

00:22:46.280 | in their past

00:22:46.960 | that are very

00:22:47.920 | uncomfortable to them

00:22:48.780 | and I'm aware

00:22:50.340 | that many people

00:22:50.840 | are working

00:22:51.300 | through those things

00:22:52.240 | through journaling,

00:22:53.120 | through talking

00:22:53.840 | to a friend,

00:22:54.540 | through any number

00:22:56.580 | of different

00:22:57.100 | sort of non-traditional

00:22:58.420 | approaches.

00:22:59.060 | One thing

00:23:00.380 | that really pertains

00:23:01.140 | to everybody

00:23:01.960 | who's working

00:23:02.980 | through fear

00:23:03.560 | and trauma

00:23:04.100 | of any kind

00:23:06.040 | is the importance

00:23:07.760 | of social connection

00:23:08.760 | as it relates

00:23:09.480 | to the chemical systems

00:23:10.880 | and the neural circuits

00:23:12.400 | associated with fear

00:23:13.540 | and trauma.

00:23:14.480 | and it's really

00:23:15.860 | important to understand

00:23:16.700 | that regular

00:23:17.460 | social connection,

00:23:18.720 | trusting social connection

00:23:20.980 | of any kind

00:23:21.940 | is going to be

00:23:22.940 | very beneficial

00:23:23.540 | for that process.

00:23:24.520 | In a few minutes,

00:23:25.440 | we are going to discuss

00:23:26.480 | some of the behavioral

00:23:27.940 | treatments,

00:23:28.500 | including some really

00:23:29.480 | new, exciting protocols

00:23:30.700 | for dealing

00:23:32.100 | with fear

00:23:32.620 | and trauma.

00:23:33.140 | But for a few minutes,

00:23:35.380 | I'd like to discuss

00:23:36.200 | some of the drug treatments

00:23:37.280 | that are starting

00:23:37.920 | to emerge

00:23:38.540 | as potential therapeutics,

00:23:40.360 | in particular

00:23:40.980 | for PTSD.

00:23:41.900 | The two drug treatments

00:23:43.640 | I'd like to focus on

00:23:44.740 | are ketamine-assisted

00:23:46.500 | psychotherapy

00:23:47.240 | and MDMA-assisted

00:23:49.940 | psychotherapy.

00:23:50.720 | Ketamine

00:23:52.040 | is a dissociative

00:23:53.500 | anesthetic.

00:23:54.400 | You know,

00:23:55.140 | dissociation

00:23:56.080 | in its essence

00:23:57.860 | is really about

00:23:58.960 | viewing what's happening

00:24:00.460 | from a different

00:24:01.160 | perspective

00:24:01.640 | than what normally

00:24:02.740 | one would view

00:24:03.920 | that experience from.

00:24:05.000 | What seems

00:24:06.300 | to be the case

00:24:06.960 | is that

00:24:07.380 | it somehow

00:24:08.340 | allows the patient,

00:24:10.000 | the individual,

00:24:10.660 | to recount

00:24:11.940 | their trauma

00:24:12.700 | while feeling

00:24:14.260 | either none

00:24:15.620 | or a very

00:24:17.020 | different set

00:24:18.060 | of emotional

00:24:19.060 | experiences

00:24:19.760 | that they experienced

00:24:21.080 | in the actual

00:24:22.060 | trauma

00:24:22.560 | or fearful

00:24:23.180 | experience.

00:24:23.820 | So it's a remapping

00:24:25.320 | of new

00:24:26.320 | onto old,

00:24:27.200 | new meaning

00:24:28.300 | new feelings

00:24:28.960 | onto old feelings

00:24:30.260 | while staying

00:24:30.940 | in the exact

00:24:31.480 | same narrative.

00:24:32.140 | And so in that way,

00:24:33.480 | we can sort of view

00:24:34.860 | or we can try

00:24:35.880 | and view ketamine-assisted

00:24:36.940 | psychotherapy

00:24:38.040 | for the treatment

00:24:39.200 | of trauma

00:24:39.660 | as bringing together

00:24:40.760 | the three elements

00:24:42.040 | that we talked

00:24:42.520 | about before.

00:24:43.020 | You want to diminish

00:24:44.020 | the intensity,

00:24:45.340 | the potency

00:24:46.020 | of the old

00:24:46.760 | original trauma

00:24:48.540 | experience

00:24:49.180 | or fear experience.

00:24:50.080 | So that seems

00:24:51.120 | to be accomplished

00:24:51.700 | through this dissociation

00:24:53.160 | that leads

00:24:54.200 | to the extinction

00:24:55.060 | of the trauma

00:24:56.380 | and the fear.

00:24:56.980 | But then there also

00:24:58.100 | seems to be

00:24:58.880 | an automatic

00:24:59.860 | or kind of built-in

00:25:01.040 | relearning

00:25:01.760 | of a new narrative

00:25:03.340 | and new set

00:25:04.060 | experiences,

00:25:04.680 | which is the next

00:25:05.600 | step that we

00:25:06.540 | described earlier.

00:25:07.440 | So it's an intriguing

00:25:09.600 | therapy.

00:25:10.160 | It's one that's

00:25:11.060 | really catching on

00:25:12.300 | and there are

00:25:12.980 | many, many clinics

00:25:13.700 | around the U.S.

00:25:14.340 | that are now doing it.

00:25:15.220 | Whether or not

00:25:16.620 | it turns out

00:25:17.180 | to be the

00:25:18.060 | ultimate treatment

00:25:19.180 | for trauma

00:25:20.520 | and for fear

00:25:21.100 | isn't clear.

00:25:22.740 | My colleagues

00:25:24.040 | in psychiatry

00:25:24.840 | tell me that

00:25:25.460 | that's unlikely,

00:25:26.340 | although it does

00:25:27.120 | seem to be beneficial

00:25:27.960 | for a number

00:25:28.840 | of people,

00:25:29.460 | especially people

00:25:30.100 | that are experiencing

00:25:31.060 | trauma

00:25:32.200 | or have existing

00:25:33.240 | traumas and fear

00:25:34.020 | that are coupled

00:25:34.660 | with depressive symptoms

00:25:35.860 | because the data

00:25:36.740 | on ketamine

00:25:37.380 | and depression

00:25:37.980 | seems to be

00:25:39.040 | quite strong.

00:25:39.620 | So now let's talk

00:25:40.740 | about MDMA.

00:25:41.580 | MDMA,

00:25:43.240 | also sometimes

00:25:44.160 | called ecstasy

00:25:45.200 | or molly

00:25:45.880 | in its recreational

00:25:47.720 | form,

00:25:48.260 | is a powerful

00:25:49.900 | synthetic drug

00:25:51.100 | that at least

00:25:53.140 | as far as we know

00:25:54.240 | creates a state

00:25:55.640 | in the brain

00:25:56.820 | and body

00:25:57.200 | that is unlike

00:25:58.160 | any other

00:25:59.120 | chemical state

00:25:59.840 | in the brain

00:26:00.300 | and body

00:26:00.680 | that's normally

00:26:01.340 | experienced.

00:26:02.000 | What do I mean by that?

00:26:03.120 | Well,

00:26:03.780 | we have several

00:26:04.680 | neuromodulator systems

00:26:05.700 | in our body.

00:26:06.320 | Good examples

00:26:07.020 | of neuromodulators

00:26:07.860 | are dopamine,

00:26:08.560 | serotonin,

00:26:09.820 | acetylcholine,

00:26:10.820 | norepinephrine,

00:26:11.720 | and there is a little

00:26:13.200 | bit of a seesaw

00:26:14.180 | type phenomenon

00:26:15.140 | with dopamine

00:26:16.000 | and serotonin.

00:26:16.840 | Dopamine most

00:26:17.640 | commonly associated

00:26:19.100 | with activating

00:26:20.200 | neural circuits

00:26:21.080 | related to motivation,

00:26:22.160 | craving,

00:26:22.660 | and reward,

00:26:23.280 | and serotonin

00:26:25.000 | more typically

00:26:26.300 | activated

00:26:26.900 | in response

00:26:27.600 | to situations

00:26:29.300 | or conditions

00:26:30.260 | in which we are

00:26:30.920 | very happy

00:26:31.440 | and content

00:26:31.840 | with what we have.

00:26:32.780 | So dopamine

00:26:33.260 | is more about

00:26:33.920 | pursuing and seeking.

00:26:34.840 | Serotonin is more

00:26:36.180 | about kind of

00:26:38.280 | pleasure and satisfaction

00:26:39.960 | with resources

00:26:40.860 | that we have

00:26:41.440 | in our immediate sphere.

00:26:42.660 | MDMA

00:26:44.260 | is a unique

00:26:45.660 | compound

00:26:46.520 | in that it leads

00:26:47.860 | to very large

00:26:49.040 | increases

00:26:49.580 | in the amount

00:26:50.400 | of both dopamine

00:26:51.340 | and serotonin

00:26:52.560 | in the brain

00:26:53.060 | and body

00:26:53.400 | simultaneously.

00:26:54.500 | And that's

00:26:55.620 | a unique circumstance

00:26:56.600 | that is

00:26:58.160 | just simply

00:26:59.180 | not seen

00:26:59.820 | under normal

00:27:00.360 | conditions.

00:27:00.860 | From a subjective

00:27:02.300 | standpoint,

00:27:02.720 | people under

00:27:03.960 | the influence

00:27:04.480 | of MDMA

00:27:05.220 | in the therapeutic

00:27:05.980 | setting

00:27:06.480 | tend to report

00:27:08.020 | immense feelings

00:27:08.900 | of connection

00:27:09.820 | or resonance

00:27:10.780 | with people

00:27:12.160 | or even things

00:27:13.200 | with music,

00:27:14.200 | with objects.

00:27:15.180 | Why would

00:27:15.940 | this state

00:27:16.580 | of mind

00:27:17.140 | and body

00:27:17.680 | be potentially

00:27:18.820 | useful

00:27:19.300 | for the treatment

00:27:19.840 | of trauma?

00:27:20.800 | what it seems

00:27:21.540 | to allow

00:27:22.560 | is a very

00:27:24.020 | fast relearning

00:27:25.980 | or new

00:27:27.840 | associations

00:27:28.600 | to be tacked

00:27:30.020 | on to the

00:27:30.760 | previously traumatic

00:27:31.600 | experience.

00:27:32.200 | So again,

00:27:32.700 | it brings us

00:27:33.180 | back to the same

00:27:34.080 | model of how

00:27:35.580 | people extinguish

00:27:36.700 | fears and traumas

00:27:37.640 | and replace them

00:27:39.020 | with new experiences

00:27:39.840 | when there is

00:27:40.980 | no drug treatment

00:27:41.740 | involved.

00:27:42.200 | There needs

00:27:43.700 | to be a diminishing

00:27:45.180 | of the old experience,

00:27:46.140 | meaning an extinction,

00:27:47.240 | and then a relearning

00:27:47.920 | of a new narrative.

00:27:48.640 | This whole business

00:27:49.760 | of fear and trauma

00:27:50.740 | relates to taking

00:27:52.680 | external experiences

00:27:54.160 | and funneling

00:27:56.160 | those experiences

00:27:57.180 | into this thing

00:27:58.640 | that I'm calling

00:27:59.240 | a threat reflex

00:28:00.360 | or the fear circuitry.

00:28:01.760 | We have a system

00:28:03.440 | that can generate

00:28:04.200 | threat responses

00:28:05.120 | and in the case

00:28:06.400 | of trauma,

00:28:06.800 | PTSD

00:28:07.360 | and extreme stress,

00:28:08.840 | chronic stress,

00:28:09.480 | that system gets ramped up

00:28:11.060 | so that it takes

00:28:11.700 | very little,

00:28:12.220 | maybe even just a memory

00:28:13.280 | or maybe even

00:28:14.000 | an association

00:28:15.260 | that we're not

00:28:15.920 | even aware of.

00:28:16.820 | How do we

00:28:17.260 | recalibrate the system?

00:28:18.320 | Well,

00:28:19.000 | most of the approaches

00:28:20.240 | that are out there

00:28:21.040 | involving drug treatments,

00:28:22.380 | typical drug treatments

00:28:24.220 | would involve

00:28:24.940 | suppressing the level

00:28:26.880 | of internal arousal,

00:28:28.500 | just trying to bring

00:28:29.560 | that down.

00:28:30.160 | So what we've been doing

00:28:32.120 | in human subjects

00:28:33.000 | is having them do

00:28:34.480 | breathing protocols

00:28:35.460 | called cyclic hyperventilation,

00:28:37.020 | which is somewhat stressful.

00:28:38.420 | It's five minutes

00:28:39.600 | a day of stress

00:28:40.980 | and involves basically

00:28:42.160 | doing this,

00:28:43.400 | what I'll do in a moment,

00:28:44.820 | for five minutes

00:28:46.400 | which is hyperventilating,

00:28:48.320 | which is

00:28:48.860 | but not continuously

00:28:54.900 | for the five minutes

00:28:55.900 | because many people

00:28:56.980 | would pass out

00:28:57.700 | or feel extremely uncomfortable.

00:28:58.960 | It involves

00:29:00.020 | inhale, exhale,

00:29:01.160 | inhale, exhale,

00:29:01.900 | very deep,

00:29:02.660 | inhale through the nose,

00:29:03.560 | exhale through the mouth

00:29:04.420 | and then every 25

00:29:05.620 | or 30 breaths or so

00:29:06.800 | doing a full exhale

00:29:08.000 | and holding one's breath,

00:29:09.480 | lungs empty

00:29:10.120 | for about 25,

00:29:11.340 | maybe 30,

00:29:12.720 | maybe even 60 seconds

00:29:13.820 | and then continuing

00:29:14.800 | until five minutes is up.

00:29:16.520 | Subjects report

00:29:17.980 | and our data indicate

00:29:19.320 | that people feel

00:29:20.480 | a heightened level

00:29:21.480 | of autonomic arousal.

00:29:23.420 | In fact,

00:29:23.820 | I can feel it right now

00:29:24.960 | even from that very brief

00:29:26.640 | cyclic hyperventilation bout

00:29:28.380 | I just did.

00:29:29.020 | You feel a heating up,

00:29:30.300 | you feel a,

00:29:31.260 | some people will perspire,

00:29:33.220 | some people get wide-eyed,

00:29:34.260 | some people feel agitated,

00:29:35.440 | that's adrenaline

00:29:36.220 | being released

00:29:36.820 | into your system.

00:29:37.540 | It's stressful

00:29:38.780 | in air quotes.

00:29:39.500 | You can imagine

00:29:40.400 | a very brief

00:29:42.020 | five minutes a day,

00:29:43.400 | two weeks intervention

00:29:45.360 | in which people

00:29:46.800 | with the support

00:29:47.780 | of a clinician,

00:29:48.280 | we would hope,

00:29:48.900 | would deliberately induce

00:29:51.380 | a physiological state

00:29:52.740 | that's very stressful,

00:29:53.920 | right?

00:29:54.620 | Not shying away

00:29:55.520 | from the stress response

00:29:56.440 | but increasing

00:29:57.400 | their own stress response

00:29:58.820 | deliberately

00:29:59.260 | and maybe

00:30:00.380 | in conjunction

00:30:01.600 | with recounting

00:30:03.180 | the traumatic

00:30:03.740 | or fearful circumstance.

00:30:06.100 | this is far and away

00:30:07.320 | different than the kind

00:30:08.500 | of state of mind

00:30:09.300 | and body

00:30:09.680 | that would come about

00:30:10.880 | in a ketamine-assisted

00:30:12.080 | trauma-induced

00:30:13.300 | psychotherapy session

00:30:14.240 | or a MDMA-assisted

00:30:16.120 | trauma psychotherapy session

00:30:18.520 | or in a purely

00:30:20.660 | narrative-based

00:30:21.620 | psychotherapy session

00:30:23.380 | aimed at alleviating

00:30:24.680 | fear or trauma.

00:30:25.760 | The reason I like

00:30:27.220 | these sorts of interventions

00:30:28.180 | is that A,

00:30:29.080 | they are very low cost

00:30:30.160 | or even zero cost,

00:30:31.300 | right?

00:30:31.640 | One could,

00:30:32.380 | you could imagine

00:30:33.280 | doing this

00:30:34.420 | while journaling

00:30:35.800 | or while recounting

00:30:37.620 | a particular experience.

00:30:38.560 | I do think

00:30:39.740 | that deliberate

00:30:40.560 | self-directed entry

00:30:42.220 | into these short

00:30:43.080 | bouts of stress

00:30:43.840 | is a very promising approach

00:30:45.300 | and it's one

00:30:46.220 | that if people

00:30:47.360 | are going to experiment,

00:30:48.100 | I just again

00:30:48.720 | want to caution people

00:30:49.600 | with anxiety

00:30:50.280 | or panic disorders,

00:30:51.240 | be very cautious,

00:30:52.140 | probably don't do it.

00:30:53.160 | Ideally,

00:30:53.740 | you would do this

00:30:54.340 | in conjunction

00:30:55.120 | with support

00:30:55.940 | from a clinician

00:30:56.900 | but I'm also aware

00:30:58.420 | that there are a lot

00:30:58.920 | of people out there

00:30:59.640 | that are dealing

00:31:00.280 | with trauma

00:31:01.060 | and dealing

00:31:01.740 | with post-traumatic stress

00:31:04.020 | of various kinds

00:31:04.760 | and that they're desperate

00:31:06.320 | for various self-directed

00:31:09.000 | intervention approaches.

00:31:10.000 | So just very briefly,

00:31:11.340 | I want to touch

00:31:11.960 | on some of the lifestyle

00:31:13.120 | and supplementation factors

00:31:14.600 | that can impact things

00:31:16.920 | like fear and trauma

00:31:18.060 | and getting over fear

00:31:19.260 | and trauma.

00:31:19.720 | To make a long story short,

00:31:22.180 | there are many things

00:31:24.340 | that we all can

00:31:25.740 | and should do

00:31:26.400 | to support our overall

00:31:27.760 | mental and physical health

00:31:29.000 | and these are

00:31:29.640 | the foundational elements

00:31:31.020 | of quality nutrition,

00:31:32.540 | what that means to you,

00:31:33.700 | quality sleep

00:31:35.800 | on a regular basis,

00:31:36.740 | ample sleep

00:31:37.620 | on a regular basis.

00:31:38.400 | I just want to briefly mention

00:31:39.960 | a few of the things

00:31:41.460 | that some people

00:31:42.620 | find great benefit

00:31:43.760 | from in the supplementation realm

00:31:45.940 | as it relates

00:31:48.340 | to anxiety, stress,

00:31:49.680 | fear and PTSD

00:31:51.160 | but I want to point out

00:31:52.840 | that again,

00:31:53.300 | these are somewhat

00:31:54.320 | indirect in their support

00:31:55.680 | and most of them

00:31:56.840 | focus on reducing anxiety

00:31:58.940 | overall.

00:32:00.020 | The two that I want

00:32:01.720 | to focus on

00:32:02.260 | are two that I've never

00:32:03.080 | talked about

00:32:03.720 | on this podcast before

00:32:04.860 | because I've done podcasts

00:32:06.760 | before on stress

00:32:07.820 | and managing stress

00:32:08.700 | in the kind of shorter term.

00:32:09.920 | The first one

00:32:10.880 | is saffron of all things

00:32:12.540 | but there are 12 studies,

00:32:14.980 | believe it or not,

00:32:15.700 | that orally ingested

00:32:17.380 | saffron at 30 milligrams

00:32:19.400 | seems to be a reliable dose

00:32:21.600 | for reducing anxiety

00:32:22.940 | on the standard inventories,

00:32:24.920 | the Hamilton Anxiety Rating Scale

00:32:26.640 | for those of you

00:32:27.140 | that want to know

00:32:27.700 | and these are significant effects

00:32:29.240 | and these were carried out

00:32:30.160 | in both male

00:32:31.100 | and female subjects

00:32:32.040 | always here

00:32:33.080 | I'm only referring

00:32:33.700 | to human studies.

00:32:34.620 | Several of these

00:32:35.800 | were double blind studies.

00:32:37.000 | There's a meta-analysis

00:32:38.720 | of the positive effects

00:32:40.600 | meaning anxiolytic effects,

00:32:43.440 | anxiety reducing effects

00:32:45.140 | that is of things

00:32:46.480 | like saffron.

00:32:47.200 | The other one

00:32:48.140 | is inositol.

00:32:49.640 | Inositol has been shown

00:32:52.000 | to create a very notable decrease

00:32:54.440 | in anxiety symptoms.

00:32:55.560 | It's a fairly high dose

00:32:57.700 | that's used

00:32:58.300 | but believe it or not,

00:32:59.720 | the potency of this effect

00:33:01.540 | is on par

00:33:02.180 | with many of the prescription

00:33:03.160 | antidepressants.

00:33:04.180 | 18 grams of inositol

00:33:06.300 | taken for a full month

00:33:07.420 | and it does take some time

00:33:09.320 | for these symptoms of anxiety

00:33:11.340 | to be improved.

00:33:12.880 | Now the question is

00:33:13.840 | when would you take it?

00:33:14.880 | Well, by the logic

00:33:15.980 | of what we spelled out today

00:33:17.260 | you probably would not want

00:33:20.040 | to take it during a session

00:33:21.580 | or prior to a session

00:33:23.140 | where you were trying

00:33:24.360 | to amplify the intensity

00:33:26.140 | of an experience

00:33:26.980 | and the recounting

00:33:27.700 | of an experience

00:33:28.360 | in efforts to eventually

00:33:30.340 | extinguish that experience, right?

00:33:32.360 | So you can imagine

00:33:33.040 | doing this outside

00:33:34.020 | of that session

00:33:34.780 | as a way to kind of

00:33:35.820 | bring your system

00:33:36.360 | back to baseline perhaps.

00:33:37.560 | So today we've reviewed

00:33:39.140 | a large amount of information

00:33:40.480 | about the biology

00:33:41.860 | of pathways in the brain

00:33:43.640 | and body

00:33:44.040 | that underlie

00:33:45.140 | the fear response

00:33:46.020 | and that give rise

00:33:47.260 | to chronic fear

00:33:48.660 | and in some cases

00:33:49.800 | to trauma and PTSD.

00:33:51.080 | We also touched on

00:33:53.400 | a large variety

00:33:54.780 | of approaches

00:33:55.380 | to dealing

00:33:56.160 | with fear,

00:33:57.420 | trauma,

00:33:57.840 | and PTSD

00:33:58.580 | that currently exist

00:34:00.040 | in the clinical

00:34:01.220 | landscape out there.

00:34:02.720 | Most important,

00:34:04.220 | I believe,

00:34:04.760 | is to understand

00:34:05.820 | and really think

00:34:06.500 | about the logical structure

00:34:07.720 | of the circuits

00:34:08.760 | that underlie

00:34:09.520 | fear and PTSD

00:34:10.800 | because in doing that

00:34:12.380 | each of us,

00:34:13.800 | all of us

00:34:14.480 | can think about

00:34:15.380 | what sorts of treatments

00:34:16.260 | and approaches

00:34:16.800 | make the most sense

00:34:17.780 | for them.

00:34:18.200 | I also hope

00:34:19.460 | that it will help people

00:34:20.380 | lean into certain practices

00:34:22.060 | involving

00:34:23.380 | re-exposure,

00:34:25.400 | provided that's done

00:34:26.460 | in a supportive environment,

00:34:27.480 | re-exposure

00:34:28.520 | to a given traumatic event

00:34:30.220 | in an attempt

00:34:30.860 | to extinguish that.

00:34:32.080 | Obviously,

00:34:32.660 | you want to do that safely,

00:34:33.700 | meaning psychologically safely

00:34:35.180 | and physically safely.

00:34:36.220 | There are great practitioners

00:34:37.680 | out there

00:34:38.380 | that can help you

00:34:40.720 | with that work.

00:34:41.340 | There are also

00:34:42.120 | a number of people

00:34:42.700 | out there,

00:34:43.200 | I am certain,

00:34:44.140 | that are carrying

00:34:45.480 | certain traumas

00:34:46.380 | or certain fears

00:34:47.780 | that they would like

00:34:48.360 | to alleviate

00:34:48.780 | that are not

00:34:49.620 | in the extreme

00:34:50.900 | clinical realm,

00:34:51.660 | and that's the reason

00:34:52.960 | why I touched on

00:34:53.620 | a number of things,

00:34:54.360 | including some

00:34:54.940 | self-directed practices

00:34:55.880 | that might be useful

00:34:57.320 | and reasonable

00:34:58.240 | for them to explore.

00:34:59.540 | you

00:35:01.600 | you

00:35:02.100 | you

Erasing Fears & Traumas Using Modern Neuroscience | Huberman Lab Essentials

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