The Science & Treatment of Obsessive Compulsive Disorder (OCD)
Andrew Huberman:
安德鲁·休伯曼：
Welcome to the Huberman Lab podcast, where we discuss science and science-based tools for everyday life.
欢迎来到休伯曼实验室播客，我们在这里讨论科学和基于科学的日常生活工具。
Andrew Huberman:
安德鲁·休伯曼：
I'm Andrew Huberman and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine.
我是安德鲁·胡伯曼，斯坦福大学医学院神经生物学和眼科教授。
Today we are talking about obsessive-compulsive disorder, or OCD.
今天我们谈论的是强迫症（OCD）。
We are also going to talk about obsessive-compulsive personality disorder, which, as you will soon learn, is distinct from obsessive-compulsive disorder.
我们还将讨论强迫性人格障碍，您很快就会了解到，强迫性人格障碍与强迫症不同。
In fact, many people that refer to themselves or others as obsessive or compulsive or "having OCD," or "OCD about this," or "OCD about that" do not have clinically diagnosable OCD.
事实上，许多称自己或他人为强迫症或强迫症或“患有强迫症”、“关于这个的强迫症”或“关于那个的强迫症”的人并没有患有临床上可诊断的强迫症。
Rather, many people have obsessive-compulsive personality disorder.
相反，许多人患有强迫性人格障碍。
However, there are many people in the world that have actual OCD, and for those people there's a tremendous amount of suffering.
然而，世界上有很多人患有真正的强迫症，对这些人来说，他们承受着巨大的痛苦。
In fact, OCD turns out to be number seven on the list of most debilitating illnesses, not just psychiatric illnesses but of all illnesses, which is remarkable and somewhat frightening.
事实上，强迫症在最使人衰弱的疾病清单上排名第七，不仅是精神疾病，而且是所有疾病中的一员，这是值得注意的，也有些令人恐惧。
Andrew Huberman:
安德鲁·休伯曼：
The good news is thanks to the fields of psychiatry, psychology, and science in general, there are now excellent treatments for OCD.
好消息是，得益于精神病学、心理学和科学领域的发展，现在对于强迫症有很好的治疗方法。
We're going to talk about those treatments today.
今天我们将讨论这些治疗方法。
Those treatments range from behavioral therapies to drug therapies and brain stimulation, and even some of the more holistic or natural therapies.
这些治疗方法包括行为疗法、药物疗法和脑刺激，甚至还有一些更全面或自然的疗法。
As you'll soon learn, for certain people, they may want to focus more on the behavioral therapies, whereas for others, more on the drug-based therapies, and so on and so forth.
您很快就会了解到，对于某些人来说，他们可能希望更多地关注行为疗法，而对于其他人来说，更多地关注基于药物的疗法，等等。
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.
我从这一集中学到的一件非常有趣和重要的事情是，应用行为和/或药物和/或整体疗法的特定顺序非常重要。
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.
事实上，研究的结果通常取决于人们是否开始药物治疗，然后进行认知行为治疗，反之亦然。
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 types of obsessions and compulsions, and the age of onset for OCD, and so on and so forth.
我们将深入探讨所有这些细节以及它们与不同类型的强迫症的关系，因为事实证明确实存在不同类型的强迫观念和强迫行为，以及强迫症的发病年龄，等等。
Andrew Huberman:
安德鲁·休伯曼：
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, and you'll have a rich array of different therapy options to explore in yourself or in others that are suffering from OCD.
我可以向您保证的是，在本集结束时，您将对什么是强迫症、什么不是强迫症、什么是强迫性人格障碍、什么不是强迫性人格障碍有更深入的了解，并且您将有丰富的不同治疗选择可供探索，以探索自己或其他患有强迫症的人。
And if neither you or others that you know suffer from OCD or obsessive-compulsive personality disorder, the information covered in today's episode will also provide insight into how the brain and nervous system translate thought into action generally.
如果您或您认识的其他人都没有患有强迫症或强迫性人格障碍，那么今天节目中涵盖的信息也将提供有关大脑和神经系统如何将思想转化为行动的见解。
And also you're going to learn a lot about goal-directed behavior generally.
而且你还将学到很多关于目标导向行为的知识。
My hope is that by the end of the episode, you'll 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.
我希望，在本集结束时，你们都会对这种我们称之为强迫症的疾病状态有更多的了解，你们将能够获得信息，让你们能够以更好的方式指导自己或他人的治疗，并且你们将更深入地了解自己的运作方式以及人类的整体运作方式。
Andrew Huberman:
安德鲁·休伯曼：
The Huberman Lab podcast is proud to announce that we've partnered with Momentous supplements.
Huberman Lab 播客自豪地宣布我们已与 Momentous 补充剂合作。
We've done that for several reasons.
我们这样做有几个原因。
First of all, the quality of their supplements is exceedingly high.
首先，他们的补品质量非常高。
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 defined place.
其次，我们希望有一个位置，您可以在一个易于定义的位置找到 Huberman Lab 播客上讨论的所有补充品。
You can now find that place at livemomentous.com/huberman.
您现在可以在 livemomentous.com/huberman 找到该地点。
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 U.S. or you live abroad.
此外，Momentous 补充剂可进行国际运输，这是许多其他补充剂公司根本不做的事情，因此无论您居住在美国还是居住在国外，这都很棒。
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.
目前，我们在 Huberman Lab 播客上讨论的补充剂并未全部列出，但补充剂目录正在迅速扩大，我们讨论过的很多补充剂，其中一些针对睡眠和注意力以及精神和身体健康其他方面的更重要的补充剂，已经在那里了。
Again, you can find them at livemomentous.com/huberman.
同样，您可以在 livemomentous.com/huberman 找到它们。
Andrew Huberman:
安德鲁·休伯曼：
Before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford.
在开始之前，我想强调一下，这个播客与我在斯坦福大学的教学和研究角色是分开的。
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 public.
然而，我的愿望和努力的一部分是将有关科学和科学相关工具的零成本消费者信息带给公众。
In keeping with that theme, I'd like to thank the sponsors of today's podcast.
为了与这个主题保持一致，我要感谢今天播客的赞助商。
Andrew Huberman:
安德鲁·休伯曼：
Let's talk about OCD, or obsessive-compulsive disorder.
我们来谈谈OCD，即强迫症。
First of all, as the name suggests, OCD includes thoughts, or obsessions; and compulsions, which are actions.
首先，顾名思义，强迫症包括思想或强迫观念；和强迫行为，即行动。
The obsessions and the compulsions are often linked.
强迫观念和强迫行为常常是联系在一起的。
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.
事实上，大多数时候，强迫观念和强迫行为是相互联系的，因此强迫行为、行为都是为了缓解强迫观念而设计的。
However, one of the hallmark themes of obsessive-compulsive disorder is that the obsessions are intrusive.
然而，强迫症的标志主题之一是强迫观念具有侵入性。
People don't want to have them.
人们不想拥有它们。
They don't enjoy having them.
他们不喜欢拥有它们。
They just seem to pop into people's minds, and they seem to pop into their mind recurrently.
它们似乎只是突然出现在人们的脑海中，而且似乎反复出现在人们的脑海中。
And the compulsions, unlike other sorts of behaviors, provide brief relief to the obsession, but then very quickly reinforce or strengthen the obsession.
与其他类型的行为不同，强迫行为可以短暂缓解强迫症，但随后很快就会强化或加强强迫症。
Andrew Huberman:
安德鲁·休伯曼：
This is a very key theme to realize about obsessive-compulsive disorder.
这是认识强迫症的一个非常关键的主题。
So I'm just going to repeat it again, these two features.
所以我想再重复一遍，这两个功能。
First, the fact that the obsessions are intrusive and recurrent, as well as the fact that the compulsions, the behaviors, provide, if anything, only brief relief for the obsessions but in most cases simply serve to make the obsessions stronger are the hallmark features of obsessive-compulsive disorder.
首先，强迫观念是侵入性的、反复出现的，以及强迫行为、行为只能暂时缓解强迫观念，但在大多数情况下只是使强迫观念变得更强烈，这些都是强迫症的标志性特征。
And 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.
事实证明，在我们前进的过程中牢记这些非常重要，不仅因为它们定义了强迫症，而且它们还定义了对强迫症有效和无效的治疗方法。
Andrew Huberman:
安德鲁·休伯曼：
And then once you understand a little bit about the neural circuitry underlying obsessive-compulsive disorder, which we'll talk about in a few moments, then you'll clearly understand why being an "obsessive person" or having obsessive-compulsive personality is not the same as OCD.
一旦你对强迫症背后的神经回路有了一些了解（我们稍后会讨论），你就会清楚地理解为什么成为一个“强迫症患者”或具有强迫症人格与强迫症不同。
In fact, we can leap ahead a little bit and compare and contrast OCD with obsessive-compulsive personality disorder along one very particular set of features.
事实上，我们可以向前迈进一点，根据一组非常特殊的特征来比较和对比强迫症和强迫性人格障碍。
Again, I'll go into this in more detail later, but it's fair to say that OCD is characterized by these recurrent and intrusive obsessions and, as I mentioned before, the fact that those obsessions get stronger as a function of people performing certain behaviors.
同样，我稍后会更详细地讨论这一点，但可以公平地说，强迫症的特点是这些反复出现和侵入性的痴迷，而且正如我之前提到的，这些痴迷随着人们执行某些行为而变得更强。
Andrew Huberman:
安德鲁·休伯曼：
So unlike an itch that you feel and then you scratch it and it feels better, OCD is more like an itch that you feel, you scratch it, and the itch intensifies.
因此，与你感觉到的痒，然后你抓它，感觉会更好，强迫症更像是你感觉到的痒，你抓它，然后痒会加剧。
That contour or that pattern of behaviors and thoughts interacting is very different than obsessive-compulsive personality disorder, which mainly involves a sense of delayed gratification that people want and somewhat enjoy because it allows them to function better or more in line with how they would like to show up in the world.
这种行为和思想相互作用的轮廓或模式与强迫性人格障碍有很大不同，强迫性人格障碍主要涉及一种人们想要并在某种程度上享受的延迟满足感，因为它可以让他们更好地运作或更符合他们想要在世界上出现的方式。
So again, OCD has mainly to do with obsessions that are intrusive and recurrent, whereas obsessive-compulsive personality disorder does not have that intrusive feature to it.
再说一次，强迫症主要与侵入性和反复出现的强迫观念有关，而强迫性人格障碍则不具有侵入性特征。
People do not mind or in fact often invite or like the particular patterns of thought that lead them to be compulsive along certain dimensions.
人们并不介意，或者事实上经常邀请或喜欢导致他们在某些维度上产生强迫性的特定思维模式。
Andrew Huberman:
安德鲁·休伯曼：
So leaving aside obsessive-compulsive personality disorder for the moment, let's focus a bit more on OCD and define how it tends to show up in the world.
因此，暂时把强迫性人格障碍放在一边，让我们更多地关注强迫症，并定义它在世界上的表现方式。
First of all, OCD is extremely common.
首先，强迫症非常普遍。
In fact, current estimates are that anywhere from 2.5% to as high as 3 or even 4% of people suffer from true OCD.
事实上，目前估计有 2.5% 到 3% 甚至 4% 的人患有真正的强迫症。
That is an astonishingly high number.
这是一个惊人的高数字。
Now, the reason the range is so big, 2.5% all the way up to 3 or maybe even 4%, is that a lot of the features of OCD go unnoticed both in the clinician's office and simply because people don't report it and don't talk about it.
现在，这个范围如此之大的原因是，强迫症的许多特征在临床医生的办公室里都没有被注意到，而且仅仅是因为人们不报告也不谈论它。
Andrew Huberman:
安德鲁·休伯曼：
In fact, it is possible to have recurrent and intrusive obsessions and not engage in the sorts of behaviors that would ever allow people to notice that somebody has OCD.
事实上，有可能会出现反复出现的侵入性强迫症，但不会做出那些会让人们注意到某人患有强迫症的行为。
That can be because some of the intrusive thoughts don't actually lead to overt behaviors like handwashing or checking that other people would notice.
这可能是因为一些侵入性想法实际上并不会导致公开的行为，例如洗手或检查其他人会注意到的行为。
It can also be because people learn to disguise or hide their obsessions and their compulsions out of shame or fear of looking strange or whatever it might be, such that they have these obsessive and intrusive thoughts and they do little micro behaviors like they might tap their fingers on their fly as a way to avoid, at least in their own mind, something catastrophic happening.
也可能是因为人们出于羞耻或害怕看起来奇怪或其他任何原因而学会掩饰或隐藏他们的强迫症和强迫症，这样他们就会有这些强迫性和侵入性的想法，并且他们会做一些微小的行为，比如他们可能会用手指敲击苍蝇，以此来避免（至少在他们自己看来）灾难性的事情发生。
That might seem crazy to you, that might seem bizarre, but this is the sort of thing that operates in a lot of people, and I really want to emphasize this because the clinical literature that are out there really point to the fact that many people have OCD, full-blown OCD and never report it because of the kind of shame and hiding associated with it.
这对你来说可能看起来很疯狂，这可能看起来很奇怪，但这是在很多人身上发生的事情，我真的想强调这一点，因为现有的临床文献确实指出了这样一个事实：许多人患有强迫症，完全的强迫症，但由于与之相关的羞耻和隐藏而从不报告。
Andrew Huberman:
安德鲁·休伯曼：
Another thing to point out is that OCD is extremely debilitating.
另一件需要指出的是，强迫症会让人极度虚弱。
I mentioned this a few minutes ago, but OCD is currently listed as number seven in terms of the most debilitating illnesses, not just mental illnesses or disorders, but all types of illnesses, including things like asthma and cancer, et cetera.
我几分钟前提到过这一点，但强迫症目前在最使人衰弱的疾病中排名第七，不仅仅是精神疾病或紊乱，而是所有类型的疾病，包括哮喘和癌症等。
So you can imagine with that standing at number seven, that it is both extremely common and extremely debilitating.
所以你可以想象，排在第七位的情况是非常常见的，也是非常令人衰弱的。
And as a consequence, it's now realized that many hours, days, weeks, months, or even years of work performance or showing up at work, of relational interactions really suffer as a consequence of people having OCD.
因此，现在人们意识到，患有强迫症的人确实会影响许多小时、几天、几周、几个月甚至几年的工作表现或工作中的人际关系互动。
So this is a vital problem that the scientific and psychiatric and psychological communities understand, and it's one of the reasons that I'm doing this podcast.
所以这是科学界、精神病学和心理学界理解的一个至关重要的问题，这也是我做这个播客的原因之一。
And of course, I received a ton of interest in OCD because of this incredibly high incidence of OCD and how debilitating it is.
当然，我对强迫症非常感兴趣，因为强迫症的发病率非常高，而且它使人衰弱。
Andrew Huberman:
安德鲁·休伯曼：
We could go really deep into why it's so debilitating.
我们可以深入探讨为什么它如此令人衰弱。
I don't want to spend too much time on that because I think most of that is pretty obvious, but some of it is not.
我不想在这上面花太多时间，因为我认为其中大部分都是非常明显的，但有些则不然。
For instance, one of the things that makes OCD so debilitating is of course, the shame that we talked about before, but it's also the fact that when people are focusing on their obsessions and their compulsions, they're not able to focus on other things.
例如，让强迫症如此令人衰弱的原因之一当然是我们之前谈到的羞耻感，但事实上，当人们专注于他们的痴迷和强迫行为时，他们无法专注于其他事情。
That's simply the way that the brain works.
这就是大脑的工作方式。
We're not able to focus on too many things at once.
我们无法同时关注太多事情。
The other thing is that OCD takes a lot of time out of people's lives.
另一件事是强迫症占用了人们大量的生活时间。
With recurrent intrusive thoughts happening at very high frequency or even at moderate frequency, people are spending a lot of time thinking about this stuff, and they're thinking about the behaviors they need to engage in and then engaging in the behaviors, which as I mentioned before, just served to strengthen the compulsions.
由于侵入性想法以非常高的频率甚至中等的频率反复发生，人们会花很多时间思考这些东西，他们会思考他们需要从事的行为，然后从事这些行为，正如我之前提到的，这只是加强了强迫行为。
Andrew Huberman:
安德鲁·休伯曼：
And so they're not actually doing the other things that make us functional human beings, like commuting to work or doing homework or doing work or listening when people are talking or interacting or sports or working out, all the things that make for a rich, quality life are taken over by OCD in many cases.
因此，他们实际上并没有做其他让我们成为正常人的事情，比如上下班、做作业、工作或在人们交谈、互动、运动或锻炼时倾听，在很多情况下，所有创造丰富、优质生活的事情都被强迫症所取代。
So while that might be obvious to some, I'm not sure that it's obvious to everybody just how much time OCD can occupy.
因此，虽然这对某些人来说可能是显而易见的，但我不确定每个人都清楚强迫症会占用多少时间。
Andrew Huberman:
安德鲁·休伯曼：
Another thing you'll soon learn is that sadly, a lot of the obsessions and compulsions in OCD often relate to taboo topics.
您很快就会了解到的另一件事是，可悲的是，强迫症中的许多痴迷和强迫行为通常与禁忌话题有关。
And that's because the general categories of OCD fall into three different bins: checking obsessions and compulsions, repetition obsessions and compulsions, and order obsessions and compulsions.
这是因为强迫症的一般类别分为三个不同的类别：检查强迫症和强迫症、重复强迫症和强迫症以及秩序强迫症和强迫症。
The checking ones are somewhat obvious: checking the stove or checking the locks, which I think we all tend to do.
检查的内容有些明显：检查炉子或检查锁，我认为我们都倾向于这样做。
I'm somebody, typically I'll head off to the car to commute to work, and I'll think, "Did I lock the front door?" And I'll go back once.
我是个大人物，通常我会开车去上班，然后我会想，“我锁了前门吗？”我会回去一次。
But I won't go back twice or 50 times.
但我不会回去两次或五十次。
People with OCD will often go back 20 or 30 times before they'll actually allow themselves to drive off, and then it's a real challenge for them to continue to drive off and discard with the idea that they didn't check the stove, or they didn't check the locks, or they didn't check something else critical.
患有强迫症的人通常会回去 20 或 30 次，然后才真正允许自己开车离开，然后，他们继续开车离开并丢弃，因为他们没有检查炉子，或者他们没有检查锁，或者他们没有检查其他重要的东西，这对他们来说是一个真正的挑战。
Andrew Huberman:
安德鲁·休伯曼：
Repetition obsessions and compulsions obviously can dovetail with the checking ones, but those tend to be things like counting off of a certain number of numbers like 1, 2, 3, 4, 5, 6, 7; 7, 6, 5, 4, 3, 2, 1.
重复的痴迷和强迫显然可以与检查的行为相吻合，但这些往往是像数一定数量的数字，如 1、2、3、4、5、6、7； 7、6、5、4、3、2、1。
People perform that repeatedly, repeatedly, repeatedly, or feel that they have to.
人们会反复、反复、反复地这样做，或者觉得他们必须这样做。
I remember years ago watching a documentary about the band the Ramones, right?
我记得几年前看过一部关于雷蒙斯乐队的纪录片，对吗？
Most people have heard of the Ramones, right?
大多数人都听说过雷蒙斯乐队，对吗？
Jeans, T-shirts, aviator glasses.
牛仔裤、T 恤、飞行员眼镜。
Everyone had to change their last name to Ramone.
每个人都必须把自己的姓氏改为雷蒙。
They weren't actually all related to one another, by the way.
顺便说一句，他们实际上并不都是相互关联的。
You had to change your last name to Ramone.
你必须把你的姓改成雷蒙。
Andrew Huberman:
安德鲁·休伯曼：
The Ramones had one band member who was admittedly and known to others as having OCD, and during that documentary, which I forget the name, I think it was called ...
雷蒙斯乐队有一位乐队成员，他被承认并且被其他人知道患有强迫症，在那部纪录片中，我忘记了名字，我认为它被称为......
I can't remember.
我不记得了。
Anyway, can't remember.
反正想不起来了。
Hippocampal lapse there.
那里有海马失灵。
But in this documentary, the band members describe Joey Ramone as leaving hotels, walking down the stairs to the parking lot but then having to walk up and down them seven or eight times, and sometimes getting out of the van again and walking up and down them seven or eight times.
但在这部纪录片中，乐队成员描述乔伊·雷蒙离开酒店，走下楼梯到停车场，然后不得不在停车场上来回走动七八次，有时又从货车里下来，在停车场上来回走动七八次。
It always had to be a certain number of times given a certain number of stairs.
给定一定数量的楼梯，它总是必须是一定次数。
This appears "crazy," but of course we don't want to think of this as crazy.
这看起来很“疯狂”，但我们当然不想认为这是疯狂的。
This is somebody who very likely had full-blown OCD.
这个人很可能患有完全的强迫症。
Andrew Huberman:
安德鲁·休伯曼：
Now, that particular example, believe it or not, is not all that uncommon.
不管你信不信，这个特殊的例子并不少见。
It just so happens that that example entailed certain compulsions and behaviors that were overt and that other people could see, and you can imagine how that would prevent somebody from moving about their daily life easily.
碰巧的是，这个例子涉及某些公开的强迫行为和行为，其他人可以看到，你可以想象这将如何阻止人们轻松地进行日常生活。
A lot of people, as I mentioned before, have obsessions and compulsions that they hide and they do these little micro behaviors, or they'll just count off in their head as opposed to generating some sort of walking up and downstairs or tapping or things of that sort.
正如我之前提到的，很多人都有隐藏的强迫症和强迫行为，他们会做这些微小的微观行为，或者他们只是在头脑中数数，而不是产生某种上下楼或敲击或类似的事情。
Andrew Huberman:
安德鲁·休伯曼：
So we have checking, we have repetition, and then there's order.
所以我们有检查，有重复，然后是秩序。
Order oftentimes is thought of as putting cleanliness or making sure everything is aligned and perfect and orderly.
秩序通常被认为是保持清洁或确保一切都对齐、完美和有序。
And oftentimes that is the case, but there are other forms of order that people with OCD can focus on in an obsessive and compulsive way.
通常情况就是如此，但强迫症患者还可以以强迫性的方式关注其他形式的秩序。
Things like incompleteness, the idea that one can't walk away from something or stop doing something because something's not right or complete in that picture.
诸如不完整之类的事情，即人们无法离开某件事或停止做某事，因为图片中的某件事不正确或不完整。
It could be the way the table is set.
这可能是餐桌布置的方式。
It could be the way that something's written on a page.
这可能是在页面上书写内容的方式。
It could be an email.
它可能是一封电子邮件。
Andrew Huberman:
安德鲁·休伯曼：
Again, now we're still talking about OCD the disorder.
再说一遍，现在我们仍在谈论强迫症这种疾病。
We're not talking about obsessive-compulsive personality disorder.
我们不是在谈论强迫性人格障碍。
I'm aware of ...
我知道...
Well, I'll just be direct.
好吧，我就直接说吧。
Several colleagues of mine, and it's just remarkable, the order in their emails, every email is perfect.
我的几位同事，他们电子邮件中的顺序，每封电子邮件都是完美的，这真是太棒了。
Punctuated, perfect.
标点符号，完美。
Grammar, perfect.
语法，完美。
Everything's spaced perfect.
一切都安排得很完美。
Do they have OCD?
他们有强迫症吗？
Well, they might, they might not.
嗯，他们可能会，也可能不会。
How would I know unless they disclose that to me?
除非他们向我透露这一点，否则我怎么知道？
But they might have obsessive-compulsive personality disorder, or they just might be able to generate a lot of order, and they have a lot of discipline around the way they write and the way they present any communication with anybody at all.
但他们可能患有强迫性人格障碍，或者他们可能能够产生很多秩序，并且他们在写作方式以及与任何人进行交流的方式方面有很多纪律。
Andrew Huberman:
安德鲁·休伯曼：
So if somebody has an OCD that's in the domain of order, it could be incompleteness and the constant feeling of something not being completed and a need to complete it.
因此，如果某人患有秩序领域的强迫症，它可能是不完整的，以及持续感觉某件事尚未完成以及需要完成它。
It can also be in terms of symmetry, that everything be aligned and symmetric in some way.
也可以是对称性，即一切都以某种方式对齐和对称。
This could be seen perhaps in young kids.
这也许可以在年幼的孩子身上看到。
This is one example that I read in the literature of children that need to arrange their stuffed animals in exact same order every day and in a particular order to the point where if you were to move the little stuffed frog over next to the stuffed rabbit, that the child would have an anxiety reaction to that and feel literally compelled, driven to fix that, maybe even multiple times over and over again.
这是我在文学作品中读到的一个例子，孩子们每天都需要以完全相同的顺序排列他们的毛绒玩具，并且按照特定的顺序，如果你把小毛绒玩具青蛙移到毛绒玩具兔子旁边，孩子就会对此产生焦虑反应，并感到真正被迫、被迫去解决这个问题，甚至可能会一遍又一遍地解决这个问题。
We'll talk about OCD and children versus adults in a little bit.
我们稍后将讨论强迫症以及儿童与成人。
Andrew Huberman:
安德鲁·休伯曼：
And then the other aspect of order, which is a little bit less than intuitive, is this notion of disgust, this idea that something is contaminated.
然后秩序的另一个方面，有点不太直观，就是厌恶的概念，即某些东西被污染的想法。
So we often think about OCD and handwashing behavior in response to people feeling that something is contaminated.
因此，我们经常会想到强迫症和洗手行为，以应对人们感觉某些东西被污染的情况。
A space, a towel, et cetera or even simply somebody else's hand, and so they're unwilling to shake somebody's hand.
空间、毛巾等等，甚至只是别人的手，所以他们不愿意与别人握手。
You can imagine how these different bins of obsessions and compulsions, checking, repetition and order could be extremely debilitating, depending on how severe they are and how many different domains of life they show up in.
你可以想象这些不同的痴迷和强迫、检查、重复和秩序会如何使人极度虚弱，具体取决于它们的严重程度以及它们出现在生活的多少个不同领域。
Because oftentimes in movies, and even the way I'm describing it now, it sounds as if, okay, well, somebody has to check the locks, but they don't have to also check the stove.
因为在电影中，甚至是我现在描述的方式，听起来好像，好吧，好吧，有人必须检查锁，但他们不必检查炉子。
Or somebody has the need to count to seven back and forth, up to seven and down to seven, seven times a day or something of that sort where they need symmetry in very specific domains of life.
或者有人需要来回数到七，向上数到七，向下数到七，每天七次，或者诸如此类的事情，他们需要在生活的特定领域保持对称。
Andrew Huberman:
安德鲁·休伯曼：
But it turns out that this recurrent and intrusive aspect of obsessions leads people with OCD to have checking repetition and/or order compulsions everywhere.
但事实证明，强迫症的这种反复出现和侵入性的方面导致强迫症患者到处都有检查重复和/或命令强迫症。
So whether or not somebody is at work or in school or trying to engage in sport or trying to engage in relationship or just something simple like walking down the street, the obsessions are so intrusive that they show up and they compel people to do things in that domain independent of whether or not they happen to be in one location or another.
因此，无论某人是在工作还是在学校，或者试图参加体育运动，或者试图建立关系，或者只是像在街上行走这样简单的事情，这些痴迷都如此具有侵入性，以至于它们会出现，并迫使人们在该领域做事情，无论他们是否碰巧在一个地方或另一个地方。
In other words, the thought patterns and the behaviors take over the environment, as opposed to the environment driving the thought patterns and behaviors.
换句话说，思维模式和行为接管环境，而不是环境驱动思维模式和行为。
So it therefore becomes impossible to ever find a room that's clean enough, to find a bed that's made well enough, to find anything that's done well enough to remove the obsession.
因此，不可能找到一个足够干净的房间，找到一张做得足够好的床，找到任何做得足够好的东西来消除这种痴迷。
Andrew Huberman:
安德鲁·休伯曼：
And I know I said it multiple times now, but I'm going to say it many times throughout this episode in a somewhat obsessive, but I believe justified way, that every time that one engages in the compulsion related to the obsession, the obsession simply becomes stronger.
我知道我现在已经说过很多次了，但我会在这一集里以一种有点强迫性的方式多次重复这句话，但我相信这是合理的，每当一个人陷入与强迫症相关的强迫行为时，强迫症就会变得更强烈。
So you can imagine what a powerful and debilitating loop that really is.
所以你可以想象这是一个多么强大而又令人衰弱的循环。
So let's drill a little bit deeper into how the obsessions and compulsions relate to one another.
因此，让我们更深入地探讨一下强迫观念和强迫行为之间的关系。
If we were to draw a line between the obsessions and the compulsions, that line could be described as anxiety.
如果我们要在强迫观念和强迫行为之间划清界限，那么这条界限可以被描述为焦虑。
Now, we need to define what anxiety is.
现在，我们需要定义什么是焦虑。
And to be quite honest, most of psychology and science can't agree on exactly what anxiety is.
老实说，大多数心理学和科学界都无法就焦虑到底是什么达成一致。
Typically, the way we think about fear is that it's a heightened state of autonomic arousal, so increased heart rate, increased breathing, sweating, et cetera in response to an immediate and present threat or perceived threat.
通常，我们对恐惧的看法是，它是自主神经兴奋的高度状态，因此心率加快、呼吸增加、出汗等等，以应对即时和当前的威胁或感知到的威胁。
Whereas anxiety, generally speaking in the scientific literature, relates to the same sorts of thought patterns and somatic bodily responses, heart rate, breathing, et cetera but without a clear and present danger being in the environment or right there.
然而，一般来说，在科学文献中，焦虑与相同类型的思维模式和躯体反应、心率、呼吸等有关，但在环境中或那里没有明显且现实的危险。
Andrew Huberman:
安德鲁·休伯曼：
So that's the way that we're going to talk about anxiety now.
这就是我们现在谈论焦虑的方式。
And anxiety is really what binds the obsessions and compulsions such that someone will have an intrusive thought.
焦虑确实会束缚强迫观念和强迫行为，从而使某人产生侵入性想法。
So for instance, someone will have the thought that if they turn left on any street, that something bad will happen.
例如，有人会想，如果他们在任何街道上左转，就会发生不好的事情。
Okay?
好的？
That's an obsession.
那是一种痴迷。
It's actually not all that uncommon.
实际上这并不少见。
Now, how bad and what the specificity of that bad thing really is will vary.
现在，坏事的严重程度和具体情况都会有所不同。
Some people will think, "If I turn left, something generally bad will happen.
有些人会想：“如果我向左转，通常会发生一些不好的事情。
It just makes me feel anxious." So they always insist on going right.
这只会让我感到焦虑。”所以他们总是坚持向右走。
Whereas other people will think, "If I turn left, so and so will die, or I will die, or something terrible will happen.
而其他人会想：“如果我向左转，谁谁就会死，或者我会死，或者会发生可怕的事情。
I'll get a disease or someone else will get a disease.
我会得病，或者其他人也会得病。
Or I'll be cursing myself or somebody else in some very specific way." This is unfortunately quite common in people with OCD.
否则我会以某种非常具体的方式诅咒自己或其他人。”不幸的是，这在强迫症患者中很常见。
Andrew Huberman:
安德鲁·休伯曼：
So they have this feeling, and the feeling can be generally or specifically related to a particular outcome, but beneath that is a feeling of anxiety, a quickening of the heartbeat, a quickening of breathing, a narrowing of one's visual focus.
所以他们有这种感觉，这种感觉可能与特定结果总体或具体相关，但在这种感觉之下是焦虑感，心跳加快，呼吸加快，视觉焦点缩小。
I've talked about this before in another podcast, the "Master Stress," another podcast.
我之前在另一个播客“Master Stress”中谈到过这个问题。
But if you haven't heard those, let me just briefly describe that when we are in a state of increased so-called autonomic arousal, alertness, stress, et cetera our visual field literally narrows.
但如果你还没有听过这些，让我简单地描述一下，当我们处于所谓的自主觉醒、警觉性、压力等增加的状态时，我们的视野实际上会变窄。
The aperture of our visual field gets smaller, and that's because of the relationship between the autonomic nervous system and your visual system, so you start seeing the world through sort of a soda-straw view or through binocular-like view as opposed to seeing the big picture.
我们的视野孔径变小，这是因为自主神经系统和视觉系统之间的关系，所以你开始通过某种苏打吸管视图或类似双眼的视图来看待世界，而不是看到大局。
Andrew Huberman:
安德鲁·休伯曼：
Why is that important?
为什么这很重要？
Well, it literally sharpens and narrows your focus toward the very thing that the obsessions and the compulsions are focused on.
嗯，它实际上使你的注意力集中在那些强迫症和强迫症所关注的事情上。
So the person walking down the street who sees the opportunity to go left or right will only see the bad decision.
因此，在街上行走的人如果看到向左或向右走的机会，只会看到错误的决定。
Their visual field narrows very tightly along that possibility of taking a left turn.
他们的视野因左转的可能性而变得非常狭窄。
And I know, as I described, this seems totally irrational, but I want to emphasize that the person with OCD knows it's irrational.
我知道，正如我所描述的，这似乎完全不合理，但我想强调的是，患有强迫症的人知道这是不合理的。
They might feel crazy because they're having these thoughts, but they know it makes no sense whatsoever that left somehow would be different than right in terms of outcomes in this particular case, and yet it feels as if it would.
他们可能会因为有这些想法而感到疯狂，但他们知道，在这种特殊情况下，左派与右派的结果会有所不同，这是毫无意义的，但感觉好像确实如此。
In fact, in some cases it feels as if they'd went left, they would have a full-blown panic attack.
事实上，在某些情况下，他们感觉好像他们已经离开了，他们会遭受全面的恐慌。
Andrew Huberman:
安德鲁·休伯曼：
So the idea here is that the obsessions and compulsions are bound by anxiety, but then by taking a right-hand turn, again in this one particular example, by taking a right-hand turn, there's a very brief, I should mention very brief relief of that anxiety at the time of the decision to go right not left.
所以这里的想法是，强迫观念和强迫行为受到焦虑的束缚，但是通过右转，再次在这个特定的例子中，通过右转，在决定向右而不是向左走时，可以非常短暂地、我应该提到非常短暂地缓解焦虑。
And there's an additional drop in anxiety while one takes the right-hand turn as opposed to the left-hand turn.
与左转相比，右转时焦虑感会进一步下降。
And then as I alluded to before, there's a reinforcement of the compulsion.
然后正如我之前提到的，这种强迫感得到了加强。
In other words, by going right, it doesn't create a situation in the brain and psychology of the person that, "You know what?
换句话说，通过向右走，它不会在人的大脑和心理中产生这样的情况：“你知道吗？
I'm not anxious anymore.
我不再着急了。
Left would've probably been okay." It reinforces the idea that right made me feel better or turning right made me feel better, and going left would've been that much worse.
向左可能还好。”它强化了这样的想法：向右让我感觉更好，或者向右转让我感觉更好，而向左转会更糟糕。
Again, it reinforces the obsession even further.
再次，它进一步强化了这种痴迷。
Andrew Huberman:
安德鲁·休伯曼：
Again, we could swap out right turns and left turns with something like handwashing, the feeling that something is contaminated and the need to wash one's hands even though one already washed their hands 20, 30, 50 times prior.
同样，我们可以用诸如洗手之类的东西来交换右转和左转，即某种东西被污染的感觉以及洗手的需要，即使一个人之前已经洗手了 20、30、50 次。
We're actually going to go back to that example a little bit later when we talk about one particular category of therapies that are very effective in many people for OCD, which are the cognitive behavioral and exposure therapies.
实际上，稍后当我们谈论对许多强迫症患者非常有效的一类特定疗法时，我们将回到这个例子，即认知行为疗法和暴露疗法。
Because I think some of you have heard of cognitive behavioral and exposure therapies, but the way they're used to treat OCD is very much different than the way they're used to treat other sorts of anxiety disorders and other sorts of disorders generally.
因为我认为你们中的一些人听说过认知行为疗法和暴露疗法，但是它们用于治疗强迫症的方式与它们用于治疗其他类型的焦虑症和其他类型的疾病的方式有很大不同。
Andrew Huberman:
安德鲁·休伯曼：
So it's fair to say that up to 70% of people with OCD have some sort of anxiety or elevated anxiety, either directly related to the OCD or indirectly related to the OCD.
因此，可以公平地说，高达 70% 的强迫症患者患有某种焦虑或焦虑程度较高，这些焦虑要么与强迫症直接相关，要么与强迫症间接相关。
And it's really hard to tease those apart because OCD can create its own anxiety.
很难将它们区分开来，因为强迫症会产生自己的焦虑。
As I mentioned before, it can even increase its own anxiety.
正如我之前提到的，它甚至会增加自己的焦虑。
There's also an issue of depression.
还有一个抑郁症的问题。
Having OCD can be very depressing, right?
患有强迫症可能会非常令人沮丧，对吗？
Especially if some of these OCD thoughts and behaviors start to really impede people's ability to function in life, at work and school and relationship.
特别是如果这些强迫症的想法和行为开始真正阻碍人们在生活、工作、学校和人际关系中发挥作用的能力。
They can start feeling less optimistic about life.
他们可能开始对生活感到不那么乐观。
And in fact, some people can become suicidally depressed.
事实上，有些人可能会出现自杀倾向。
That's how bad OCD can be for us.
这就是强迫症对我们的危害。
Andrew Huberman:
安德鲁·休伯曼：
So we have to be careful when saying that 70% of people with OCD also have anxiety, or X number of people with OCD are also depressed because we don't know whether or not the depression led the OCD or the other way around or whether or not they're operating, as we say in science, in parallel.
因此，当我们说 70% 的强迫症患者也有焦虑症，或者 X 名强迫症患者也患有抑郁症时，我们必须小心，因为我们不知道抑郁症是否导致了强迫症，或者反过来，也不知道他们是否像我们在科学中所说的那样，同时发生作用。
Some of the drug treatments for OCD and depression and anxiety can tease some of that apart, and we'll talk about that.
一些治疗强迫症、抑郁症和焦虑症的药物可以将其中一些分开，我们将讨论这一点。
But I think it's fair to say that what binds the obsessions and compulsions is anxiety.
但我认为可以公平地说，束缚强迫观念和强迫行为的是焦虑。
That there's a feeling of it, or I should say an urgent feeling of a need to get rid of the obsession, and the person feels as if the only way they can do that is to engage in a particular compulsive behavior.
有一种感觉，或者我应该说是一种需要摆脱痴迷的迫切感觉，而人们觉得他们能做到这一点的唯一方法就是从事某种特定的强迫行为。
Andrew Huberman:
安德鲁·休伯曼：
Some people are probably wondering if there's a genetic component to OCD.
有些人可能想知道强迫症是否有遗传因素。
And indeed there is, although the nature of it isn't exactly clear.
确实存在，尽管其本质尚不清楚。
Oftentimes when people hear that something has a genetic component, they think it's always directly inherited from a parent, and that's not always the case.
通常，当人们听说某些东西具有遗传成分时，他们认为它总是直接从父母那里继承的，但事实并非总是如此。
There can be genes that surface in siblings or genes that surface in children that are not readily apparent in terms of what we call a phenotype.
可能存在在兄弟姐妹中出现的基因，或者在儿童中出现的基因，这些基因在我们所说的表型方面并不明显。
So you have a genotype, the gene, and then you have a phenotype, the way it shows up as a body form or eye color, or how it shows up in terms of a behavioral or behavioral pattern.
因此，你有一个基因型，即基因，然后你有一个表型，它以身体形态或眼睛颜色的方式显示，或者以行为或行为模式的方式显示。
Andrew Huberman:
安德鲁·休伯曼：
Based on twin studies, where researchers have examined identical twins, fraternal twins, even identical twins that share the same sac in utero, what we call monochorionic, so sitting in the same little bag during pregnancy or in different little bags, you can see different levels of what's called genetic concordance.
根据双胞胎研究，研究人员检查了同卵双胞胎、异卵双胞胎，甚至是在子宫内共享同一个囊的同卵双胞胎（我们称之为单绒毛膜），因此在怀孕期间坐在同一个小袋子或不同的小袋子中，您可以看到不同程度的所谓遗传一致性。
But if we were to just sort of cut a broad swath through all of the genetic data, it's fair to say that about 40 to 50% of OCD cases have some genetic component, some mutation or some inherited aspect that's genetic and that one could point to if they got their genome mapped.
但如果我们对所有遗传数据进行大范围的剖析，可以公平地说，大约 40% 到 50% 的强迫症病例具有某些遗传成分、某些突变或某些遗传方面，如果他们绘制了基因组图谱，人们就可以指出这些方面。
Andrew Huberman:
安德鲁·休伯曼：
Now, while that's interesting, I don't think it's terribly useful for most people.
现在，虽然这很有趣，但我认为它对大多数人来说并不是很有用。
First of all, you can't really control your genes, at least at this point in history, even though there are things like epigenetic control, and people are very excited about technologies like CRISPR for modifying the genome in humans at some point, most people can't control their genetics, right?
首先，你无法真正控制你的基因，至少在历史的这个阶段，即使有表观遗传控制之类的东西，而且人们对像 CRISPR 这样用于修改人类基因组的技术在某些时候非常兴奋，但大多数人无法控制他们的基因，对吗？
You can't pick who your parents were, as they say.
正如人们所说，你无法选择你的父母是谁。
So just know that there is a genetic component in about half of people with OCD, but not always.
因此，只要知道大约一半的强迫症患者存在遗传因素，但并非总是如此。
Andrew Huberman:
安德鲁·休伯曼：
Now, as is typical for this podcast, I want to focus on some of the neural mechanisms and chemical systems in the brain and body that generate obsessive-compulsive disorder.
现在，正如本播客的典型做法，我想重点关注大脑和身体中产生强迫症的一些神经机制和化学系统。
In fact, if you've watched this podcast before or listened to this podcast before, this is always how I structure things.
事实上，如果您以前看过或听过这个播客，这就是我构建事物的方式。
First, we introduce a topic and we explore that topic in detail and really define what it is and what it isn't.
首先，我们介绍一个主题，然后详细探讨该主题，并真正定义它是什么和不是什么。
And then it's very important that we focus on what is known and what is not known about the biological mechanisms that generate whatever that thing happens to be, in this case OCD and an obsessive-compulsive personality disorder.
然后，非常重要的是，我们要关注产生该事物的生物机制的已知和未知内容，在本例中是强迫症和强迫性人格障碍。
Andrew Huberman:
安德鲁·休伯曼：
Now, I want to emphasize that even if you don't have a background in biology, I will make this information accessible to you.
现在，我想强调，即使您没有生物学背景，我也会让您可以访问这些信息。
And I also want to emphasize that for those of you that are interested in treatments and are anxiously awaiting the description of things that can help with OCD, I encourage you, if you will, to please try and digest some of the material about the underlying mechanisms, because understanding even just a little bit of those biological mechanisms can really help shed light on why particular drug and behavioral treatments and other sorts of treatments work and don't work.
我还想强调，对于那些对治疗感兴趣并焦急地等待有助于治疗强迫症的事物的描述的人来说，我鼓励您，如果您愿意的话，请尝试消化一些有关潜在机制的材料，因为即使只了解这些生物机制的一点点，也可以真正帮助阐明为什么特定的药物和行为治疗以及其他类型的治疗有效和无效。
This is especially important in the case of OCD, where it turns out that the order and type of treatment can really vary according to individual.
这对于强迫症来说尤其重要，事实证明治疗的顺序和类型确实因人而异。
And that's something really special and important about OCD that we really can't say for a number of the other sorts of disorders that we've described on previous podcasts.
对于强迫症来说，这是非常特别和重要的事情，对于我们在之前的播客中描述的许多其他类型的疾病来说，我们确实不能说这一点。
Andrew Huberman:
安德鲁·休伯曼：
So let's take a step back and look at the neural circuitry.
让我们退后一步看看神经回路。
What's going on in the brain and body of people with OCD?
强迫症患者的大脑和身体发生了什么？
Why the intrusive recurrent thoughts?
为什么会反复出现侵入性的想法？
Why the compulsions?
为什么会有强迫症？
Why is that whole system bound by anxiety?
为什么整个系统都会受到焦虑的束缚？
And in some ways, in thinking about that, I want you to keep in mind that the brain has two main functions.
在某种程度上，在思考这个问题时，我希望你记住大脑有两个主要功能。
The brain's main functions are to take care of all the housekeeping stuff, make sure digestion works, make sure the heart beats, make sure you keep breathing no matter what, make sure that you can see, you can hear, you can smell, et cetera the basic stuff.
大脑的主要功能是处理所有家务事，确保消化正常，确保心脏跳动，确保无论如何都能保持呼吸，确保你能看到、能听到、能闻到，等等基本的东西。
And then there's an enormous amount of brain real estate that's designed to allow you to predict what's going to happen next, either in the immediate future or in the long-term future.
然后，大脑中有大量的空间可以让你预测接下来会发生什么，无论是在不久的将来还是在长期的将来。
And largely that's done based on your knowledge of the past.
这很大程度上是根据你对过去的了解来完成的。
So you also have memory systems.
所以你也有记忆系统。
And of course you have systems in the brain and body that are designed to bind what's happening at the housekeeping level, like your heart rate, to your anticipation of what's going to happen next.
当然，你的大脑和身体中有一些系统，旨在将内务层面发生的事情（比如你的心率）与你对接下来会发生的事情的预期联系起来。
Andrew Huberman:
安德鲁·休伯曼：
So if you're thinking about something very fearful, your body will have one type of reaction.
因此，如果你正在思考一些非常可怕的事情，你的身体就会有一种反应。
If you're thinking about something very pleasant and relaxing, your body will have another type of reaction.
如果你正在思考一些非常愉快和放松的事情，你的身体会有另一种反应。
So whenever I hear about the brain-body distinction, I have to just remind everybody that there really is no distinction between brain and body when you think about it through the nervous system.
因此，每当我听到大脑与身体的区别时，我都必须提醒大家，当你通过神经系统思考时，大脑和身体之间实际上没有区别。
The nervous system is the brain, the eyes, the spinal cord, but of course, all their connections with all the organs of the body and the connections of all the organs of the body with the brain, the spinal cord, et cetera.
神经系统是大脑、眼睛、脊髓，当然，还有它们与身体所有器官的所有连接以及身体所有器官与大脑、脊髓等的连接。
Andrew Huberman:
安德鲁·休伯曼：
So as I describe these neural circuits, I don't want you to think of them as just things happening in the head.
因此，当我描述这些神经回路时，我不希望您将它们视为仅发生在头脑中的事情。
They are certainly happening in the head.
它们肯定发生在头脑中。
In fact, the circuits I'll describe most in detail do exist within the confines of your cranial vault.
事实上，我将最详细描述的电路确实存在于您的颅顶范围内。
That's nerd-speak for skull.
这是书呆子们对头骨的说法。
But those circuits are driving particular predictions and therefore particular biases towards particular actions in your body.
但这些回路正在驱动特定的预测，因此对你体内的特定行为产生特定的偏见。
They're creating a state of readiness or a state of desire to check, or desire to count, or desire to avoid, et cetera, et cetera.
他们正在创造一种准备状态或一种渴望检查、或渴望计数、或渴望避免的状态，等等。
Andrew Huberman:
安德鲁·休伯曼：
So what are these circuits?
那么这些电路是什么？
Well, there's been a lot of wonderful research exploring the neural circuits underlying obsessive-compulsive disorder, and that's mainly been accomplished through a couple of methods.
嗯，有很多精彩的研究探索强迫症背后的神经回路，这主要是通过几种方法完成的。
Most of those methods when applied in humans involve getting some look into which brain areas are active when people are having obsessions and when people are engaging in compulsions.
当应用于人类时，大多数这些方法都涉及到当人们有强迫症和强迫症时，了解哪些大脑区域是活跃的。
Now, that might seem simple to do, but, of course, your brain is housed inside the cranial vault, and in order to look inside it, you have to use things like magnetic resonance imaging, which is just fancy technology for looking at blood flow, which relates to activation of neurons, nerve cells.
现在，这看起来似乎很简单，但是，当然，你的大脑位于颅顶内部，为了观察它的内部，你必须使用磁共振成像之类的东西，这是一种观察血流的奇特技术，与神经元、神经细胞的激活有关。
Or things like PET, PET imaging, which has nothing to do with the verb "pet" and has nothing to do with your house pet.
或者诸如 PET、PET 成像之类的东西，它与动词“宠物”无关，也与您的家养宠物无关。
It has everything to do with positron emission tomography, which is just another way of seeing which brain areas are active.
它与正电子发射断层扫描密切相关，正电子发射断层扫描只是查看哪些大脑区域活跃的另一种方法。
And then you can also use PET to figure out what sorts of neurochemicals are active, like dopamine, et cetera.
然后您还可以使用 PET 来找出哪些类型的神经化学物质具有活性，例如多巴胺等。
Andrew Huberman:
安德鲁·休伯曼：
Many studies, we can fairly say dozens if not hundreds of studies, have now identified a particular circuit or loop of brain areas that are interconnected and very active in obsessive-compulsive disorder.
许多研究，我们可以公平地说，数十甚至数百项研究，现在已经确定了大脑区域的特定回路或环路，这些区域是相互关联的并且在强迫症中非常活跃。
That loop includes the cortex, which is kind of the outer shell of the human brain, the lumpy stuff, as it sometimes appears if the skull is removed.
这个环包括皮质，它是人类大脑的外壳，是块状的东西，就像头骨被移除时有时会出现的那样。
And it involves an area called the striatum, which is involved in action, selection and holding back action.
它涉及一个称为纹状体的区域，该区域涉及行动、选择和阻止行动。
The striatum is involved in what's commonly called Go and No-Go types of behaviors.
纹状体涉及通常所说的“Go”和“No-Go”类型的行为。
So every type of behavior like picking up a pen or a mug of coffee involves a Go-type function.
因此，每种类型的行为（例如拿起笔或一杯咖啡）都涉及 Go 类型的函数。
It involves generating an action.
它涉及生成一个动作。
But every time I resist an action, my nervous system is also doing that using this brain structure, the striatum, which includes, among other things, the basal ganglia.
但每次我抵制某个动作时，我的神经系统也会利用这种大脑结构——纹状体——其中包括基底神经节——来做到这一点。
I've talked about that before.
我之前已经谈过这一点。
I'm not trying to overload you with
我并不想让你负担过重
Andrew Huberman:
安德鲁·休伯曼：
Ganglia ...
神经节...
We've talked about that before.
我们之前已经讨论过这一点。
I'm not trying to overload you with terminology here, but I know some people are interested in terminology.
我并不是想用术语让您负担过重，但我知道有些人对术语感兴趣。
So you have Go behaviors and you have No-Go, resisting of behaviors.
因此，你有“Go”行为，也有“No-Go”行为和“抵制”行为。
Not going toward behavior.
不走向行为。
The cortex and the striatum are in this intricate back and forth talk.
皮质和纹状体处于这种复杂的来回对话中。
It's really loops of connections.
这确实是连接的循环。
The cortex doesn't tell the striatum what to do, the striatum doesn't tell the cortex what to do.
皮层不告诉纹状体做什么，纹状体也不告诉皮层做什么。
They're in a cross talk.
他们正在相声。
Like any good relationship, there's a lot of back-and-forth communication.
就像任何良好的关系一样，有很多来回的沟通。
Andrew Huberman:
安德鲁·休伯曼：
There's a third element in this cortico-striatal loop, as it's called, and that's the thalamus.
这个皮质纹状体环中有第三个元素，正如它所说的那样，那就是丘脑。
Now, the thalamus is not a structure I've talked a lot about before on this podcast, but it's one of my favorite structures to think about and teach about in neuroanatomy, which I teach back at Stanford and have taught for many years elsewhere.
现在，丘脑不是我之前在这个播客上谈论过很多的结构，但它是我在神经解剖学中最喜欢思考和教授的结构之一，我在斯坦福大学教授神经解剖学，并在其他地方教授了很多年。
Because the thalamus is this incredible egg-like structure in the center of your brain that has different channels through it — channels for relaying visual information or auditory information or touch information from your environment up into your cortex, and as a consequence making certain things that are happening to you and around you apparent to you, making you aware of them, making you perceive them, and suppressing others.
因为丘脑是大脑中央令人难以置信的鸡蛋状结构，它有不同的通道——将来自环境的视觉信息或听觉信息或触觉信息传递到皮质的通道，从而使发生在你和你周围的某些事情对你来说显而易见，让你意识到它们，让你感知它们，并抑制其他事物。
Andrew Huberman:
安德鲁·休伯曼：
So, for instance, right now, if you're hearing me say this, your thalamus has what are called auditory nuclei.
所以，举例来说，现在，如果你听到我这么说，你的丘脑就有所谓的听觉核团。
There's collections of neurons that respond to sound waves that are, of course, coming in through your ears, and your thalamus is active in a way that those particular regions of your thalamus are allowed, literally permitted, to pass the information coming from your ears through some other steps but then to your thalamus, your auditory thalamus, then up to your cortex, and you can hear what I'm saying right now.
当然，有一些神经元对通过你的耳朵传入的声波做出反应，你的丘脑以某种方式活跃，你的丘脑的那些特定区域被允许，字面上允许，通过一些其他步骤传递来自你耳朵的信息，然后到达你的丘脑，你的听觉丘脑，然后到达你的皮层，你可以听到我现在在说什么。
Andrew Huberman:
安德鲁·休伯曼：
At the same time, your thalamus is surrounded by a kind of a shell, something called the thalamic reticular nucleus.
与此同时，你的丘脑被一种外壳包围，称为丘脑网状核。
Again, you don't have to remember the names, but this thalamic reticular nucleus, also sometimes called the reticular thalamic nucleus ...
再说一次，你不必记住名字，但是这个丘脑网状核，有时也称为网状丘脑核......
This is, believe it or not, a subject of debate in science.
不管你信不信，这是科学界争论的一个话题。
There are people that literally hated each other — and probably still hate each other, even though one of them is dead — for decades because they would argue it was thalamic reticular nucleus, the other was reticular thalamic nucleus.
有些人确实互相仇恨——而且可能仍然互相仇恨，即使其中一个已经死了——几十年来，因为他们会争辩说这是丘脑网状核，另一个是网状丘脑核。
Anyway, these are scientists.
无论如何，这些都是科学家。
They're people.
他们是人。
They tend to debate.
他们倾向于辩论。
Andrew Huberman:
安德鲁·休伯曼：
But that the thalamic reticular nucleus, as I'm going to call it, serves as a sort of gate as to which information is allowed to pass through up to your conscious experience and which is not.
但我将称之为丘脑网状核，它充当一种大门，决定哪些信息可以通过你的意识体验，哪些则不允许。
That gating mechanism is strongly regulated by the chemical GABA.
这种门控机制受到化学物质 GABA 的强烈调控。
GABA is a neurotransmitter that is inhibitory, as we say.
正如我们所说，GABA 是一种抑制性神经递质。
It serves to shut down or suppress the activity of other neurons.
它用于关闭或抑制其他神经元的活动。
Andrew Huberman:
安德鲁·休伯曼：
So the thalamic reticular nucleus is really saying, "No. Touch information cannot come in right now.
所以丘脑网状核实际上是在说：“不。触摸信息现在无法输入。
You should not be thinking about the contact of the back of your legs with the chair that you're sitting on, Andrew.
你不应该考虑你的腿后部与你坐的椅子的接触，安德鲁。
You should be thinking about what you're trying to say and what you're hearing and how your voice sounds and what you see in front of you, et cetera." Whereas if I'm about to get an injection from a doctor, or I'm in pain, or I'm in pleasure, I'm going to think about my somatic sensation at the level of touch, and I'm probably going to think less about smells in the room, although I might also think about smells in the room, or what I'm seeing and what I'm hearing.
你应该思考你想说的话、你听到的内容、你的声音听起来如何、你在你面前看到什么，等等。”而如果我要接受医生注射，或者我感到疼痛，或者我感到快乐，我会在触摸层面上考虑我的躯体感觉，而且我可能会少考虑房间里的气味，尽管我也可能会考虑房间里的气味，或者我正在做的事情。看到的和听到的。
We can combine all these different sensory modalities, but that the thalamic reticular nucleus really allows us to funnel, to direct particular categories of sensory experience into our conscious awareness and suppress other categories of sensory experience.
我们可以结合所有这些不同的感觉方式，但丘脑网状核确实允许我们将特定类别的感觉体验引导到我们的意识意识中，并抑制其他类别的感觉体验。
Andrew Huberman:
安德鲁·休伯曼：
In addition, the thalamic reticular nucleus plays a critical role in which thoughts are allowed to pass up to our conscious perception and which ones are not.
此外，丘脑网状核起着至关重要的作用，其中思想可以被允许传递到我们的意识感知，而哪些则不能。
So much so that some neuroscientists and indeed some neuro-philosophers, if you want to call them that, have theorized, or philosophized, that the thalamic reticular nucleus is actually involved in our consciousness.
以至于一些神经科学家，甚至一些神经哲学家，如果你想这样称呼他们，已经理论化或哲学化地认为丘脑网状核实际上与我们的意识有关。
Andrew Huberman:
安德鲁·休伯曼：
Now, consciousness isn't a topic that I really want talk about this episode, and it's a very kind of mushy, murky, as we say in science, it's a shmooey term because it doesn't really have clear definitions, so arguments about it often get lost in the fact that people are arguing about different things.
现在，意识并不是我真正想在这一集中谈论的话题，它是一个非常糊涂、模糊的话题，正如我们在科学中所说的那样，这是一个含糊不清的术语，因为它没有真正明确的定义，所以关于它的争论经常在人们争论不同事物的事实中迷失。
But when I say consciousness, what I mean is conscious awareness.
但当我说意识时，我的意思是有意识的意识。
Andrew Huberman:
安德鲁·休伯曼：
So let's zoom out and take a look at the circuit that we've got and that we now know, based on neuroimaging studies, is intimately involved in generating obsessions and compulsions in OCD.
因此，让我们缩小范围，看看我们所拥有的电路，根据神经影像学研究，我们现在知道，该电路与强迫症中的强迫观念和强迫行为密切相关。
We have a cortex, or neocortex, which is involved in perception and understanding of what's happening.
我们有一个皮质或新皮质，它参与对正在发生的事情的感知和理解。
We have the striatum and basal ganglia, which are involved in generating behaviors (Go) and suppressing behaviors (No-Go).
我们有纹状体和基底神经节，它们参与产生行为（Go）和抑制行为（No-Go）。
And we have the thalamus, which collects all of our sensory experience in parallel ...
我们有丘脑，它同时收集我们所有的感官体验......
Hearing, touch, smell, et cetera.
听觉、触觉、嗅觉等等。
Not so much smell through the thalamus, I should mention, but the other senses, that is.
我应该提一下，与其说是通过丘脑的气味，不如说是通过其他感官。
And then that thalamus is encased by the thalamic reticular nucleus, which serves as a kind of a guard, saying, "You can pass through," and, "You can pass through," but, "You, you, you can't pass through up to conscious understanding and perception".
然后丘脑被丘脑网状核包围，它充当一种守卫，说，“你可以通过”，“你可以通过”，但是，“你，你，你不能通过有意识的理解和感知”。
Andrew Huberman:
安德鲁·休伯曼：
So that loop, this cortico-striatal thalamic loop, cortico-striatal-thalamic loop, is the circuit thought to underlie OCD.
因此，这个环路，即皮质-纹状体-丘脑环路，皮质-纹状体-丘脑环路，被认为是强迫症的基础环路。
Dysfunction in that circuit is what's thought to underlie OCD.
该回路的功能障碍被认为是强迫症的根源。
Now again, this circuit exists in all of us, and it can operate in healthy ways, or it can operate in ways that make us feel unhealthy or even suffer from full-blown OCD.
现在，这个回路存在于我们所有人体内，它可以以健康的方式运作，也可以以让我们感觉不健康甚至患有全面强迫症的方式运作。
Andrew Huberman:
安德鲁·休伯曼：
How do we know that this circuit is involved in OCD?
我们怎么知道这个回路与强迫症有关？
Well, there we can look to some really interesting studies that involved bringing human subjects into the laboratory and generating their obsessions and compulsions, and then imaging their brain using any variety of techniques that we talked about before.
好吧，我们可以看到一些非常有趣的研究，这些研究涉及将人类受试者带入实验室并产生他们的痴迷和强迫行为，然后使用我们之前讨论过的各种技术对他们的大脑进行成像。
What would such an experiment look like?
这样的实验会是什么样子？
Well, in order to do that sort of experiment, first of all, you need people who have OCD, and of course you need control subjects that don't.
嗯，为了做这样的实验，首先，你需要患有强迫症的人，当然你还需要没有强迫症的对照对象。
Then you need to be able to reliably evoke the obsessions and the compulsions.
然后你需要能够可靠地唤起痴迷和强迫行为。
Now it turns out this is most easily, or I should say most simply done, because it can't be easy for the people with OCD, but this is most straightforward.
现在事实证明这是最容易的，或者我应该说是最简单的，因为对于患有强迫症的人来说这并不容易，但这是最简单的。
That's the word I was looking for.
这就是我一直在寻找的词。
Most straightforward when looking at the category of obsessions and compulsions that relate to order and cleanliness.
当考虑与秩序和清洁相关的痴迷和强迫类别时，这是最直接的。
Andrew Huberman:
安德鲁·休伯曼：
So what they do typically is bring subjects into the laboratory who have an obsession about germs and contamination and a compulsion to hand wash.
因此，他们通常所做的就是将那些对细菌和污染有痴迷并有洗手强迫症的受试者带入实验室。
They give these people, believe it or not, a sweaty towel that contains the sweat and the odor and the liquid, basically, from somebody else's hands.
不管你信不信，他们给了这些人一条汗湿的毛巾，其中含有汗水、气味和液体，基本上是从别人的手上滴下来的。
In fact, they'll sometimes have someone wipe their own sweat off the back of their neck and put it on the towel, and then they'll put it in front of the person, which as you can imagine for someone with OCD is incredibly anxiety-provoking and almost always evokes these obsessions about, "Oh, this is really bad.
事实上，他们有时会让人把自己脖子后面的汗擦掉，然后把毛巾放在毛巾上，然后把毛巾放在对方面前，你可以想象，这对于患有强迫症的人来说是令人难以置信的焦虑症，而且几乎总是会引起这样的困扰：“哦，这真的很糟糕。
This is really bad.
这实在是太糟糕了。
I need to clean, I need to clean, I need to clean." Now they're doing all this while someone is in a brain scanner or while they're being imaged for positron emission tomography.
我需要打扫，我需要打扫，我需要打扫。”现在，他们在某人接受脑部扫描或进行正电子发射断层扫描成像时完成这一切。
Then they can also look at the patterns of activation in the brain while the person is doing handwashing.
然后他们还可以观察人们洗手时大脑的激活模式。
Although sometimes the apparati associated with these imaging studies make it hard to do a lot of movement, they can do these sorts of studies.
尽管有时与这些成像研究相关的设备很难进行大量运动，但他们可以进行此类研究。
Andrew Huberman:
安德鲁·休伯曼：
They have done these sorts of studies in many subjects using different variations of what I just described, and low and behold what lights up ...
他们使用我刚才描述的不同变体在许多主题中进行了此类研究，低头看看什么亮了......
When I say lights up, what sorts of brain regions are more metabolically active, more blood flow, more neural activity?
当我说“亮起来”时，什么样的大脑区域代谢更活跃、血流量更多、神经活动更多？
Well, it's this particular cortico-striatal-thalamic loop.
嗯，这就是这个特殊的皮质-纹状体-丘脑环。
Andrew Huberman:
安德鲁·休伯曼：
In addition to that, some of the drug treatments that are effective in some, and I want to emphasize some, individuals at suppressing obsessions and/or compulsions, such as the selective serotonin reuptake inhibitors, or SSRIs, which we'll talk about in a bit, when people take those drugs, they see not just a suppression of the obsession and compulsion but also a suppression of these particular neural circuits.
除此之外，一些药物治疗对某些人有效，我想强调一些，可以抑制强迫症和/或强迫症，例如选择性血清素再摄取抑制剂，或SSRIs，我们稍后会讨论，当人们服用这些药物时，他们不仅看到对强迫症和强迫症的抑制，而且还看到对这些特定神经回路的抑制。
They become less active.
他们变得不那么活跃。
Now, I want to emphasize and telegraph a little bit of what's coming later: these drugs, like SSRIs, do not work for everybody with OCD.
现在，我想强调并传达一些稍后发生的事情：这些药物，如 SSRIs，并不对每个强迫症患者都有效。
As many of you know, they carry other certain problems and side effects for many, but not all, individuals.
正如你们许多人所知，它们对许多人（但不是所有人）带来其他某些问题和副作用。
Andrew Huberman:
安德鲁·休伯曼：
But nonetheless, what we have now is an observation that this circuit, the cortico-striatal-thalamic loop, is active in OCD.
但尽管如此，我们现在观察到这个回路，即皮质-纹状体-丘脑环路，在强迫症中是活跃的。
We have a manipulation that when people take a drug that at least in those individuals is effective in suppressing or eliminating the obsessions and compulsions, there's less activity in this loop.
我们有一种操纵方法，当人们服用一种至少对这些人有效抑制或消除强迫观念和强迫行为的药物时，这个循环中的活动就会减少。
Thanks to some very good animal model studies that, at least at this point in time, you really couldn't do in humans (although soon that may change) we now know in a causal way that the equivalent circuitry A.
感谢一些非常好的动物模型研究，至少在目前的时间点上，你确实无法在人类身上做到这一点（尽管很快这可能会改变），我们现在以因果方式知道等效电路 A.
exists in other animals such as mice, such as cats, such as monkeys, and that activation of those particular cortico-striatal-thalamic circuits in animal models can indeed evoke OCD in an individual that prior to that did not have OCD.
存在于其他动物中，例如小鼠、猫、猴子，并且动物模型中那些特定的皮质-纹状体-丘脑回路的激活确实可以在之前没有强迫症的个体中诱发强迫症。
Andrew Huberman:
安德鲁·休伯曼：
So I'm just going to briefly describe one study.
因此，我将简要描述一项研究。
This is a now-classic study published in the journal Science, one of the three apex journals, in 2013.
这是2013年发表在三大顶尖期刊之一的《Science》杂志上的一项现在经典的研究。
The first author on this paper is Susanne Ahmari.
这篇论文的第一作者是 Susanne Ahmari。
I will provide a link to this in the show notes, it is a truly landmark paper, done in René Hen's lab at Columbia University.
我将在展览笔记中提供此内容的链接，这是一篇真正具有里程碑意义的论文，是在哥伦比亚大学 René Hen 实验室完成的。
The title of the paper is "Repeated cortico-striatal stimulation generates," that's the key word here, "Generates persistent OCD-like behavior." What they did is they took mice.
这篇论文的标题是“重复皮质纹状体刺激产生”，这是这里的关键词，“产生持续的强迫症样行为”。他们所做的就是抓老鼠。
Mice do mouse things: they move around, they play with toys, they eat, they pee, they mate, they do various things in their cage.
老鼠会做老鼠的事情：它们四处走动，它们玩玩具，它们吃东西，它们撒尿，它们交配，它们在笼子里做各种事情。
But they also groom.
但他们也会打扮。
Andrew Huberman:
安德鲁·休伯曼：
Humans groom, animals with fur groom.
人类用毛皮来梳理毛发，动物则用皮毛来梳理毛发。
Well, you hope most people groom, some people overgroom, some people undergroom.
好吧，你希望大多数人都打扮得漂漂亮亮，有些人打扮得过度，有些人打扮得不够整洁。
But most people groom.
但大多数人都会打扮。
They'll comb their hair, they'll clean, et cetera.
他们会梳理头发、打扫卫生等等。
Those are normal behaviors that humans engage in.
这些是人类的正常行为。
I'm not aware that mice comb their hair, but mice adjust their hair.
我不知道老鼠会梳头发，但老鼠会调整头发。
So they'll kind of pet their hair, and they'll do this.
所以他们会抚摸自己的头发，他们会这样做。
They'll sometimes even do it to each other.
他们有时甚至会互相这样做。
We used to have mice in the lab, now we only do human studies.
我们过去在实验室里有老鼠，现在我们只做人体研究。
But the mice will groom themselves, and typical what we call wild-type mice, not because they're wild but because they're typical, will groom themselves at a particular frequency but not to the point where their hair is falling out.
但老鼠会梳理自己，典型的我们所说的野生型老鼠，不是因为它们是野生的，而是因为它们是典型的，会以特定的频率梳理自己，但不会达到毛发脱落的程度。
Not constantly.
不是不断的。
They are grooming some of the time, and they're doing other mouse things other mouse times.
它们有时会梳理毛发，有时则在做其他老鼠的事情。
Andrew Huberman:
安德鲁·休伯曼：
So in this particular study, what they did is they used some technology, which actually was discussed on a previous episode of the Huberman Lab podcast.
因此，在这项特殊的研究中，他们所做的是使用了一些技术，这实际上是在 Huberman 实验室播客的前一集中讨论过的。
This is technology that was developed by a psychiatrist and bioengineer by the name of Karl Deisseroth, one of my colleagues at Stanford School of Medicine.
这项技术是由一位名叫 Karl Deisseroth 的精神病学家和生物工程师开发的，他是我在斯坦福大学医学院的同事之一。
This is technology that allows researchers to use the presentation of light to control neural activity in particular brain areas in a very high-fidelity way.
这项技术允许研究人员利用光的呈现以非常高保真的方式控制特定大脑区域的神经活动。
You control the activity in the cortex or the striatum or the thalamus when you want and how you want.
您可以在您想要的时间和方式控制皮层、纹状体或丘脑的活动。
It's really a beautiful technology.
这确实是一项美丽的技术。
Andrew Huberman:
安德鲁·休伯曼：
In any event, what they did in this study is, or I should say what Susanne Ahmari and colleagues did in this study, was to stimulate the cortico-striatal circuitry in animals that did not have any OCD-like behavior.
无论如何，他们在这项研究中所做的，或者我应该说 Susanne Ahmari 和同事在这项研究中所做的，是刺激没有任何强迫症样行为的动物的皮质纹状体回路。
When they did that, those animals started grooming incessantly to the point where their hair was falling out or ...
当他们这样做时，这些动物开始不断地梳理毛发，直到它们的毛发脱落或......
They didn't take the experiments this far, fortunately, but the animals would have a tendency to almost rub themselves raw, in the same way that somebody who has a compulsion to hand wash would sadly, people will hand wash to the point where their hands are actually bleeding and raw.
幸运的是，他们没有进行这么远的实验，但动物们几乎会把自己擦得生疼，就像那些有洗手强迫症的人会悲伤一样，人们会洗手到他们的手实际上流血和生疼的程度。
It's really that bad.
真的有那么糟糕。
I know that's tough imagery to imagine, and you can't even imagine why someone would self-harm in that way.
我知道这很难想象，你甚至无法想象为什么有人会以这种方式自残。
But again, that's that incredible anxiety relationship between the obsession and the compulsion and the fact that engaging in the compulsion simply strengthens the obsession and therefore the anxiety.
但同样，这就是痴迷和强迫之间令人难以置信的焦虑关系，而事实上，参与强迫只会强化痴迷，从而增强焦虑。
Andrew Huberman:
安德鲁·休伯曼：
So that collection of studies, of data, fMRI, pet scanning in humans, the treatment with SSRIs, and these experiments where researchers have actively triggered these particular circuits in animal models that previously did not have too much activity in these circuits and then they observe OCD emerging, really points squarely to the fact that the cortico-striatal-thalamic loop is likely to be the basis of OCD.
因此，研究、数据、功能磁共振成像、人类宠物扫描、SSRIs治疗以及这些实验的收集，研究人员在动物模型中主动触发了这些特定的回路，而这些回路以前在这些回路中没有太多的活动，然后他们观察到强迫症的出现，确实直接指出了这样一个事实：皮质-纹状体-丘脑环路可能是强迫症的基础。
Now, of course, other circuits could also be involved, but the cortico-striatal-thalamic circuit seems to be the main circuit generating OCD-like behavior.
当然，现在还可能涉及其他回路，但皮质-纹状体-丘脑回路似乎是产生类似强迫症行为的主要回路。
Andrew Huberman:
安德鲁·休伯曼：
That's a lot of mechanism.
这是很多机制。
Hopefully it was described in a way that you can digest and understand.
希望它以您可以消化和理解的方式进行描述。
Some of you might be thinking, "Well, so what?
你们中有些人可能会想：“那又怎样？
Why does that help me?
为什么这对我有帮助？
I mean, I can't reach into my brain and turn off my cortex.
我的意思是，我无法进入我的大脑并关闭我的皮层。
I can't reach into my brain and turn off my thalamus." And indeed, on the one hand that's true.
我无法进入我的大脑并关闭我的丘脑。”事实上，一方面这是事实。
But as you'll next learn when thinking about the various behavioral treatments and drug treatments and holistic treatments for OCD, what you'll notice is that each one taps into a different component of this cortico-striatal-thalamic loop.
但是，正如您接下来在考虑强迫症的各种行为治疗、药物治疗和整体治疗时将了解到的那样，您会注意到，每种治疗都利用了皮质-纹状体-丘脑环路的不同组成部分。
By understanding that, you can start to see why certain treatments might work at one stage of the illness versus others.
通过了解这一点，您可以开始明白为什么某些治疗方法可能在疾病的一个阶段比其他阶段更有效。
You will also start to understand why obsessive-compulsive personality disorder does not have the same sorts of engagements of these neural loops and yet relies on other aspects of brain and body, and therefore responds best to other sorts of treatments.
您还将开始理解为什么强迫性人格障碍没有这些神经环路的相同类型的参与，而是依赖于大脑和身体的其他方面，因此对其他类型的治疗反应最好。
Or in some cases, people with obsessive-compulsive personality disorder are not even seeking treatment, as I alluded to before.
或者在某些情况下，患有强迫性人格障碍的人甚至不寻求治疗，正如我之前提到的。
Andrew Huberman:
安德鲁·休伯曼：
The point here is that by understanding the underlying mechanism why certain drugs and behavioral treatments work and don't work will become immediately apparent.
这里的要点是，通过了解某些药物和行为治疗有效和无效的潜在机制，我们会立即明白。
In thinking about that, in knowing that, you'll be able to make excellent choices, I believe, in terms of what sorts of treatments you pursue, what sorts of treatments you abandon, and most importantly the order, the sequence that you pursue and apply those treatments.
我相信，在思考这一点、了解这一点后，您将能够做出出色的选择，包括您追求哪种治疗、放弃哪种治疗，以及最重要的是您追求和应用这些治疗的顺序和顺序。
Andrew Huberman:
安德鲁·休伯曼：
Before we go any further, I'd like to give people a little bit of a window into what a diagnosis for OCD would look like, give you a sense of the sorts of questions that a clinician would ask to determine whether or not somebody has OCD or not.
在我们进一步讨论之前，我想为人们提供一个了解强迫症诊断的窗口，让您了解临床医生在确定某人是否患有强迫症时会提出的各种问题。
Now, I want to be clear, I'm not going to do this in an exhaustive way.
现在，我想澄清的是，我不会以详尽的方式进行此操作。
I wouldn't want anyone to self-diagnose.
我不希望任何人进行自我诊断。
Although I'm hoping that by sharing some of this that some of you might get insight into whether or not you do have obsessions and compulsions that might qualify for OCD and perhaps even to seek out help.
尽管我希望通过分享其中的一些内容，你们中的一些人可能会深入了解自己是否确实有可能符合强迫症资格的强迫观念和强迫行为，甚至可能寻求帮助。
Andrew Huberman:
安德鲁·休伯曼：
The most commonly used test of OCD, or for OCD I should say, is called the Yale Brown Obsessive-Compulsive Scale.
最常用的强迫症测试，或者我应该说的强迫症测试，被称为耶鲁布朗强迫量表。
Scientists love acronyms, as do the military, and it's the Y-BOCS.
科学家们喜欢缩写词，军队也喜欢缩写词，这就是 Y-BOCS。
The Y dash B-O-C-S.
Y 破折号 B-O-C-S。
So typically someone will go into the clinic, either because a family member encouraged them to or because they feel that they're suffering from obsessions and compulsions.
因此，通常有人会去诊所，要么是因为家庭成员鼓励他们，要么是因为他们觉得自己患有强迫症和强迫症。
Before the clinician would proceed with any kind of direct questions, they would very clearly define what obsessions and compulsions are.
在临床医生提出任何类型的直接问题之前，他们会非常清楚地定义什么是强迫观念和强迫行为。
Here I'm actually reading from the Y-BOCS, "Obsessions are unwelcome and distressing ideas, thoughts, images, or impulses that repeatedly enter your mind.
我在这里实际上读到了 Y-BOCS 的内容：“痴迷是指反复出现在你脑海中的不受欢迎且令人痛苦的想法、想法、图像或冲动。
They may seem to occur against your will.
它们的发生似乎违背了您的意愿。
They may be repugnant to you.
他们可能令你反感。
You may recognize them as senseless, and they may not fit your personality." Then there are compulsions: "Compulsions, on the other hand, are behaviors or acts that you feel driven to perform, although you may recognize them as senseless or excessive.
你可能会认为它们毫无意义，而且它们可能不适合你的个性。”然后是强迫行为：“另一方面，强迫行为是你感到被迫执行的行为或行动，尽管你可能认为它们是毫无意义或过度的。
At times you may try to resist doing them, but this may prove difficult.
有时您可能会尝试抵制这样做，但这可能会很困难。
You may experience anxiety that does not diminish until the behavior is completed." As I mentioned before, in many cases, immediately after the behavior is completed, the anxiety doesn't just return.
在该行为完成之前，你可能会感到焦虑，这种焦虑不会减轻。”正如我之前提到的，在很多情况下，行为完成后，焦虑不会立即回来。
It indeed can strengthen.
确实可以强化。
Andrew Huberman:
安德鲁·休伯曼：
Now there are a tremendous number of questions on the Y-BOCS.
现在，关于 Y-BOCS 存在大量问题。
So I'm just going to highlight a few of the general categories.
所以我只想强调一些一般类别。
Typically, the person will fill out a checklist, so they will designate whether or not, currently or in the past, they have, for instance, aggressive obsessions.
通常，这个人会填写一份清单，这样他们就会指定他们当前或过去是否有，例如，攻击性的痴迷。
Fear that one might harm themselves.
担心有人会伤害自己。
Fear that one might harm others.
害怕一个人可能会伤害别人。
Fear that they'll steal things.
生怕他们偷东西。
Fear that they will act on unwanted impulses currently, in the past, or both.
担心他们会根据当前、过去或两者的不良冲动采取行动。
That's one category.
这是一类。
The other one are contamination obsessions; so concern with dirt or germs, bothered by sticky substances or residues, et cetera, cetera.
另一种是对污染的痴迷。所以要担心污垢或细菌，受粘性物质或残留物的困扰，等等。
Andrew Huberman:
安德鲁·休伯曼：
So there are a bunch of different categories that include, for instance, sexual obsessions, what are called saving obsessions, even moral obsessions, right?
所以有很多不同的类别，例如，包括性痴迷，所谓的拯救痴迷，甚至道德痴迷，对吗？
Excess concern with right or wrong or morality, concern with sacrilege and blasphemy.
过度关注对错或道德，关注亵渎和亵渎。
Obsession with need for symmetry and exactness.
痴迷于对称性和精确性的需求。
Again, all of these questions being answered as either present in the past or not present in the past, present currently or not present currently.
同样，所有这些问题都被回答为过去存在或过去不存在、当前存在或当前不存在。
Then the test generally transitions over to questions about target symptoms.
然后测试通常会转向有关目标症状的问题。
They really try and get people to identify, if they have obsessions, what are their exact obsessions.?
他们确实试图让人们确定，如果他们有强迫症，他们到底强迫症是什么？
Now, this turns out to be really important because as we talk about some of the therapies that really work, I'll just give away a little bit of why they work best in certain cases and why they don't work as well in other cases.
现在，事实证明这非常重要，因为当我们谈论一些真正有效的疗法时，我将透露一些为什么它们在某些情况下效果最好以及为什么它们在其他情况下效果不佳。
Andrew Huberman:
安德鲁·休伯曼：
It turns out that it becomes very important for the clinician and the patient to not just identify the obsessions and the compulsions generally, in a kind of generic or top-contour way, but to really encourage or even force the patient to define very precisely what the biggest, most catastrophic fear is.
事实证明，对于临床医生和患者来说，不仅要以一种通用或概括的方式识别强迫观念和强迫行为，而且要真正鼓励甚至强迫患者非常准确地定义最大的、最具灾难性的恐惧是什么，这一点变得非常重要。
What the obsession really relates to.
痴迷真正与什么有关。
That turns out to be very important in disrupting this cortico-striatal-thalamic loop and getting relief from symptoms one way or the other.
事实证明，这对于破坏皮质-纹状体-丘脑循环并以某种方式缓解症状非常重要。
Andrew Huberman:
安德鲁·休伯曼：
So the Yale Brown Obsessive-Compulsive Scale, this Y-BOCS, again, is very extensive.
因此，耶鲁布朗强迫症量表（Y-BOCS）的范围非常广泛。
It goes on for dozens of pages actually and has all these different categories, not so much designed to just pinpoint what people obsess about or what they feel compelled to do, but to also try and identify, what is the fear that's driving all this?
它实际上有几十页，并且有所有这些不同的类别，其设计目的不仅仅是为了查明人们痴迷的东西或他们觉得有必要做的事情，而是试图找出驱动这一切的恐惧是什么？
In the way that we've set this up thus far, we've been talking about obsessions and compulsions as kind of existing in a vacuum.
到目前为止，我们一直在谈论存在于真空中的强迫观念和强迫行为。
You're obsessed about germs, and you're compelled to wash your hands.
你对细菌很着迷，所以你不得不洗手。
Obsessed about germs, compelled to wash your hands.
痴迷于细菌，被迫洗手。
Or obsessed about symmetry, compelled to put right angles on everything.
或者痴迷于对称，强迫所有东西都成直角。
Or obsessed about counting and therefore counting, et cetera.
或者痴迷于计数并因此计数，等等。
Andrew Huberman:
安德鲁·休伯曼：
But beneath that is a cognitive component that is not at all apparent from someone describing their obsession and from someone describing or displaying their compulsion.
但在其之下是一种认知成分，从描述他们的痴迷的人以及描述或表现他们的强迫的人来看，这种认知成分根本不明显。
The deeper layer to all that is, what is the fear, exactly, if one were to not perform the compulsion?
更深层次的是，如果一个人不执行强迫行为，那么到底恐惧是什么？
Meaning what is the fear that's driving the obsession?
这意味着什么恐惧导致了这种痴迷？
So that brings us to a very powerful category of treatments that I should say does not work in everybody with OCD, but works in many people with OCD, and really speaks to the underlying neural circuitry that generates OCD and how to interrupt it.
因此，这给我们带来了一种非常强大的治疗方法，我应该说，这种治疗方法并不对每个强迫症患者都有效，但对许多强迫症患者有效，并且真正涉及产生强迫症的潜在神经回路以及如何中断它。
That is the treatment of cognitive behavioral therapy, and, in particular, exposure-based cognitive behavioral therapy.
这就是认知行为疗法，特别是基于暴露的认知行为疗法。
Andrew Huberman:
安德鲁·休伯曼：
So we're going to talk about cognitive behavioral therapy and exposure therapy now.
所以我们现在要讨论认知行为疗法和暴露疗法。
But right at the outset, I want to distinguish the kinds of cognitive behavioral therapy and exposure therapies that are done for obsessive-compulsive disorder, and the sorts of cognitive behavioral therapies that are done for other types of mental challenges and disorders.
但首先，我想区分针对强迫症进行的认知行为疗法和暴露疗法的种类，以及针对其他类型的精神挑战和障碍进行的认知行为疗法的种类。
Because cognitive behavioral therapy for OCD really has everything to do with identifying the utmost fear.
因为强迫症的认知行为疗法确实与识别最大的恐惧有关。
In some sense, we can think of fears as kind of along a hierarchy.
从某种意义上说，我们可以将恐惧视为一种等级制度。
In the example earlier of somebody being afraid to turn left and therefore feeling compelled to turn right, you would want to take that person and really understand, what do they fear most about turning left?
在前面的例子中，有人害怕左转，因此感觉不得不右转，你会想要带那个人真正了解，他们最害怕左转的是什么？
Now, they might not be aware of it, they might not be conscious to what that really is.
现在，他们可能没有意识到这一点，他们可能没有意识到那到底是什么。
But if you were to probe them in a clinical setting, you would eventually get to an answer.
但如果你在临床环境中探究它们，你最终会得到答案。
That answer could be at first, "I don't know, just it's just bad.
这个答案一开始可能是：“我不知道，只是这很糟糕。
I don't know why it's bad, it makes no sense, but it's just bad.
我不知道为什么它不好，这没有意义，但它就是不好。
I do not want to go left.
我不想向左走。
I don't know why.
我不知道为什么。
I don't know why." But if you were to push that person a little bit, in a respectful and kind and caring way aimed at their treatment, if you were to push them and say, "Well, what do you mean by bad?
我不知道为什么。”但如果你要以尊重、友善和关心的方式推动那个人一点，针对他们的待遇，如果你要推动他们并说：“好吧，你说的不好是什么意思？
If you turn left, do you think the world would end?" They might say, "No, the world's not going to end, but someone is going to die suddenly.
如果你向左转，你认为世界就会终结吗？”他们可能会说：“不，世界不会末日，但有人会突然死亡。
I know that sounds crazy, but somebody's going to die suddenly." This almost sounds like superstition.
我知道这听起来很疯狂，但有人会突然死亡。”这听起来几乎像是迷信。
We'll talk about superstitions later.
稍后我们会讨论迷信。
But indeed it is somewhat superstitious.
但确实有些迷信。
So for instance, you would say, "Who's going to die?" And they'd say, "I don't know," and you'd say, "No, really?
例如，你会说：“谁会死？”他们会说，“我不知道”，你会说，“不，真的吗？
Who's going to die if you think about this?
如果你想想这个，谁会死呢？
Are you going to die?
你会死吗？
Is so-and-so going to die?"
某某人会死吗？”
Andrew Huberman:
安德鲁·休伯曼：
Very often, very often, what you find is that people will start to reveal the underlying obsession at a level of detail that both to the clinician and to them can be somewhat astonishing even though they've been living with that detail in their mind for a very long time.
很多时候，很多时候，你会发现人们会开始详细地揭示潜在的困扰，这对临床医生和他们来说都可能有点令人惊讶，尽管他们已经在脑海中记住了这些细节很长一段时间。
Now, how could somebody start to reveal detail about something that's existed in their mind for a very long time but not known about it?
现在，一个人怎么可能开始揭示一些在他们脑海中存在了很长时间但不为人所知的事情的细节呢？
Not been aware of it?
没有意识到吗？
Now, some of you might think, "Oh, it's repressed or something." That's not at all what's happening.
现在，你们中的一些人可能会想，“哦，它被压抑了或者什么的。”事实并非如此。
If you think about the architecture of OCD, typically people will have an obsession and then they'll engage in the compulsion as quickly as they can to relieve that obsession.
如果你考虑一下强迫症的架构，通常人们都会有一种强迫症，然后他们会尽快陷入强迫行为以缓解这种强迫症。
So in many ways, the disease itself prevents people from ever getting to the bottom of that trough, ever getting to the point where they really clearly articulate to themselves exactly what it is that they fear.
因此，从很多方面来说，这种疾病本身阻止人们跌入低谷，阻止人们真正清楚地向自己表达自己到底害怕什么。
But it becomes so essential to articulate exactly what it is that they fear, for a somewhat counterintuitive reason.
但出于某种有点违反直觉的原因，准确地表达出他们所害怕的东西变得非常重要。
Andrew Huberman:
安德鲁·休伯曼：
You might think, "Oh, the moment they realize exactly what they fear, everything lifts, the circuit turns off, and they just feel better because they realized it." I wish I could tell you that's the case, but it turns out it's the opposite.
你可能会想，“哦，当他们真正意识到自己害怕什么的那一刻，一切都恢复了，电路关闭了，他们感觉好多了，因为他们意识到了这一点。”我希望我能告诉你情况确实如此，但事实证明恰恰相反。
What the clinician is actually trying to do is get people to feel more anxiety, not less.
临床医生实际上想做的是让人们感到更多的焦虑，而不是更少。
What they're trying to get them to do is to short-circuit, no pun intended, to intervene in their own neural circuit, I should say, with that relief of anxiety, however brief, brought on by engaging in the compulsion related to the obsession.
我应该说，他们试图让他们做的是短路（不是双关语），干预他们自己的神经回路，通过参与与痴迷相关的强迫行为来缓解焦虑，无论多么短暂。
So whereas typically someone would feel the obsession with, "Ugh, I don't want to turn left because something bad's going to happen, someone's going to die," and then they turn right, they never get the option or the opportunity to really explore what would happen were they to turn left or to not be able to turn right.
因此，尽管通常有人会痴迷于“呃，我不想左转，因为会发生不好的事情，有人会死”，然后他们右转，但他们从来没有机会或选择真正探索如果他们左转或无法右转会发生什么。
By forcing them down the path of inquiry that leads them to the place where they very clearly identify the fear, the anxiety, it raises the anxiety in them.
通过迫使他们走上探究的道路，引导他们到达非常清楚地识别恐惧和焦虑的地方，这会增加他们的焦虑。
That's actually what the clinician is after.
这实际上就是临床医生所追求的。
Andrew Huberman:
安德鲁·休伯曼：
Cognitive behavioral therapy and exposure therapy, in the context of OCD, most often involves trying to get people to tolerate, not relieve, their anxiety.
在强迫症的背景下，认知行为疗法和暴露疗法通常涉及试图让人们忍受而不是缓解他们的焦虑。
This is extremely important, and I realize there's variation to this depending on the style of cognitive behavioral therapy, the style of exposure therapy.
这非常重要，而且我意识到，根据认知行为疗法、暴露疗法的风格，这一点会有所不同。
But almost across the board the goal again is to get people to feel the anxiety that normally they are able to at least partially relieve, however briefly, by engaging in the compulsion.
但几乎所有的目标都是让人们感受到焦虑，通常他们可以通过参与强迫行为来至少部分缓解，无论时间多么短暂。
Andrew Huberman:
安德鲁·休伯曼：
So if we think back to that circuit of cortico-striatal-thalamic, what's going on here?
那么，如果我们回想一下皮质-纹状体-丘脑的回路，这里发生了什么？
Where is CBT intervening?
CBT 干预在哪里？
What part of the circuit is getting interrupted?
电路的哪一部分被中断？
Well, as you recall, the cortex is involved in conscious perception.
嗯，正如你所记得的，皮质参与有意识的感知。
The thalamus and that thalamic reticular nucleus are involved in the passage of certain types of experience up to our conscious perception, not others.
丘脑和丘脑网状核参与某些类型的体验向我们的意识感知的传递，而不是其他体验。
And the striatum is involved in this Go/ No-Go-type behavior.
纹状体参与了这种“Go/No-Go”型行为。
When OCD is really expressing itself in its fullness, people feel an anxiety around a particular thought, and they either have a Go, for instance wash hands, or a No-Go, do-not-turn-left-type reaction.
当强迫症真正充分表达自己时，人们会对某个特定想法感到焦虑，他们要么会做出“去”（例如洗手）的反应，要么会做出“不去”（不左转）的反应。
By having people progressively in a kind of hierarchical way reveal their precise source of anxiety, their utmost fear in this context, what happens is they feel enormous amounts of autonomic arousal.
通过让人们以一种分层的方式逐步揭示他们的焦虑的确切来源，他们在这种情况下最大的恐惧，发生的事情是他们感到大量的自主唤醒。
Now, in the context of anxiety treatment or other types of treatments, the goal would be to teach people to dampen, to lessen their anxiety, through breathing techniques or through visualization techniques or through self-talk or through social support, any of the number of things that are well known to help people self-regulate their own anxiety.
现在，在焦虑治疗或其他类型的治疗中，目标是教会人们通过呼吸技巧、可视化技巧、自言自语或社会支持等任何众所周知的可以帮助人们自我调节焦虑的方法来抑制、减轻焦虑。
Andrew Huberman:
安德鲁·休伯曼：
Here it's the opposite.
这里恰恰相反。
What they're trying to get the patient to do is to really feel the anxiety at its maximum, but then do the exact opposite of whatever the normal compulsion is.
他们试图让患者真正感受到最大程度的焦虑，然后做与正常强迫行为完全相反的事情。
So if normally the compulsion is to wash one's hands, then the idea is to suppress handwashing while being in the experience of the utmost anxiety.
因此，如果通常的强迫行为是洗手，那么我们的想法就是在极度焦虑的情况下抑制洗手。
Or in the case of not turning left, the person is expected to, or would hopefully be able to actually turn left.
或者在不左转的情况下，该人预计或希望能够实际左转。
And as you can imagine, that would evoke tremendous anxiety, and yet to tolerate that anxiety.
正如你可以想象的那样，这会引起巨大的焦虑，但又要忍受这种焦虑。
Andrew Huberman:
安德鲁·休伯曼：
Now, I want to be very clear, this is not the sort of thing you want to do on your own.
现在，我想非常清楚地表明，这不是你想要自己做的事情。
This is not the sort of thing you want to do for a friend.
这不是你想为朋友做的事情。
This is done by trained licensed psychologists and psychiatrists.
这是由经过培训的有执照的心理学家和精神病学家完成的。
But nonetheless, it really points to the fact that as an anxiety-related disorder, OCD is distinct from other types of anxiety and anxiety-related disorders, things like PTSD and panic disorder, et cetera.
但尽管如此，它确实指出了这样一个事实：作为一种与焦虑相关的疾病，强迫症与其他类型的焦虑和焦虑相关的疾病（如创伤后应激障碍（PTSD）和恐慌症等）不同。
Because the goal, again, is to bring the person right up close to the thing that they fear the most and then to interrupt the circuit.
因为我们的目标是让人们靠近他们最害怕的东西，然后中断电路。
Now you should be able to know just intuitively because you understand the mechanisms that the circuit you're trying to disrupt is the pattern of information flow from the thinking part of the brain, the perception part of the brain which is the cortex, to the striatum.
现在你应该能够凭直觉知道，因为你了解你试图破坏的电路的机制是从大脑的思考部分、大脑的感知部分（即皮质）到纹状体的信息流模式。
The striatum has these neurons which are active, that essentially are ...
纹状体具有这些活跃的神经元，本质上是......
I know it sounds a little bit like a discussion about free will, but they're trying to get the person to generate a certain behavior or suppress a certain behavior.
我知道这听起来有点像关于自由意志的讨论，但他们试图让人们产生某种行为或抑制某种行为。
As anxiety ramps up, it's sort of a hydraulic pressure to do that very thing that they've done for so long and they suffer from so much.
随着焦虑的加剧，他们做了这么长时间的事情，并遭受了如此多的痛苦，这就像一种液压压力。
Andrew Huberman:
安德鲁·休伯曼：
We talked about hydraulic pressure in the context of aggression in the aggression episode.
我们在攻击事件中讨论了攻击背景下的液压。
This is very similar.
这非常相似。
There's kind of ...
有一种...
Now, when I say hydraulic pressure, it's not actual hydraulic pressure, it's the confluence of a lot of different systems.
现在，当我说液压时，它不是实际的液压，而是许多不同系统的汇合。
It's neurochemicals, we'll soon learn, it's hormonal, it's electrical, it's a lot of different things operating in parallel.
我们很快就会了解到，它是神经化学物质，它是荷尔蒙，它是电的，它是许多不同的东西并行运作的。
So we can't point to one chemical or transmitter.
所以我们不能指出一种化学品或发射器。
What's happening is the person is feeling compelled to act, act, act to relieve the anxiety.
所发生的情况是，人们感到有必要采取行动、采取行动、采取行动来缓解焦虑。
And through a progressive type of exposure — you don't throw people in the deep end in this kind of therapy right off the bat — you gradually ratchet them toward or move them toward the discussion of exactly what they fear the most, and then eventually move them toward the interruption of the compulsion as they're feeling this extremely elevated anxiety, of course within the context of a supportive clinical setting.
通过渐进式的暴露——你不会立即让人们陷入这种治疗的深渊——你逐渐让他们开始讨论他们最害怕的事情，然后最终让他们中断强迫症，因为他们感到这种极度焦虑，当然是在支持性临床环境的背景下。
But in doing that, what you are teaching people is that the anxiety can exist without the need to engage in the compulsion.
但在这样做的过程中，你教导人们的是，焦虑可以存在，而不需要参与强迫。
Andrew Huberman:
安德鲁·休伯曼：
Now, some of this might sound to people like, "Oh, this is a lot of kind of fancy psychological neuroscience speak around something that's kind of intuitive." But I think for most people, this is not intuitive.
现在，有些人可能会觉得，“哦，这是一种围绕直觉的奇特心理神经科学的说法。”但我认为对于大多数人来说，这并不直观。
For people with OCD, there's no really other way to put it, the impulse and the compulsion to avoid anxiety is such a powerful driving force that it should now make sense to you as to why being able to tolerate anxiety and really sit with it and do the exact opposite of what you're normally compelled to do is going to be the path to treatment.
对于患有强迫症的人来说，没有其他的说法，避免焦虑的冲动和强迫是一种如此强大的驱动力，现在你应该明白为什么能够容忍焦虑并真正忍受它并做与你通常被迫做的事情完全相反的事情将成为治疗之路。
Indeed, CBT has been shown to be enormously effective, again, for a large number of people with OCD, but not all of them.
事实上，事实证明，认知行为治疗对于很多强迫症患者（但不是全部）来说非常有效。
Oftentimes it requires that it also be used in concert with certain drug treatments, which we're going to talk about in a moment.
通常，它还需要与某些药物治疗配合使用，我们稍后将讨论这一点。
Andrew Huberman:
安德鲁·休伯曼：
Next, let's talk about some of the really unique features of cognitive behavioral therapy and exposure therapy, in the context of OCD, that you often don't see in the use of CBT, that is cognitive behavioral therapy, for other types of psychiatric challenges and disorders.
接下来，我们来谈谈在强迫症背景下认知行为疗法和暴露疗法的一些真正独特的特征，这些特征在使用 CBT（即认知行为疗法）治疗其他类型的精神挑战和疾病时经常看不到。
The first element is one of staircasing.
第一个元素是楼梯。
I already mentioned this before, but this gradual and progressive increase in the anxiety that you're trying to evoke from the patient, from the person suffering from OCD.
我之前已经提到过这一点，但是你试图从患者、强迫症患者身上唤起焦虑的逐渐增加。
That's done in the context of the office or the laboratory, again by a trained and licensed clinician.
这是在办公室或实验室中完成的，同样是由经过培训和获得许可的临床医生完成的。
But then the person leaves.
但随后这个人就离开了。
They leave the office, they leave the laboratory.
他们离开办公室，离开实验室。
A very vital component of CBT and exposure therapy for people with OCD is that they have and perform what's called homework, it's literally what they call it.
对于强迫症患者来说，CBT 和暴露疗法的一个非常重要的组成部分是他们有并执行所谓的家庭作业，这就是他们所说的。
This might be seen in other sorts of treatments, but for OCD homework is extremely important.
这可能会在其他类型的治疗中出现，但对于强迫症来说，家庭作业极其重要。
Because within the context of a laboratory experiment or the clinic, patients often feel so much support that they can tolerate those heightened levels of anxiety and interrupt their compulsions.
因为在实验室实验或诊所的背景下，患者常常会感受到如此多的支持，以至于他们可以忍受高度的焦虑并中断他们的强迫行为。
Whereas when they get home, oftentimes the familiarity of the environment brings them to a place where all of a sudden those obsessions and compulsions start interacting the same way, and they have a very hard time suppressing the behaviors.
然而，当他们回到家时，通常对环境的熟悉感会让他们突然开始以同样的方式相互作用，而他们很难抑制这些行为。
Andrew Huberman:
安德鲁·休伯曼：
Why would that be?
为什么会这样呢？
Well, in neuroscience we have a phrase, it's called conditioned place preference and conditioned place avoidance.
嗯，在神经科学中我们有一个短语，叫做条件性位置偏好和条件性位置回避。
There's some other phrases too, but basically it all has to do with a simple thing, which is when you feel something repeatedly in a given environment or sometimes even once within a given environment, you tend to feel that same thing again when you return to that or similar environments.
还有一些其他的短语，但基本上都与一个简单的事情有关，那就是当你在给定的环境中反复感受到某种东西，或者有时甚至在给定的环境中一次时，当你回到那个或类似的环境时，你往往会再次感受到同样的东西。
So conditioned place blank or conditioned place that is simply fancy nerd-speak for the fact that when you're in a place and something good happens, you tend to feel good if you return to that place or a place like it, or if something bad happens in a given place, you tend to feel bad when you return to that place or a place like it.
所以条件化的地方空白或条件化的地方只是奇特的书呆子所说的事实，当你在一个地方并且发生了好事时，如果你回到那个地方或类似的地方，你往往会感觉良好，或者如果在给定的地方发生不好的事情，当你回到那个地方或类似的地方时，你往往会感觉不好。
Andrew Huberman:
安德鲁·休伯曼：
I think that most salient example that leaps to mind is in unfortunately the category of bad, but I had some friends years ago visit San Francisco.
我认为不幸的是，我想到的最突出的例子属于不好的类别，但几年前我有一些朋友访问了旧金山。
There's been an ongoing, it seems like it's been happening forever, but this is really in the last decade, of daytime break-ins and nighttime break-ins into cars to steal anything from computers to what seems to be like a box of tissues.
一直以来，似乎一直在发生，但这确实是在过去十年里，白天和夜间闯入汽车，窃取从电脑到一盒纸巾之类的任何东西。
There are numerous reasons for this I don't want to get into — it's not the topic of today's podcast, but I will use this an opportunity to say, if you're visiting anywhere in the Bay Area, do not leave anything in your car because the window will get broken into, sometimes in broad daylight.
造成这种情况的原因有很多，我不想谈——这不是今天播客的主题，但我会借此机会说，如果您要去湾区的任何地方，不要在车里留下任何东西，因为窗户会被闯入，有时是在光天化日之下。
PART 1 OF 4 ENDS Andrew Huberman:
第 1 部分（共 4 部分）结束 Andrew Huberman：
Your car because the window will get broken into, sometimes in broad daylight.
你的车因为窗户会被闯入，有时是在光天化日之下。
Some good friends of mine were visiting the Bay Area, and I texted them and said, "Hey, by the way, when you're headed to dinner, guys, make sure you bring in all your luggage and computers, however inconvenient that might be." They wrote back, "Too late, everything got stolen."
我的一些好朋友正在访问湾区，我给他们发短信说：“嘿，顺便说一句，伙计们，当你们去吃晚饭时，请确保带上所有行李和电脑，无论这可能会多么不方便。”他们回信说：“太晚了，所有东西都被偷了。”
Andrew Huberman:
安德鲁·休伯曼：
So it was some years ago now, I think five, six years ago this happened.
所以那是几年前的事了，我想五六年前这件事发生了。
Sadly, everything got stolen.
不幸的是，所有东西都被偷了。
Most of it could be replaced, but some of it was very sentimental to them.
大部分都可以更换，但也有一些对他们来说非常有感情。
Every time we talk, every time we consider having a meeting in a particular city, this comes up as, "I don't want, I don't want to be there, I don't like that city anymore," et cetera.
每次我们谈话时，每次我们考虑在某个特定城市举行会议时，都会出现这样的情况：“我不想，我不想在那里，我不再喜欢那个城市了，”等等。
And of course, San Francisco has some wonderful redeeming features, but it only takes one bad incident in one location to kind of color the whole picture dark, so to speak.
当然，旧金山有一些美妙的可取之处，但可以这么说，只要在一个地方发生一件糟糕的事件，整个画面就会变得暗淡。
Andrew Huberman:
安德鲁·休伯曼：
The brain works that way.
大脑就是这样工作的。
The brain generalizes it.
大脑概括了它。
It's not a very specific organ.
它不是一个非常具体的器官。
Again, it's a prediction machine, in addition to other things.
再说一遍，除了其他功能之外，它还是一台预测机器。
So, in the case of CBT therapy, the reason there's homework is that when people go home, oftentimes that's when they relapse, if you want to call it that, back into their obsessions and compulsions.
所以，就 CBT 治疗而言，之所以有作业，是因为当人们回家时，通常就是他们旧病复发的时候，如果你想这么称呼的话，又回到了他们的痴迷和强迫之中。
And that location, that conditioned place, is where it becomes most important to challenge the anxiety and to deal with the anxiety, to not try and suppress the anxiety through compulsions or other means.
那个位置，那个受条件限制的地方，是挑战焦虑和处理焦虑的最重要的地方，而不是试图通过强迫或其他方式抑制焦虑。
And when I say other means, I want to highlight something that will come up again a little bit later in the podcast, that substance abuse is very common in people with OCD because of the anxiety component and also because of people's feelings that they just can't escape from the thoughts or behavioral patterns that are so characteristic of OCD.
当我说其他方式时，我想强调稍后会在播客中再次出现的一些内容，即药物滥用在强迫症患者中非常常见，因为其中存在焦虑成分，也因为人们感觉他们无法摆脱强迫症特有的思想或行为模式。
Andrew Huberman:
安德鲁·休伯曼：
So alcohol abuse or cannabis abuse or other forms of narcotics abuse are very common in OCD.
因此，酗酒、滥用大麻或其他形式的麻醉品滥用在强迫症中非常常见。
Later, we'll talk about whether or not cannabis can or cannot help with OCD, but needless to say, suppressing anxiety is exactly the wrong direction that one should take if the goal is to ultimately relieve or eliminate the OCD.
稍后我们会讨论大麻是否可以帮助治疗强迫症，但不用说，如果目标是最终缓解或消除强迫症，抑制焦虑恰恰是错误的方向。
So, we now have two characteristics of CBT exposure therapy that are extremely important for OCD and somewhat unique to the treatment of OCD.
因此，我们现在有了 CBT 暴露疗法的两个特征，这两个特征对于强迫症来说极其重要，并且对于强迫症的治疗来说有些独特。
And that's the staircasing up towards the really bad fear, the really severe and specific articulation and understanding and feeling of how bad things really would be if someone engaged in a particular behavior or avoided a particular behavior.
这就是通往真正糟糕的恐惧的阶梯，真正严重和具体的表达、理解和感觉，如果有人从事某种特定的行为或避免某种特定的行为，事情到底会有多糟糕。
Then there's the component of homework given by the clinician, for the person to be able to create a broader set of context in which they can deal with the anxiety, not engage in the compulsions.
然后是临床医生布置的家庭作业，让患者能够创造更广泛的环境，在其中应对焦虑，而不是陷入强迫行为。
Andrew Huberman:
安德鲁·休伯曼：
And then, a very unique feature of treatment of OCD that you don't see in many other psychiatric disorders are home visits.
然后，强迫症治疗的一个非常独特的特点是家访，这是你在许多其他精神疾病中看不到的。
And I find this fascinating.
我觉得这很有趣。
I think that the field of psychiatry and psychology, traditionally doesn't allow for or invite home visits.
我认为精神病学和心理学领域传统上不允许或邀请家访。
But this component of context, location and context being so vital to the treatment and relief of OCD has inspired many psychiatrists and psychologists to get permission to do home visits where they actually go visit their patients in their native setting, in their home cages, right?
但是，环境、地点和环境的这一组成部分对于强迫症的治疗和缓解至关重要，这激励了许多精神科医生和心理学家获得许可进行家访，他们实际上去患者的家乡、家里的笼子里拜访他们，对吗？
They're not mice, but in their home, home cages, right?
它们不是老鼠，但在它们的家里，家里的笼子里，对吧？
I'm being facetious here, but people, mice live in cages, at least in the laboratory, and humans generally live in houses or elsewhere.
我在这里开玩笑，但是人，老鼠住在笼子里，至少在实验室里，而人类通常住在房子里或其他地方。
So they visit them in their home, in order to see how they're interacting and the particular locations that evoke the most anxiety and the least anxiety.
因此，他们会到他们家中拜访，以了解他们如何互动，以及最容易引起焦虑和最不焦虑的特定地点。
Andrew Huberman:
安德鲁·休伯曼：
Some of the ...
一些...
I don't want to call them crutches, but some of the tools that people are using to confront and deal with the obsessions and compulsions and, in particular, to try and identify some of the tools and tricks that people are using to try and avoid that heightened anxiety.
我不想称它们为拐杖，而是人们用来面对和处理强迫观念和强迫行为的一些工具，特别是尝试识别人们用来避免高度焦虑的一些工具和技巧。
Andrew Huberman:
安德鲁·休伯曼：
Because once again, and I know I'm repeating myself, but I think this is just so vital and so unique about OCD and the treatment of OCD, the critical need for the patient to be able to tolerate extremely elevated levels of anxiety is so crucial.
因为我知道我在重复自己的话，但我认为这对于强迫症和强迫症的治疗来说是如此重要和独特，患者能够忍受极度升高的焦虑水平的迫切需要是如此重要。
So, if people are avoiding certain rooms in the house, or if people are avoiding certain foods or certain locations in the kitchen, the clinician can start to identify that, by mere observation.
因此，如果人们避开房屋中的某些房间，或者人们避开厨房中的某些食物或某些位置，临床医生仅通过观察就可以开始识别。
Andrew Huberman:
安德鲁·休伯曼：
And I should mention here that patients are not always aware of how they're interacting with their home environment.
我应该在这里提到，患者并不总是知道他们如何与家庭环境互动。
Some of these patterns are so deeply ingrained in people that they don't even realize that they're constantly turning to the left, or they don't even realize that they're only washing their hands on one side of the sink.
其中一些模式在人们心中根深蒂固，以至于他们甚至没有意识到自己在不断地向左转，或者甚至没有意识到自己只是在水槽的一侧洗手。
And so the clinician, by visiting the home, can start to interrogate a bit in a polite way, in a friendly, in a supportive way, as to, "Do you ever think about why you always flip the faucet to the left or flip the faucet to the right?" et cetera.
因此，临床医生通过拜访家庭，可以开始以礼貌、友好、支持的方式询问，“你有没有想过为什么你总是把水龙头向左转动或向右转动？”等等。
Andrew Huberman:
安德鲁·休伯曼：
Now, we all do a lot of things that are habitual.
现在，我们都做了很多习惯性的事情。
We all do things that are somewhat regular from day to day.
我们每天都会做一些有规律的事情。
In fact, I would invite you to ask yourself, do you always put your toothbrush in the same location?
事实上，我想请你问问自己，你总是把牙刷放在同一个位置吗？
Do you always cap the toothbrush before or after you use it?
您是否总是在使用牙刷之前或之后盖上盖子？
What sorts of things do you do?
你会做哪些事情？
Do you wipe the little threading on the toothpaste or not?
牙膏上的小线头你擦不擦？
I'm somebody, I confess that I have, well, I have about 3,500 pet peeves, but one of my pet peeves is toothpaste on the thread of the toothpaste.
我是个大人物，我承认我有，嗯，我有大约 3,500 个小烦恼，但我的小烦恼之一是牙膏线上的牙膏。
It really bothers me.
这真的很困扰我。
I don't know why.
我不知道为什么。
Almost as much as trying to wipe it off bothers me, which creates a certain challenge.
几乎和试图把它擦掉一样困扰着我，这给我带来了一定的挑战。
And if I talk about this any further, then I think I would qualify for obsessive-compulsive personality disorder.
如果我再进一步谈论这个，那么我想我就有资格患上强迫性人格障碍。
But I have to say I don't experience a ton of anxiety about it.
但我不得不说我并没有对此感到太多焦虑。
Andrew Huberman:
安德鲁·休伯曼：
It doesn't govern my life.
它不能主宰我的生活。
In fact, I realize that right now there are tubes of toothpaste that have toothpaste along the thread everywhere in the world.
事实上，我意识到现在世界各地都有一管牙膏，上面有牙膏。
It doesn't really bother me.
这并不真正困扰我。
I can still sit here and provide some information about OCD to you.
我仍然可以坐在这里为您提供一些关于强迫症的信息。
It's not intrusive, at least not to my awareness.
这并不具有侵扰性，至少在我看来是这样。
So by the home visit, the therapist can really start to explore through direct questioning, and can allow the patient to explore through direct questioning themselves, the things that they might be conscious of and the things that they might not be conscious of that would qualify for OCD.
因此，通过家访，治疗师可以真正开始通过直接提问进行探索，并可以让患者通过直接提问自己探索他们可能意识到的事情和他们可能没有意识到的事情，这些事情符合强迫症的条件。
Andrew Huberman:
安德鲁·休伯曼：
So I'd like to just briefly summarize the key elements of cognitive behavioral therapy and exposure therapy and how they can be combined with drug treatments that are very effective.
因此，我想简单总结一下认知行为疗法和暴露疗法的关键要素，以及它们如何与非常有效的药物治疗相结合。
Much of what I'm going to talk about next relates to the data and indeed the practice of an incredible research scientist and clinician.
接下来我要讨论的大部分内容都与数据以及一位令人难以置信的研究科学家和临床医生的实践有关。
So this is Helen Blair Simpson, or I should say Dr. Helen Blair Simpson, because she is indeed an MD, medical doctor, and a PhD research scientist at Columbia University School of Medicine, and one of the world's foremost experts, if not the expert — I would put her in a category of maybe just one to three people who are most knowledgeable about the mechanisms of OCD — is actively researching OCD in humans, trying to find new treatments, trying to unveil new mechanisms and expand on our current understanding, and who also treats OCD quite actively in her own clinic.
这是海伦·布莱尔·辛普森（Helen Blair Simpson），或者我应该说海伦·布莱尔·辛普森（Helen Blair Simpson）博士，因为她确实是哥伦比亚大学医学院的医学博士、医学博士和博士研究科学家，也是世界上最重要的专家之一，如果不是专家的话——我会把她归入对强迫症机制最了解的一到三个人的类别中——正在积极研究人类强迫症，试图找到新的治疗方法，试图揭示新的机制并扩展我们目前的理解，在她自己的诊所里也非常积极地治疗强迫症。
Dr. Simpson gave a beautiful presentation where she summarized some of the core elements of CBT and exposure therapy for the treatment of obsessive-compulsive disorders.
辛普森博士做了精彩的演讲，她总结了 CBT 和暴露疗法治疗强迫症的一些核心要素。
Andrew Huberman:
安德鲁·休伯曼：
She describes that the key procedures are exposures, of course, done in person and with the actual thing that evokes the obsessions and compulsions.
她描述说，关键的程序当然是曝光，是亲自完成的，并且是用能引起痴迷和强迫的实际事物进行的。
So this could be the sweaty towel as described earlier, or could be any number of different triggers done with the patient in real time.
因此，这可能是如前所述的出汗的毛巾，也可能是对患者实时执行的任意数量的不同触发器。
So, in vivo as we say.
所以，正如我们所说的体内。
And it could also be things that are imaginal, sitting somebody down in a chair in an office and saying, "Okay, I want you to imagine the thing that triggers the intrusive thought," or, "Let's just focus on the intrusive thought as it arises," and then to explore and expose the patient to their obsessions and compulsions that way, so it can be real or it can be imaginal.
也可能是想象中的事情，让某人坐在办公室的椅子上，说：“好吧，我想让你想象一下触发侵入性想法的事情，”或者，“让我们只关注侵入性想法出现的情况，”然后以这种方式探索并让患者暴露在他们的强迫观念和强迫行为中，这样它可以是真实的，也可以是想象的。
And the goal, of course, then is to gradually and progressively increase the level of anxiety, but then to intervene in so-called ritual prevention, to prevent the person from engaging in the compulsion.
当然，目标是逐渐增加焦虑程度，然后干预所谓的仪式预防，以防止人陷入强迫行为。
Andrew Huberman:
安德鲁·休伯曼：
The goals, again, I'm paraphrasing here, are to, as she states, "Disconfirm fears and challenge the beliefs about the obsessions and compulsions," so to intervene in the thoughts and the behaviors, "and to break the habit of ritualizing and avoiding." Now, how is this typically done?
正如她所说，我在这里再次解释的目标是“消除恐惧并挑战有关强迫症和强迫症的信念”，从而干预思想和行为，“并打破仪式化和回避的习惯。”现在，这通常是如何完成的？
What are the nuts and bolts of this procedure?
该程序的具体细节是什么？
Typically, this is done through two planning sessions, with the patient, so, describing to the patient what will happen and when it will happen and how long it will happen so they're not just thrown into this out of the blue, and then 15 exposure sessions done twice a week or more.
通常，这是通过与患者进行两次计划会议来完成的，因此，向患者描述将发生什么、何时发生以及将发生多长时间，这样他们就不会突然陷入这种情况，然后每周进行两次或更多 15 次暴露会议。
Andrew Huberman:
安德鲁·休伯曼：
So the one thing to really understand about cognitive behavioral therapy is that it can take some period of time, several or more weeks, as many as 10 or 12 weeks.
因此，要真正了解认知行为疗法的一件事是，它可能需要一段时间，几周或更长的时间，最多 10 或 12 周。
However, as you'll soon learn, many of the drug treatments that are effective in treating OCD either alone or in combination with behavioral therapies also can take 8, 10, 12 weeks or longer.
然而，您很快就会了解到，许多可有效治疗强迫症的药物治疗，无论是单独使用还是与行为疗法相结合，也可能需要 8、10、12 周或更长时间。
And many of those never work at all.
其中许多根本不起作用。
So, even though 10 to 12 weeks seems like a long period of time, it's actually pretty standard.
因此，尽管 10 到 12 周看起来很长，但实际上是相当标准的。
Andrew Huberman:
安德鲁·休伯曼：
If you'd like to see more complete description of the protocols for cognitive behavioral therapy and exposure therapy for OCD, I'll provide links to two papers: Kozak and Foa, F-O-A, which is published in 1997, which might seem like a long time ago, but nonetheless, the protocols are still very useful — and then the second paper is by that last author, Foa, et al., in 2012, and we'll provide links to both of those.
如果您想查看强迫症认知行为疗法和暴露疗法方案的更完整描述，我将提供两篇论文的链接：Kozak 和 Foa，F-O-A，发表于 1997 年，这似乎是很久以前的事了，但尽管如此，这些方案仍然非常有用，然后第二篇论文是最后一位作者 Foa 等人于 2012 年发表的，我们将提供这两篇论文的链接。
In addition, Dr. Blair Simpson and others have explored what are the best treatments for patients with OCD by comparing cognitive behavioral therapy alone; placebo, so essentially, no intervention or something that takes an equivalent amount of time but is not thought to be effective in treatment; as well as selective serotonin reuptake inhibitors.
此外，布莱尔·辛普森博士和其他人通过比较单独的认知行为疗法，探索了强迫症患者的最佳治疗方法；安慰剂，本质上是不进行干预或需要同等时间但不被认为对治疗有效的东西；以及选择性血清素再摄取抑制剂。
So what is an SSRI?
那么什么是SSRI？
An SSRI is a drug that prevents the reuptake of serotonin at the synapse.
SSRI 是一种防止突触重新摄取血清素的药物。
Andrew Huberman:
安德鲁·休伯曼：
What are synapses?
什么是突触？
They're the little spaces between neurons where neurons communicate with one another by vomiting little bits of chemical into the space, the synapse, and then those chemicals either evoke or suppress the electrical activity of the next neuron across the synapse.
它们是神经元之间的小空间，神经元通过向突触这一空间中吐出少量化学物质来相互交流，然后这些化学物质会引起或抑制突触上下一个神经元的电活动。
Andrew Huberman:
安德鲁·休伯曼：
And in this case, the neurotransmitter, the chemical that we're referring to, is serotonin, SSRI, selective serotonin reuptake inhibitors prevent the reuptake of the chemical that's left, in this case the serotonin that's left in the synapse after that, I called it vomiting to be dramatic, but it's not actually a vomiting — the extrusion of the chemical into the synapse, and as a consequence, there's more serotonin around, to have more of an effect over time.
在这种情况下，神经递质，我们指的化学物质，是血清素，SSRI，选择性血清素再摄取抑制剂可以防止残留的化学物质的再摄取，在这种情况下，在这种情况下，残留在突触中的血清素，我称之为戏剧性的呕吐，但这实际上不是呕吐 - 将化学物质挤出到突触中，因此，有更多周围的血清素，随着时间的推移会产生更大的效果。
The net effect being more serotonergic transmission, more serotonin overall — so not more serotonin being made, more serotonin being available for use.
最终的效果是更多的血清素能传递，更多的血清素——所以不是制造更多的血清素，而是更多的血清素可供使用。
That's what an SSRI does.
这就是 SSRI 的作用。
Andrew Huberman:
安德鲁·休伯曼：
So, they compared cognitive behavioral therapy, SSRIs.
因此，他们比较了认知行为疗法 SSRIs。
They also had the placebo group, and they had cognitive behavioral therapy plus the selective serotonin reuptake inhibitor.
他们还接受安慰剂组，并接受认知行为疗法和选择性血清素再摄取抑制剂。
This was a 12-week study done as described before, two times a week over the course of 12 weeks.
这是一项为期 12 周的研究，如前所述，在 12 周的过程中每周进行两次。
First of all, the most important thing, of course, the placebo did nothing.
首先，最重要的一点，当然，安慰剂没有任何作用。
It did not relieve the OCD to any significant degree.
它并没有在任何程度上缓解强迫症。
How did they know that?
他们是怎么知道的？
They gave them the Y-BOCS test that we talked about before, the Yale Brown test, with all those questions, of which I read a few.
他们给了他们我们之前讨论过的 Y-BOCS 测试，即耶鲁布朗测试，其中包含所有这些问题，我读了其中的一些问题。
So the OCD severity that one has to have on the Y-BOCS is measured in terms of an index that goes from eight all the way up to 28.
因此，Y-BOCS 上的强迫症严重程度是用从 8 一直到 28 的指数来衡量的。
That shouldn't mean anything.
那不应该意味着什么。
So, that number eight is kind of meaningless here.
所以，这个数字 8 在这里毫无意义。
It's in terms of an index that's only meaningful for the Y-BOCS, but if somebody has a threshold of 16 or higher, it means that they're still having somewhat debilitating symptoms or very debilitating symptoms.
这是一个仅对 Y-BOCS 有意义的指数，但如果某人的阈值为 16 或更高，则意味着他们仍然存在某种程度的衰弱症状或非常衰弱的症状。
Andrew Huberman:
安德鲁·休伯曼：
Placebo did not reduce the obsessions or compulsions to any significant degree.
安慰剂并没有在任何程度上减少强迫观念或强迫行为。
However, and I think quite excitingly, cognitive behavioral therapy had a dramatic effect in reducing the obsessions and compulsions, such that by four weeks, that score, that in this case ranged from eight to 28, dropped all the way from 25 down to about 11.
然而，我认为非常令人兴奋的是，认知行为疗法在减少强迫观念和强迫行为方面具有显着效果，因此到了四个星期，分数（在本例中为 8 到 28）从 25 一路下降到了 11 左右。
So it's a huge drop in the severity of the symptoms.
所以症状的严重程度大幅下降。
Now, what's really interesting is that when you look at the effects of SSRIs in the treatment of OCD symptoms, they had a significant effect in reducing the symptoms of OCD that showed up first at four weeks and then continued to eight weeks.
现在，真正有趣的是，当你观察 SSRIs 在治疗强迫症症状方面的效果时，你会发现它们对减轻强迫症症状有显着效果，这种症状首先在第四周出现，然后持续到八周。
In fact, there was a progressive and further reduction in OCD symptoms from the four-to-eight-week period.
事实上，从四到八周的时间里，强迫症症状逐渐进一步减轻。
Again, these are the people just taking the SSRI, and then, it sort of flattened out a little bit, such that by 12 weeks, there was still a significant reduction in OCD symptoms for people taking SSRIs, as compared to placebo.
同样，这些是刚刚服用 SSRI 的人，然后，情况有点趋于平缓，因此到 12 周时，与安慰剂相比，服用 SSRI 的人的强迫症症状仍然显着减轻。
Andrew Huberman:
安德鲁·休伯曼：
But the severity, their symptoms were still much greater than those receiving cognitive behavioral therapy alone.
但他们的症状的严重程度仍然比那些单独接受认知行为治疗的人要严重得多。
So, at least in this study, and I should tell you which study it is: This is Foa, Liebowitz, 2005, in the American Journal of Psychiatry.
所以，至少在这项研究中，我应该告诉你它是哪项研究：这是 Foa，Liebowitz，2005 年，发表在《美国精神病学杂志》上。
We'll also provide a link to this so you can peruse the data if you like.
我们还将提供一个链接，以便您可以根据需要仔细阅读这些数据。
But at least in this study, cognitive behavioral therapy was the most effective; selective serotonin reuptake inhibitors, less effective.
但至少在这项研究中，认知行为疗法是最有效的。选择性5-羟色胺再摄取抑制剂，效果较差。
So, what happens when you combine them?
那么，当你将它们结合起来时会发生什么？
Well, they explored that as well, and the combination of cognitive behavioral therapy and the SSRIs together did not lead to any further decrease in OCD symptoms.
好吧，他们也对此进行了探索，认知行为疗法和 SSRI 的结合并没有导致强迫症症状的进一步减轻。
This points to the idea that cognitive behavioral therapy is the most effective treatment.
这表明认知行为疗法是最有效的治疗方法。
And again, when I say cognitive behavioral therapy, now I'm still referring to cognitive behavioral/exposure therapy done in the way that I detailed before, twice a week for 12 weeks or more.
再说一次，当我说认知行为疗法时，我现在指的仍然是按照我之前详述的方式进行的认知行为/暴露疗法，每周两次，持续 12 周或更长时间。
Andrew Huberman:
安德鲁·休伯曼：
So, all of the data, at least in this study, point to the fact that cognitive behavioral therapy is really effective and the most effective.
所以，所有的数据，至少在这项研究中，都表明认知行为疗法确实有效并且是最有效的。
Does it alleviate OCD symptoms for everybody?
它可以减轻每个人的强迫症症状吗？
No. Is it very time consuming?
不是，很费时间吗？
Yes, twice a week for two sessions or more of 15 minutes, sometimes, in the office, plus there's homework, plus, in an ideal case, there are also home visits from the psychiatrist or psychologist.
是的，每周两次，每次两次或以上，每次 15 分钟，有时在办公室，再加上家庭作业，此外，在理想的情况下，还有精神科医生或心理学家的家访。
That's a lot of investment, a lot of time investment, to say nothing of the potential financial investment.
这是大量的投资，大量的时间投资，更不用说潜在的财务投资了。
Andrew Huberman:
安德鲁·休伯曼：
Now, Dr. Blair Simpson has given some beautiful talks where she describes these data and also emphasizes the fact that despite the demonstrated power of cognitive behavioral therapy for the treatment of OCD, most people are given drug treatments simply because of the availability of those drug treatments.
现在，布莱尔·辛普森博士做了一些精彩的演讲，她描述了这些数据，并强调了这样一个事实：尽管认知行为疗法在治疗强迫症方面已被证明具有功效，但大多数人接受药物治疗仅仅是因为这些药物治疗的可用性。
Now, when I say most people, I want to emphasize that I'm referring to most people who actually go seek treatment, because a really important thing to realize is that most people with OCD do not actually go seek evidence-based treatment.
现在，当我说大多数人时，我想强调的是，我指的是大多数真正去寻求治疗的人，因为要认识到的一个非常重要的事情是，大多数患有强迫症的人实际上并没有去寻求循证治疗。
Andrew Huberman:
安德鲁·休伯曼：
I want to repeat that.
我想重复一遍。
Most people with OCD do not seek evidence-based treatment, which is a tragic thing.
大多数患有强迫症的人不寻求循证治疗，这是一件悲惨的事情。
One of the motivations for doing this podcast episode is to try and encourage people who think they may have persistent obsessions and compulsions to seek treatment, but most people don't, for a variety of reasons we spelled out earlier — shame, et cetera.
做这个播客节目的动机之一是尝试鼓励那些认为自己可能有持续的强迫症和强迫症的人寻求治疗，但大多数人没有这样做，因为我们之前阐述过多种原因——羞耻等等。
Of those that do, the first line of attack is typically a prescription, most often an SSRI, although not always just SSRIs, because soon we'll talk about the somewhat common use of also prescribing a low dose of a neuroleptic or an antipsychotic, not always, but often.
在那些这样做的人中，第一线攻击通常是处方，最常见的是 SSRI，尽管并不总是只是 SSRI，因为很快我们将讨论开低剂量抗精神病药或抗精神病药的常见用法，虽然不总是，但经常。
So the important thing to understand here is that excellent researchers like Dr. Simpson understand that while there are treatments that we could say are best or are ideal based on the data, that doesn't necessarily mean that's what's being deployed most often in the general public.
因此，这里需要理解的重要一点是，像辛普森博士这样的优秀研究人员明白，虽然根据数据我们可以说有些治疗方法是最好的或理想的，但这并不一定意味着这就是公众最常采用的治疗方法。
Andrew Huberman:
安德鲁·休伯曼：
As a consequence, Dr. Simpson and others have explored in a very practical way whether or not it matters if somebody is getting SSRI treatment and is experiencing that reduction in OCD symptoms that, as you may recall, is more than what they would experience with placebo alone, but not as dramatic a reduction in OCD symptoms as they would get with cognitive behavioral therapy.
因此，辛普森博士和其他人以一种非常实用的方式探讨了是否有人接受 SSRI 治疗并且正在经历强迫症症状的减轻是否重要，正如你可能还记得的那样，这种减轻比他们单独使用安慰剂所经历的要多，但强迫症症状的减轻不像认知行为疗法那样显着。
And as I mentioned before, there was this exploration of combining drug treatment with cognitive behavioral therapy from the outset, but they also, quite impressively, explored what happens when people who are already taking SSRIs initiate cognitive behavioral therapy.
正如我之前提到的，从一开始就有将药物治疗与认知行为疗法相结合的探索，但令人印象深刻的是，他们还探索了当已经服用 SSRI 的人开始认知行为疗法时会发生什么。
This is a really wonderful thing that they've done this because in doing that, first of all, they're acknowledging that there are many people out there who have sought treatment and are getting some relief from those SSRIs, but it perhaps is not as much relief as they could get, and they are actively acknowledging that many people are getting these drug treatments first.
他们这样做真是一件了不起的事情，因为这样做，首先，他们承认有很多人寻求治疗，并从 SSRI 中得到了一些缓解，但这可能并没有他们所能得到的那么多，而且他们积极承认许多人正在首先接受这些药物治疗。
Andrew Huberman:
安德鲁·休伯曼：
In fact, most often people are getting these drug treatments first.
事实上，大多数情况下人们首先接受这些药物治疗。
So what happens when you add in cognitive behavioral therapy?
那么当你加入认知行为疗法时会发生什么？
Well, the good news is when you add cognitive behavioral therapy to someone who's already taking SSRIs, that further improves their symptoms.
好消息是，当您对已经服用 SSRI 的人进行认知行为治疗时，可以进一步改善他们的症状。
Now, that's different than the results that I described before, from the same laboratory, in fact, that if you combine cognitive behavioral therapy with SSRIs from the outset, there's no additional benefit of SSRI.
现在，这与我之前描述的结果不同，来自同一个实验室，事实上，如果你从一开始就将认知行为疗法与 SSRI 结合起来，那么 SSRI 就不会带来额外的好处。
Andrew Huberman:
安德鲁·休伯曼：
However, as I just described, if someone is already taking an SSRI and they're experiencing a reduction in their OCD symptoms, by adding in cognitive behavioral therapy, there is a further reduction in the symptoms of OCD.
然而，正如我刚才所描述的，如果有人已经在服用 SSRI，并且他们的强迫症症状有所减轻，那么通过添加认知行为疗法，强迫症症状会进一步减轻。
So it's very important.
所以这非常重要。
So for those of you that have sought treatment and you're taking a SSRI, or if you're thinking about treatment and you're prescribed an SSRI, the ideal scenario really would be to combine the drug treatment with cognitive behavioral therapy or, in some cases, maybe cognitive behavioral therapy alone.
因此，对于那些已经寻求治疗并且正在服用 SSRI 的人，或者如果您正在考虑治疗并且开了 SSRI 处方，理想的情况实际上是将药物治疗与认知行为疗法相结合，或者在某些情况下，可能单独使用认知行为疗法。
Although that's a decision that you really have to make with the close advice and oversight of a licensed physician, because, of course, these are prescription drugs, and anytime you're going to add or remove a prescription drug or change dosage, you really want to do that in close discussion with and on the advice of your physician.
尽管您确实必须在有执照的医生的密切建议和监督下做出决定，但因为当然，这些都是处方药，无论何时您要添加或删除处方药或改变剂量，您都需要与医生密切讨论并根据医生的建议进行。
I don't just say that to protect me, I say that to protect you and because it's just the right thing to do.
我这么说不仅是为了保护我自己，也是为了保护你，因为这是正确的做法。
Andrew Huberman:
安德鲁·休伯曼：
So again, cognitive behavioral therapy is extremely powerful.
再说一遍，认知行为疗法非常强大。
Drug treatments seem less powerful, though if you're already on a drug treatment, adding cognitive behavioral therapy can really help.
药物治疗似乎不太有效，但如果您已经在接受药物治疗，那么添加认知行为疗法确实会有帮助。
So I've been talking about SSRIs and I described a little bit about how they work at a kind of superficial level of keeping more serotonin in the synapse, so that more serotonin can be in action, as opposed to gobbled back up by those neurons.
所以我一直在谈论 SSRI，并描述了它们如何在一种表面水平上发挥作用，即在突触中保留更多的血清素，以便更多的血清素可以发挥作用，而不是被这些神经元吞噬回来。
I should just mention what some of the selective serotonin reuptake inhibitors are.
我只想提一下一些选择性血清素再摄取抑制剂。
So things like clomipramine, which is not entirely selective.
像氯米帕明这样的东西，并不是完全有选择性的。
I should say that one generally falls into a category of less selective, so it can impair or can enhance some of the other neurotransmitter or neuromodulator systems like epinephrine, et cetera.
我应该说，它通常属于选择性较低的一类，因此它可能会损害或增强某些其他神经递质或神经调节系统，如肾上腺素等。
Andrew Huberman:
安德鲁·休伯曼：
The selective serotonin reuptake inhibitors are, at least the classic ones are, fluoxetine, Prozac; fluvoxamine, Luvox; paroxetine, sertraline, citalopram, et cetera, et cetera.
选择性血清素再摄取抑制剂是，至少经典的有氟西汀、百忧解；氟伏沙明、Luvox；帕罗西汀、舍曲林、西酞普兰等等。
There are about six classic SSRIs.
大约有六种经典的 SSRIs。
Some of them like citalopram, are used in children and are available in pediatric doses.
其中一些药物如西酞普兰，用于儿童，并有儿科剂量可供选择。
Some like Prozac may or may not be used in children.
有些药物（如百忧解）可能会也可能不会用于儿童。
The details of which SSRIs, et cetera, is a very extensive literature and discussion, and I think it's safe to say that which drugs to use and at which dosage and whether or not to continue the same dosage over time depends a lot on the individual variation that people express and the responses that they have.
关于哪种 SSRI 等的详细信息，有非常广泛的文献和讨论，我认为可以肯定地说，使用哪种药物、剂量以及是否随着时间的推移继续使用相同的剂量在很大程度上取决于人们表达的个体差异和他们的反应。
All of these drugs, in fact I think we can say all drugs, have side effects.
所有这些药物，事实上我认为我们可以说所有药物都有副作用。
The question is how detrimental those side effects are to daily life.
问题是这些副作用对日常生活有多大危害。
Andrew Huberman:
安德鲁·休伯曼：
The SSRIs are well known to have effects on appetite.
众所周知，SSRIs 会影响食欲。
In some cases, they abolish appetite.
在某些情况下，它们会消除食欲。
In some cases, they just reduce it a little bit.
在某些情况下，他们只是稍微减少一点。
In some cases, they increase appetite.
在某些情况下，它们会增加食欲。
Really, it's highly individual.
确实，这是非常个性化的。
They can have effects on libido, for instance.
例如，它们会对性欲产生影响。
They can reduce sex drive, sometimes in a dose-dependent way, sometimes in a way that's more like a step function, where people are fine at, say, five or 10 milligrams, but then they get to 15 milligrams and there's a cliff for their libido.
它们可以降低性欲，有时以剂量依赖的方式，有时以更像阶跃函数的方式，人们在5毫克或10毫克时就很好，但当他们达到15毫克时，他们的性欲就会出现悬崖。
That can happen.
这可能会发生。
It really depends.
这确实取决于。
Please don't take those dosages as exact values, because this is going to depend on what they're being used for, depression or anxiety or OCD.
请不要将这些剂量视为精确值，因为这将取决于它们的用途：抑郁症、焦虑症或强迫症。
And it's also going to depend on the drug, et cetera.
这也取决于药物等。
I just threw out those numbers as a way to illustrate what a kind of a step function would look like.
我只是抛出这些数字来说明阶跃函数是什么样子。
It's not gradual — it's immediate at a given dose, is what that means.
它不是渐进的——在给定的剂量下它是立即的，这就是这个意思。
Andrew Huberman:
安德鲁·休伯曼：
The other thing is that some of these drugs will have transient effects, so side effects that show up and then disappear.
另一件事是，其中一些药物会产生短暂的作用，因此副作用会出现然后消失。
Or sadly, people will sometimes take these drugs for a while, and then side effects will surface later that weren't there previously, depending on life factors, nutrition factors.
或者可悲的是，人们有时会服用这些药物一段时间，然后根据生活因素、营养因素，以前没有的副作用就会出现。
So it's a very complicated landscape overall and that's why it's really important to explore any kind of drug treatment, SSRI or otherwise, really in close communication with a psychiatrist who really understands the pharmacokinetics and has a lot of patient history and experience with them.
因此，总体而言，这是一个非常复杂的情况，这就是为什么探索任何类型的药物治疗（SSRI 或其他）非常重要，与真正了解药代动力学并拥有大量患者病史和经验的精神科医生密切沟通。
Andrew Huberman:
安德鲁·休伯曼：
So what I'm about to tell you next is most certainly going to come as a big surprise, which is that despite the fact that the selective serotonin reuptake inhibitors can be effective in reducing the symptoms of OCD, at least somewhat, and certainly more than placebo, there is very little if any evidence that the serotonin system is disrupted in OCD.
因此，我接下来要告诉您的内容肯定会令人大吃一惊，那就是，尽管选择性血清素再摄取抑制剂可以有效地减轻强迫症的症状，至少在一定程度上，而且肯定比安慰剂更有效，但几乎没有证据表明强迫症中的血清素系统受到破坏。
And I have to point out that this is a somewhat consistent theme in the field of psychiatry, that is, a given drug can be very effective or even partially effective in reducing symptoms or in changing the overall landscape of a psychiatric disorder or illness.
我必须指出，这是精神病学领域的一个有些一致的主题，即某种药物在减轻症状或改变精神障碍或疾病的整体情况方面可能非常有效，甚至部分有效。
And yet, there is very little, if any evidence that that particular system is what's causal for OCD or anxiety or depression, et cetera.
然而，几乎没有证据表明该特定系统是导致强迫症、焦虑或抑郁等疾病的原因。
Andrew Huberman:
安德鲁·休伯曼：
This is just the landscape that we're living in, in terms of our understanding of the brain and psychiatry and the ways of treating brain disorders.
就我们对大脑和精神病学的理解以及治疗大脑疾病的方法而言，这就是我们所生活的情况。
So as a consequence, there are a huge number of academic reviews that clinicians and research scientists have generated and read and share.
因此，临床医生和研究科学家生成、阅读和分享了大量学术评论。
One of the more, I think, thorough ones in recent years was published in 2021.
我认为，近年来比较全面的一篇已于 2021 年出版。
I'll provide a link to this.
我将提供一个链接。
This is by an excellent, truly excellent researcher from Yale University School of Medicine.
这是耶鲁大学医学院一位非常非常优秀的研究人员的成果。
I should say not just a researcher, but a clinician scientist, again an MD, PhD.
我应该说不仅仅是一名研究员，而且是一名临床科学家，同样是医学博士、博士。
This is Christopher Pittenger, and the title of the review is "Pharmacotherapeutic strategies and new targets in OCD." And again, we'll provide a link to it.
我是 Christopher Pittenger，这篇评论的标题是“强迫症的药物治疗策略和新目标”。我们将再次提供它的链接。
This is a just gorgeous review describing, as I just told you, that the serotonin system isn't really disrupted in OCD, and yet SSRIs can be very effective.
正如我刚才告诉你的，这是一篇精彩的评论，描述了强迫症中的血清素系统并没有真正受到破坏，但 SSRIs 却非常有效。
Andrew Huberman:
安德鲁·休伯曼：
The review goes on to explore even what sorts of receptors for serotonin might be involved if it's in fact the case that serotonin is a culprit in the creation of OCD symptoms.
该综述还进一步探讨了如果血清素确实是造成强迫症症状的罪魁祸首，那么哪些类型的血清素受体可能参与其中。
Talk about the serotonin 2A receptor and the serotonin 1A receptor.
谈论血清素 2A 受体和血清素 1A 受体。
Why am I mentioning all that detail, if in fact it's not clear serotonin is involved?
如果事实上还不清楚血清素是否参与其中，为什么我要提到所有这些细节呢？
Because, I'll just tell you right now, there is currently a lot of interest in whether or not some of the psychedelics, in particular psilocybin, can be effective in the treatment of OCD.
因为，我现在就告诉你，目前人们对某些迷幻药（特别是裸盖菇素）是否能有效治疗强迫症很感兴趣。
Psilocybin has been shown in various clinical trials, in particular the clinical trials done at Johns Hopkins School of Medicine by Matthew Johnson and others ...
裸盖菇素已在各种临床试验中得到证实，特别是由马修·约翰逊等人在约翰霍普金斯大学医学院进行的临床试验......
Matthew was on the Huberman Lab podcast.
马修是休伯曼实验室播客的主持人。
He's been on the Tim Ferris podcast.
他参加了蒂姆·费里斯播客。
He's been on the Lex Fridman podcast.
他一直在 Lex Fridman 播客上。
He's a world-class researcher on the use of psychedelics for depression and other psychiatric challenges.
他是一位世界级的研究人员，致力于使用迷幻药治疗抑郁症和其他精神疾病。
Andrew Huberman:
安德鲁·休伯曼：
And there, psilocybin treatment has been seen, at least in those trials, to be very effective in the treatment of certain kinds of major depression.
至少在这些试验中，裸盖菇素治疗对于治疗某些类型的重度抑郁症非常有效。
Currently, the exploration of psilocybin for the treatment of OCD has not yielded similar results, although the studies are ongoing.
目前，尽管研究仍在进行中，但裸盖菇素用于治疗强迫症的探索尚未取得类似的结果。
Again, has not yielded similar effectiveness, but the studies are ongoing and the serotonin 2A receptor and the serotonin 1A receptor are primary targets for the drug psilocybin.
同样，尚未产生类似的效果，但研究正在进行中，血清素 2A 受体和血清素 1A 受体是药物裸盖菇素的主要目标。
So I figured there were going to be some questions about whether or not psychedelics help with OCD.
所以我想会有一些关于迷幻药是否有助于治疗强迫症的问题。
Thus far it's inconclusive.
到目前为止还没有定论。
If any of you have been part of clinical trials or have knowledge or intuition about this relationship, or potential relationship, I should say, between psilocybin or other psychedelics and OCD, please put them in the comment section, we'd love to hear from you.
如果你们中的任何人参与过临床试验，或者对裸盖菇素或其他迷幻药与强迫症之间的这种关系或潜在关系有了解或直觉，请把它们放在评论部分，我们很乐意听取您的意见。
Andrew Huberman:
安德鲁·休伯曼：
One thing I should point out is that even though serotonin has not been directly implicated in OCD, serotonin and the general systems of serotonin, the circuits in the brain that carry serotonin and depend on it, have been shown to impact cognitive flexibility and inflexibility, which are kind of hallmark themes of OCD.
我应该指出的一件事是，尽管血清素与强迫症没有直接关系，但血清素和血清素的一般系统，大脑中携带血清素并依赖它的回路已被证明会影响认知灵活性和不灵活性，这是强迫症的标志性主题。
Andrew Huberman:
安德鲁·休伯曼：
So, in animals that have their serotonin depleted or in humans that have very low levels of serotonin, you can see evidence of cognitive inflexibility, challenges in task switching, challenges in switching the rules by which one performs a game, challenges in any kind of cognitive domain switching.
因此，在血清素耗尽的动物或血清素水平非常低的人类中，你可以看到认知不灵活的证据、任务转换的挑战、改变玩游戏规则的挑战、任何类型的认知领域转换的挑战。
And so that does indirectly implicate serotonin in some of the aspects of OCD.
因此，这确实间接表明血清素与强迫症的某些方面有关。
Again, when one starts to explore the different transmitter systems that have been explored in animal models and in humans, it's a vast, vast landscape.
同样，当人们开始探索在动物模型和人类中探索过的不同发射器系统时，这是一幅巨大的景观。
But serotonergic drugs do seem to be the most effective drugs in treating OCD, despite the fact, again, despite the fact that there's no direct evidence that serotonin systems are the problem in OCD.
但血清素药物似乎确实是治疗强迫症最有效的药物，尽管事实上没有直接证据表明血清素系统是强迫症的问题所在。
If you recall the cortico-striatal-thalamic loop that is so central to the etiology, the presence and the patterns of symptoms in OCD, of course serotonin is impacting that system.
如果您还记得皮质-纹状体-丘脑环路对于强迫症的病因、症状的存在和模式至关重要，那么血清素当然会影响该系统。
Andrew Huberman:
安德鲁·休伯曼：
Serotonin is impacting just about every system in the brain, but there's no evidence that tinkering with serotonin levels specifically in that network, is what's leading to the improvements in OCD.
血清素几乎影响大脑中的每个系统，但没有证据表明专门调整该网络中的血清素水平可以改善强迫症。
However, if people go into a fMRI scanner, and those people have OCD, and they evoke the obsessions and compulsions, you see activity in that cortico-striatal-thalamic loop.
然而，如果人们进入功能磁共振成像扫描仪，而这些人患有强迫症，他们会引起强迫症和强迫症，你会看到皮质-纹状体-丘脑环路的活动。
Treatments like SSRIs that reduce the symptoms of OCD equate to a situation where there is less activity in that loop.
诸如 SSRIs 之类减轻强迫症症状的治疗方法相当于该循环中活动减少的情况。
Andrew Huberman:
安德鲁·休伯曼：
And, I should point out, cognitive behavioral therapy, which we have no reason to believe only taps into the serotonin system.
而且，我应该指出，认知行为疗法，我们没有理由相信它只会利用血清素系统。
I think it would be extreme stretch.
我认为这将是极端的伸展。
It would be false actually to say that that cognitive behavioral therapy taps only into the serotonin system.
事实上，说认知行为疗法只利用血清素系统是错误的。
Clearly, it's going to affect a huge number of circuits and neurochemical systems.
显然，它将影响大量的回路和神经化学系统。
Well, people do cognitive behavioral therapy and find some relief for OCD.
嗯，人们进行认知行为疗法并找到了缓解强迫症的方法。
They also show reductions in those cortico-striatal-thalamic loops.
它们还显示出皮质-纹状体-丘脑环的减少。
Andrew Huberman:
安德鲁·休伯曼：
So, basically we have a situation where we have a behavioral therapy that works, in many people, not all, and we have a pretty good understanding of about why it works.
所以，基本上我们的情况是，我们的行为疗法对很多人有效，但不是对所有人有效，而且我们对它为什么有效有很好的理解。
It increases anxiety tolerance and interference with pattern execution.
它增加了焦虑耐受力和对模式执行的干扰。
Getting people to not engage in the same sorts of behaviors that are detrimental to them.
让人们不要从事对他们有害的同类行为。
And we have drug treatments that work, at least to some degree, but we don't know how they work or where they work in the brain.
我们的药物治疗至少在某种程度上有效，但我们不知道它们是如何起作用的，也不知道它们在大脑中的哪个部位起作用。
One of the things that really unifies the behavioral treatments and the drug treatments is that they take some period of time.
行为治疗和药物治疗真正统一的原因之一是它们需要一段时间。
Some relief from symptoms seems to show up around four weeks and certainly by eight weeks for both cognitive behavioral therapy and the SSRIs.
对于认知行为疗法和 SSRIs 来说，症状似乎会在四个星期左右出现一些缓解，当然八周左右就会出现。
But it's really at the 10-to-12-week stage, when someone's been doing these twice-a-week cognitive behavioral sessions, where they've been taking an SSRI for 10 to 12 weeks, that the really significant reduction in OCD symptoms starts to really show up.
但真正到了 10 到 12 周的阶段，当有人每周进行两次认知行为课程，并服用 SSRI 药物 10 到 12 周时，强迫症症状的真正显着减轻才开始真正显现出来。
Andrew Huberman:
安德鲁·休伯曼：
Now up until now I've been talking about the fact that people are getting relief from these treatments, but sadly in the case of OCD, there is a significant population that simply does not respond to CBT or to SSRIs or to their combination, which is why psychiatrists also explore the combination of SSRIs and neuroleptics or drugs that tap into the so-called dopamine system or the glutamate system.
到目前为止，我一直在谈论这样一个事实：人们正在从这些治疗中得到缓解，但遗憾的是，就强迫症而言，有相当多的人群对 CBT 或 SSRI 或其组合根本没有反应，这就是为什么精神科医生也在探索 SSRI 与精神安定药或利用所谓的多巴胺系统或谷氨酸系统的药物的组合。
Andrew Huberman:
安德鲁·休伯曼：
These are other neurotransmitters and neuromodulators that impact different circuits in the brain.
这些是影响大脑不同回路的其他神经递质和神经调节剂。
And just to really remind you what neurotransmitters and neuromodulators do, because this is important to contextualize all this.
只是为了真正提醒您神经递质和神经调节剂的作用，因为这对于了解所有这些非常重要。
Neurotransmitters are typically involved in the rapid communication between neurons, and the two most common neurotransmitters for that are the neurotransmitter glutamate, which we say is excitatory, meaning when it's released into the synapse, it causes the next neuron to be more active or active.
神经递质通常参与神经元之间的快速通信，其中两种最常见的神经递质是神经递质谷氨酸，我们说它是兴奋性的，这意味着当它释放到突触时，它会导致下一个神经元更加活跃或活跃。
And GABA, which is a neurotransmitter that is inhibitory, meaning when it's released into the synapse, typically not always, but typically that GABA is going to encourage the next neuron to be less electrically active or even silence its activity.
GABA 是一种抑制性神经递质，这意味着当它被释放到突触时，通常并不总是如此，但通常 GABA 会鼓励下一个神经元减少电活动，甚至使其活动沉默。
Andrew Huberman:
安德鲁·休伯曼：
The neuromodulators, by contrast, so not neurotransmitters, but neuromodulators like dopamine, serotonin, epinephrine, and acetylcholine and others, operate a little bit differently.
相比之下，神经调节剂（不是神经递质，而是多巴胺、血清素、肾上腺素和乙酰胆碱等神经调节剂）的运作方式略有不同。
They tend to act a little bit more broadly.
他们的行为往往更广泛一些。
They can act within the synapse, but they can also change the general patterns of activity in the brain, making certain circuits more likely to be active and other circuits less likely to be active.
它们可以在突触内起作用，但它们也可以改变大脑中的一般活动模式，使某些回路更有可能活跃，而其他回路则不太可能活跃。
Andrew Huberman:
安德鲁·休伯曼：
So when we say dopamine does X or dopamine does Y, or serotonin does X or serotonin does Y, they don't really do one thing, they change the sort of overall tonality.
因此，当我们说多巴胺作用 X 或多巴胺作用 Y，或者血清素作用 X 或血清素作用 Y 时，它们实际上并没有做一件事，而是改变了整体音调。
They make it more likely or less likely that certain circuits will be active.
它们使某些电路更有可能或不太可能处于活动状态。
You can think of them as kind of activating playlists or genres of activity in the brain, rather than being involved in the specific communication, or specific songs, if you will, in this analogy, or discussions between particular neurons.
你可以将它们视为激活大脑中的播放列表或活动类型，而不是参与特定的通信或特定的歌曲（如果你愿意的话），在这个类比中，或特定神经元之间的讨论。
Andrew Huberman:
安德鲁·休伯曼：
So, when we hear that SSRIs increase serotonin and reduce the symptoms of OCD, or a neuroleptic reduces the amount of dopamine and makes people feel calmer, for instance, or can remove some stereotype, repetitive motor behavior, which they can either generate or reduce motor behavior, it turns out.
因此，当我们听说 SSRIs 可以增加血清素并减轻强迫症的症状，或者精神安定药可以减少多巴胺的量并使人们感到平静时，或者可以消除一些刻板印象、重复性运动行为（它们可以产生或减少运动行为），事实证明。
So when I say that, what I'm referring to is the fact that these neuromodulators are turning up the volume on certain circuits and turning down the volume on other circuits.
因此，当我这么说时，我指的是这些神经调节器正在调高某些电路的音量并调低其他电路的音量。
I say that because if you are going to explore drug treatments, again with a licensed physician, if you're going to explore drug-
我这么说是因为如果你要探索药物治疗，再次与有执照的医生一起，如果你要探索药物-
PART 2 OF 4 ENDS Andrew Huberman:
第 2 部分（共 4 部分）结束 Andrew Huberman：
...
...
again, with a licensed physician.
再次，由有执照的医生指导。
If you're going to explore drug treatments for OCD, and in particular, if you are not getting results from SSRIs, or you're not getting results from cognitive behavioral therapy, or the side-effect profiles of the drugs that you're taking for OCD are causing problems that you don't want to take them, well then it's important to understand that anytime you take one of these drugs, they're not acting specifically on the cortico-striatal-thalamic circuit.
如果您打算探索强迫症的药物治疗方法，特别是如果您没有从 SSRI 中获得结果，或者您没有从认知行为疗法中获得结果，或者您正在服用的治疗强迫症的药物的副作用导致您不想服用它们，那么重要的是要了解，无论何时您服用其中一种药物，它们都不会专门作用于皮质-纹状体-丘脑回路。
That would be wonderful.
那太好了。
That's the future of psychiatry.
这就是精神病学的未来。
But, as now, when you take a drug, it acts systemically, so it's impacting serotonin in your gut.
但是，就像现在一样，当您服用药物时，它会在全身发挥作用，因此会影响肠道中的血清素。
It's also impacting serotonin in other areas of the brain.
它还会影响大脑其他区域的血清素。
Hence, the effects on things like digestion or libido or any number of different things that serotonin is involved in.
因此，它会对消化、性欲或血清素参与的许多不同事物产生影响。
Andrew Huberman:
安德鲁·休伯曼：
Likewise, if you take a neuroleptic like haloperidol or something that reduces dopamine transmission, well then it's going to have some motor effects, because dopamine is involved in the generation of motor sequences and smooth limb movement.
同样，如果您服用氟哌啶醇等精神抑制药或减少多巴胺传递的药物，那么它将会产生一些运动效应，因为多巴胺参与运动序列的生成和平滑的肢体运动。
That's why people with Parkinson's who don't have much dopamine will get a resting tremor, have a hard time generating smooth movement.
这就是为什么没有太多多巴胺的帕金森病患者会出现静止性震颤，很难产生平稳的运动。
And so the side effects start to make sense, given the huge number of different neural circuits that these different neuromodulators are involved in.
因此，考虑到这些不同的神经调节剂涉及大量不同的神经回路，副作用开始变得有意义。
Andrew Huberman:
安德鲁·休伯曼：
I don't say that to be discouraging.
我这么说并不是为了令人沮丧。
I say that to encourage patients and careful systematic exploration of different drug treatments for OCD, always, again, with the careful and close guidance and oversight of a psychiatrist.
我这么说是为了鼓励患者在精神科医生的仔细、密切的指导和监督下，仔细系统地探索强迫症的不同药物治疗方法。
Because psychiatrists really understand which side-effect profiles make it likely that you can or cannot or will never, or maybe someday will be able to take a given drug at a given dose.
因为精神科医生真正了解哪些副作用使您可能可以或不能或永远不会，或者也许有一天能够以给定剂量服用给定药物。
They are the ones that really have that knowledge.
他们是真正拥有这些知识的人。
This is not the sort of thing that you want to cowboy and go try and figure out yourself.
这不是那种你想要牛仔并自己去尝试弄清楚的事情。
Andrew Huberman:
安德鲁·休伯曼：
Now, I also want to acknowledge that there are other forms of drug treatments.
现在，我还想承认还有其他形式的药物治疗。
We touched on psilocybin briefly, but there are other forms of drug treatments that have been explored for OCD.
我们简要介绍了裸盖菇素，但人们还探索了其他形式的强迫症药物治疗方法。
Earlier, we talked a little bit about cannabis.
早些时候，我们讨论了一些大麻。
Why would cannabis be a place of exploration at all?
为什么大麻会成为一个探索之地？
Well, first of all, a number of people try and self-medicate for OCD.
嗯，首先，许多人尝试对强迫症进行自我治疗。
There is some clinical evidence, I'm not talking about recreational use, I'm talking about clinical evidence that cannabis can reduce anxiety.
有一些临床证据，我不是在谈论娱乐用途，我在谈论大麻可以减少焦虑的临床证据。
Andrew Huberman:
安德鲁·休伯曼：
Now, earlier we were talking about not reducing anxiety, but learning anxiety tolerance in order to deal with and treat OCD in the context of cognitive behavioral therapies.
现在，早些时候我们谈论的不是减少焦虑，而是学习焦虑耐受力，以便在认知行为疗法的背景下处理和治疗强迫症。
That doesn't necessarily rule out cannabis as a candidate for the treatment of OCD.
这并不一定排除大麻作为治疗强迫症的候选药物。
And in fact, this has been explored.
事实上，这已经被探索过。
A study from Dr. Blair Simpson herself looked at this.
布莱尔·辛普森博士本人的一项研究对此进行了研究。
This was a fairly small-scale study.
这是一项相当小规模的研究。
So, first of all, I'll give you the title and, again, we'll provide a link.
因此，首先，我会给您标题，然后我们将再次提供一个链接。
This is entitled "Acute effects of cannabinoids on symptoms of obsessive-compulsive disorder: A human laboratory study."
该研究的标题是“大麻素对强迫症症状的急性影响：一项人类实验室研究”。
Andrew Huberman:
安德鲁·休伯曼：
Very briefly, this was 14 adults with OCD.
简而言之，这是 14 名患有强迫症的成年人。
They had prior experience with cannabis.
他们之前有吸食大麻的经验。
This was randomized, placebo-controlled.
这是随机、安慰剂对照的。
The cannabis was smoked.
大麻被吸了。
They had different varietals, as they're called.
正如它们的名字一样，它们有不同的品种。
They had had a placebo.
他们服用了安慰剂。
So this is basically a condition in which certain subjects consumed a cigarette that had 0% THC, others had 7% THC — other groups that is — or some had 0.4% CBD and THC.
因此，这基本上是一种情况，其中某些受试者消费了含有 0% THC 的香烟，其他受试者含有 7% THC（其他群体是），或者一些受试者含有 0.4% CBD 和 THC。
So they looked at CBD.
所以他们把目光投向了 CBD。
I know a lot of people out there are interested in CBD.
我知道很多人对 CBD 感兴趣。
This is one of the few studies I could find where they explored different percentages of THC and CBD in these cannabis or marijuana cigarettes, basically.
这是我能找到的为数不多的研究之一，他们基本上探索了这些大麻或大麻香烟中不同比例的 THC 和 CBD。
The total amount that they consumed, I believe, was 800 milligrams.
我相信他们消耗的总量是 800 毫克。
These, again, are not suggestions.
再次强调，这些并不是建议。
This is just simply reporting what's in this study.
这只是简单地报告本研究中的内容。
Andrew Huberman:
安德鲁·休伯曼：
Again, I'll provide a link.
再次，我将提供一个链接。
They looked at OCD symptoms ratings, they looked at cardiovascular effects.
他们研究了强迫症症状评级，研究了心血管影响。
They had a large number of different things that they explored.
他们探索了大量不同的事物。
And I should say this study was done in 2020, and it was the first placebo-controlled investigation of cannabis in adults with obsessive-compulsive disorder.
我应该说这项研究是在 2020 年完成的，这是第一个针对成人强迫症患者的安慰剂对照研究。
Pretty interesting.
很有趣。
And I'm just reading from their conclusions here.
我只是在这里阅读他们的结论。
The data suggests that smoked cannabis, whether containing primarily THC or CBD — remember, they looked at different concentrations of those — has little acute impact, meaning immediate impact, on OCD symptoms and yields smaller reductions in anxiety compared to placebo.
数据表明，吸食大麻，无论主要含有 THC 还是 CBD（请记住，他们研究了不同浓度的大麻），对强迫症症状几乎没有什么急性影响，即直接影响，并且与安慰剂相比，对焦虑的减轻程度较小。
So they did not see, when I say a positive effect, I mean an ameliorative effect, an effect in reducing symptoms of OCD, from cannabis or CBD.
因此，当我说积极效果时，他们没有看到大麻或 CBD 的改善效果，即减少强迫症症状的效果。
Which, it's unfortunate, I think it's unfortunate anytime a treatment doesn't work.
不幸的是，我认为任何时候治疗不起作用都是不幸的。
Andrew Huberman:
安德鲁·休伯曼：
But nonetheless, those are the data.
但尽管如此，这些都是数据。
I'm sure there are going to be other studies.
我确信还会有其他研究。
I'm sure there are also going to be people in the YouTube comments section saying that cannabis and CBD helps their OCD symptoms, at least I anticipate there probably will.
我确信 YouTube 评论部分也会有人说大麻和 CBD 可以帮助他们的强迫症症状，至少我预计可能会。
Almost everything I say here, somebody will contradict it with something from their experience, which I encourage, by the way.
几乎我在这里所说的一切，都会有人与他们的经验相矛盾，顺便说一句，我鼓励这样做。
I want to hear about your experience with certain things, even if it's not from randomized placebo-controlled studies.
我想听听您对某些事情的体验，即使它不是来自随机安慰剂对照研究。
I still find it very interesting to know what people are doing and what they're experiencing.
我仍然觉得了解人们在做什么以及他们正在经历什么非常有趣。
I think that's one of the better uses of social media comment sections is to be able to share some of that, not in an advice-giving way or prescriptive way, but simply as a way to share and encourage different types of exploration.
我认为社交媒体评论部分的更好用途之一是能够分享其中的一些内容，不是以提供建议或规定的方式，而只是作为分享和鼓励不同类型探索的一种方式。
Andrew Huberman:
安德鲁·休伯曼：
There are other sorts of drug treatments that are gaining popularity for OCD, at least in the research realm.
其他类型的强迫症药物治疗方法也越来越受欢迎，至少在研究领域是这样。
One treatment that is a legal, L-E-G-A-L, right?
一种合法的治疗方法，L-E-G-A-L，对吗？
— sometimes when I say legal, sometimes people think I say illegal — but that is legal, at least by prescription in the United States, is ketamine.
- 有时当我说合法时，有时人们认为我说非法 - 但这是合法的，至少在美国是合法的，这就是氯胺酮。
The actions of ketamine are somewhat complex, although we know, for instance, that ketamine acts on the glutamate system.
氯胺酮的作用有些复杂，尽管我们知道氯胺酮作用于谷氨酸系统。
It tends to disrupt the transmission or the relationship, I should say, between glutamate, not glutamine, not the amino acid,, but glutamate, the neurotransmitter, and the so-called NMDA, the N-methyl-D-aspartate receptor.
我应该说，它往往会破坏谷氨酸（不是谷氨酰胺，不是氨基酸，而是谷氨酸，神经递质）和所谓的 NMDA（N-甲基-D-天冬氨酸受体）之间的传递或关系。
Andrew Huberman:
安德鲁·休伯曼：
Which is a receptor that's very special in the nervous system because when glutamate binds to the NMDA receptor, it tends to offer the opportunity for that particular synapse to get stronger — so-called neuroplasticity.
这是一种在神经系统中非常特殊的受体，因为当谷氨酸与 NMDA 受体结合时，它往往会为该特定突触提供变得更强的机会，即所谓的神经可塑性。
And ketamine is, essentially, an antagonist, although it works through a complicated mechanism.
氯胺酮本质上是一种拮抗剂，尽管它通过复杂的机制发挥作用。
It tends to block that binding of glutamate to the NMDA receptor or the effectiveness of that.
它往往会阻断谷氨酸与 NMDA 受体的结合或其有效性。
Ketamine therapy is now being used quite extensively for the treatment of trauma and for depression.
氯胺酮疗法现在广泛用于治疗创伤和抑郁症。
It leads to a dissociative state — it's a so-called dissociative analgesic — and there are a variety of ways in which that happens.
它会导致一种解离状态——即所谓的解离性镇痛药——并且这种情况发生的方式有很多种。
Andrew Huberman:
安德鲁·休伯曼：
We did an episode on depression.
我们做了一个关于抑郁症的剧集。
We're going to do another entire episode all about ketamine, describing the networks that ketamine impacts, et cetera.
我们将制作另一整集关于氯胺酮的内容，描述氯胺酮影响的网络等等。
Ketamine therapies are being explored for OCD.
氯胺酮疗法正在探索治疗强迫症。
As of now, the data look somewhat promising, but there's still a lot more work that needs to be done.
截至目前，数据看起来有些乐观，但仍有很多工作需要完成。
My read of the data are that the more extensive clinical trials have not happened yet.
我对数据的解读是，更广泛的临床试验尚未发生。
The smaller studies that have happened reveal that some patients do get some relief from ketamine therapy for OCD, but there was nothing overwhelmingly pointing to the fact that ketamine is a magic bullet for OCD treatment.
已经进行的较小规模的研究表明，一些患者确实通过氯胺酮治疗强迫症得到了一些缓解，但没有任何证据表明氯胺酮是治疗强迫症的灵丹妙药。
Andrew Huberman:
安德鲁·休伯曼：
So cannabis, CBD, at least now, even though it's one smaller study, there's no real evidence that it can alleviate OCD symptoms.
所以大麻，CBD，至少现在，尽管这是一项规模较小的研究，但没有真正的证据表明它可以缓解强迫症症状。
If there are new studies published soon, I'll be sure to update you.
如果很快有新的研究发表，我一定会向您通报最新情况。
And if you see those studies, please send them to me.
如果您看到这些研究，请将其发送给我。
Ketamine therapy, the jury is still out.
氯胺酮治疗，目前尚无定论。
Psilocybin, the jury is still out.
裸盖菇素，目前还没有定论。
These are early days.
现在还处于早期阶段。
Andrew Huberman:
安德鲁·休伯曼：
Another treatment that's becoming somewhat common, or at least people are commonly excited about, is transcranial magnetic stimulation.
另一种越来越常见的治疗方法，或者至少人们普遍感到兴奋的方法是经颅磁刺激。
So this is the use of a magnetic coil, this is completely noninvasive, placed on one portion of the skull, and one can direct magnetic energy toward particular areas of the brain to either suppress, or nowadays you can also activate particular brain regions.
这就是磁线圈的使用，这是完全无创的，放置在头骨的一部分上，可以将磁能引导到大脑的特定区域以进行抑制，或者现在您也可以激活特定的大脑区域。
There are some interesting data showing that if TMS is applied to areas of the brain involved in the generation of motor action, so the so-called motor areas or supplementary motor areas as they're called, while people think about or have intrusive thoughts, we know that the TMS coil can interrupt the motor behaviors, the compulsive behaviors.
有一些有趣的数据表明，如果将TMS应用于大脑中涉及运动动作产生的区域，即所谓的运动区域或辅助运动区域，当人们思考或有侵入性想法时，我们知道TMS线圈可以中断运动行为，强迫行为。
And at least in a small cohort of studies and a small number of patients within those studies, this has been shown to be effective not just while the coil is on the head, of course, but act after the study has been performed or the treatment's been performed, in reducing OCD symptoms by disrupting the tendency for the compulsive behavior to be so automatic.
至少在一小群研究和这些研究中的少数患者中，这不仅在线圈戴在头上时有效，而且在研究或治疗完成后也能有效，通过破坏强迫行为的自动倾向来减少强迫症症状。
Andrew Huberman:
安德鲁·休伯曼：
One of the key features of obsessive-compulsive disorder is that, especially if it's been around for a while, the person's been dealing with it for a while, there isn't a pattern in which the person thinks, "Oh, I have this contamination fear," or, "I need symmetry," or, "I'm kind of obsessed to count to the number seven," and then they pause and they go, "Oh," and then they do it.
强迫症的一个关键特征是，特别是如果它已经存在了一段时间，这个人已经处理它有一段时间了，没有一种模式让这个人想，“哦，我有这种污染恐惧”，或者“我需要对称”，或者“我有点痴迷于数到数字七”，然后他们停下来，他们说“哦”，然后他们就这么做了。
No, typically there's a very close pairing of the obsession and the compulsion in time, so that somebody's walking down the street thinking 1, 2, 3, 4, 5, 6, 7; 1, 2, 3, 4, 5, 6, 7 .
不，通常情况下，痴迷和强迫在时间上是非常接近的配对，所以有人走在街上想着 1、2、3、4、5、6、7； 1, 2, 3, 4, 5, 6, 7 。
And then they're doing this in such rapid succession, because the obsessions are coming up so quickly, thoughts can be generated very quickly, and then they're generating the compulsions as a way to beat down or to try and suppress that anxiety, and then it comes right back up again, even stronger, as I described earlier.
然后他们会如此快速地连续这样做，因为痴迷来得如此之快，想法可以很快产生，然后他们产生强迫行为，作为击败或试图抑制焦虑的一种方式，然后它又回来了，甚至更强，正如我之前所描述的。
Andrew Huberman:
安德鲁·休伯曼：
So transcranial magnetic stimulation seems to intervene in these various fast processes.
因此，经颅磁刺激似乎干预了这些不同的快速过程。
Right now, I don't think it's fair to say that TMS is a magic bullet either.
现在，我认为说 TMS 是灵丹妙药也不公平。
I think there's a lot of excitement about TMS, and in particular, I really want to nail this point home, in particular, there's excitement about the combination of TMS with drug treatments or the combination of TMS with cognitive behavioral therapy.
我认为 TMS 有很多令人兴奋的地方，特别是，我真的很想强调这一点，尤其是 TMS 与药物治疗的结合或 TMS 与认知行为疗法的结合令人兴奋。
Andrew Huberman:
安德鲁·休伯曼：
And this is a really important point, not just for sake of discussion about obsessive-compulsive disorder, but also depression, ADHD, schizophrenia, any number of different psychiatric challenges and disorders in most cases are going to respond best to a combination of behavioral treatment that's ongoing that occurs in the laboratory and clinical setting, but also in the home setting, where there's homework, maybe even home visits.
这是非常重要的一点，不仅是为了讨论强迫症，而且抑郁症、注意力缺陷多动症、精神分裂症、任何数量的不同精神挑战和疾病在大多数情况下都将对实验室和临床环境中正在进行的行为治疗组合产生最佳反应，而且在家庭环境中，有家庭作业，甚至可能是家访。
Drug treatments, often, not always, are a terrific augment to those cognitive behavioral therapies or other behavioral therapies.
药物治疗通常（但并非总是）是对认知行为疗法或其他行为疗法的极大增强。
Andrew Huberman:
安德鲁·休伯曼：
And then, now we are living in the age of brain machine interface.
然后，现在我们生活在脑机接口时代。
You have companies like Neuralink that, I think it's fair to say, are going to enter the brain machine interface world first through the treatment of certain syndromes, movement syndromes or psychiatric syndromes, probably, before they start putting electrodes into the brain to stimulate enhanced memory or enhance cognition.
我认为公平地说，像 Neuralink 这样的公司将首先通过治疗某些综合症、运动综合症或精神综合症进入脑机接口世界，然后再开始将电极放入大脑中以刺激增强记忆或增强认知。
Who knows?
谁知道？
I don't know exactly what they're doing behind the walls of Neuralink.
我不知道他们到底在 Neuralink 的墙后面做什么。
But I have to imagine, in fact, I would wager, maybe not both arms, but I'll wager my left arm, that the first set of FDA-approved technologies to come out of companies like Neuralink are going to be those for the treatment of things like Parkinson's and movement disorders and cognitive disorders.
但我必须想象，事实上，我敢打赌，也许不是双臂，但我敢打赌我的左臂，像 Neuralink 这样的公司推出的第一套经 FDA 批准的技术将是用于治疗帕金森病、运动障碍和认知障碍等疾病的技术。
Rather than, shall we say, kind of recreational cognitive enhancement or things of that sort.
我们应该说，而不是一种娱乐性的认知增强或类似的事情。
Andrew Huberman:
安德鲁·休伯曼：
So transcranial magnetic stimulation is noninvasive, it doesn't involve going down below the skull, can have some effect.
所以经颅磁刺激是非侵入性的，它不涉及到颅骨以下，就能有一定的效果。
But most laboratories that I'm aware of at Stanford and elsewhere that are exploring TMS for things like OCD and other types of psychiatric challenges are using TMS in combination with drug therapies.
但据我所知，在斯坦福大学和其他地方，大多数正在探索 TMS 治疗强迫症和其他类型精神疾病的实验室都将 TMS 与药物疗法结合使用。
Are using, in some cases — for instance, a laboratory at Stanford, hope to get them on the podcast, a psychiatrist, Nolan Williams, is exploring TMS in combination with psychedelic therapies, not necessarily at the same time, but nonetheless combining them or exploring how they impact brain circuitry.
在某些情况下，例如斯坦福大学的一个实验室，精神科医生诺兰·威廉姆斯希望将它们纳入播客，正在探索 TMS 与迷幻疗法的结合，不一定是同时进行，但仍然将它们结合起来或探索它们如何影响大脑回路。
Andrew Huberman:
安德鲁·休伯曼：
So if you have OCD, should you run out and get TMS, or should you try ketamine therapy, of course with a licensed physician?
因此，如果您患有强迫症，您应该跑去接受 TMS，还是应该尝试氯胺酮疗法（当然是在有执照的医生的指导下进行）？
I think it's too early to say yes.
我认为现在说“是”还为时过早。
I think the answer is we need to wait and see.
我认为答案是我们需要拭目以待。
I think cognitive behavioral therapy, the SSRIs and some other drug treatments like neuroleptics combined with SSRIs and cognitive behavioral therapy are where the real bulk of the data are.
我认为认知行为疗法、SSRIs 和其他一些药物治疗（例如抗精神病药与 SSRIs 相结合）和认知行为疗法才是真正的大量数据所在。
Andrew Huberman:
安德鲁·休伯曼：
I want to make one additional point about cannabis CBD as it relates to obsessive-compulsive disorder.
关于大麻 CBD，我想补充一点，因为它与强迫症有关。
To me, it's not at all surprising that cannabis CBD did not improve symptoms of OCD.
对我来说，大麻 CBD 没有改善强迫症的症状一点也不奇怪。
Because in my discussion with Dr. Paul Conti a few weeks ago — and I should mention, Dr. Conti is indeed a medical doctor, psychiatrist — we were talking about cannabis in its various uses, because it does have some clinical applications.
因为在几周前我与保罗·康蒂博士的讨论中——我应该提一下，康蒂博士确实是一名医生、精神病学家——我们讨论了大麻的各种用途，因为它确实有一些临床应用。
And he mentioned that one of the main effects of cannabis is to tighten focus, and to enhance concentration on and thoughts about one particular thing.
他提到大麻的主要作用之一是加强注意力，并增强对某一特定事物的注意力和思考。
And in some cases, that can be clinically beneficial, and in other cases that can be clinically detrimental.
在某些情况下，这可能在临床上有益，而在其他情况下，这可能在临床上有害。
Andrew Huberman:
安德鲁·休伯曼：
If you accept the idea that cannabis increases focus, and you think about OCD and the networks involved, and you think about the anxiety and the relationship between the obsession and compulsion, well, then it shouldn't come as any surprise that cannabis did not improve the symptoms of OCD.
如果你接受大麻可以提高注意力的观点，并且考虑强迫症和所涉及的网络，并且考虑焦虑以及强迫症和强迫症之间的关系，那么大麻没有改善强迫症的症状就不足为奇了。
Because, if anything, it would increase focus on the obsessions and the compulsions.
因为，如果有什么不同的话，那就是它会增加人们对强迫观念和强迫行为的关注。
Andrew Huberman:
安德鲁·休伯曼：
Now, that's not what they observed.
现在，这不是他们观察到的。
They did not see an exacerbation, or a worsening, of the symptoms of OCD with cannabis, at least that's not my read of the data.
他们没有看到大麻导致强迫症症状恶化或恶化，至少我读到的数据不是这样。
But they did not see an improvement in OCD symptoms with cannabis or CBD.
但他们没有发现大麻或 CBD 可以改善强迫症症状。
And to me, that's not surprising, given that cannabis, CBD seems to increase focus.
对我来说，这并不奇怪，因为大麻、CBD 似乎增加了人们的关注度。
Andrew Huberman:
安德鲁·休伯曼：
Next, I'd like to talk about some of the research on and the roles of hormones in OCD, because it turns out to be a very interesting relationship there.
接下来，我想谈谈激素在强迫症中的一些研究和作用，因为事实证明这是一个非常有趣的关系。
But before I do, I want to point out something that I realize I probably should have said earlier, which is one of the key things for someone with OCD to come to understand if they're going to experience any relief of their symptoms, whether or not they're doing drug treatments or behavioral treatments or otherwise, is that thoughts are not as bad as actions, right?
但在我这样做之前，我想指出一些我意识到我可能应该早点说的事情，这是强迫症患者要了解的关键事情之一，他们是否会经历症状的缓解，无论他们是否正在接受药物治疗或行为治疗或其他治疗，思想并不像行动那么糟糕，对吗？
Andrew Huberman:
安德鲁·休伯曼：
Thoughts are not as bad as actions.
想法并不像行动那么糟糕。
One of the rules that people with OCD seem to adopt for themselves is that thoughts are really truly the equivalent of actions.
强迫症患者似乎为自己采纳的规则之一是，思想实际上等同于行动。
So they'll have an intrusive thought, and we haven't spent too much time on this today, but earlier I touched on the fact that some of the intrusive thoughts that people have in OCD are really disturbing.
所以他们会有侵入性想法，我们今天没有花太多时间在这方面，但早些时候我谈到了这样一个事实，即人们在强迫症中的一些侵入性想法确实令人不安。
They can be really gross, or at least gross to that person.
它们可能真的很恶心，或者至少对那个人来说很恶心。
They can evoke imagery that is toxic or infectious, or is highly sexualized in a way that is disturbing to them, can be very taboo.
他们可能会唤起有毒或传染性的意象，或者以一种令他们不安的方式高度性感化，可能是非常禁忌的。
Andrew Huberman:
安德鲁·休伯曼：
This is not uncommon when you start talking to people with OCD and you start pulling on the thread.
当你开始与患有强迫症的人交谈并开始拉扯话题时，这种情况并不少见。
Again, this would be a psychiatrist who was trained to ask the right questions and gain the comfort and trust of a patient, and they start to reveal that these thoughts are really intrusive and kind of disturbing, which is why they feel so compelled to try and suppress them with behaviors.
同样，这将是一位接受过培训的精神科医生，他接受过提出正确问题并获得患者安慰和信任的培训，他们开始揭示这些想法确实具有侵入性和令人不安，这就是为什么他们感到如此有必要尝试用行为来压制它们。
One of the powerful elements of treatment for OCD is to really support the patient and make them realize that thoughts are just thoughts and that everyone has disturbing thoughts, and that oftentimes those disturbing thoughts arise at the most inconvenient and sometimes what seems like the most inappropriate circumstances.
强迫症治疗的强大要素之一是真正支持患者，让他们认识到想法只是想法，每个人都有令人不安的想法，而这些令人不安的想法常常出现在最不方便的情况下，有时似乎是最不适当的情况下。
Andrew Huberman:
安德鲁·休伯曼：
And this relates to a whole larger discussion that we could have about what are thoughts and why do they surface?
这涉及到我们可以进行的一个更大的讨论，即什么是思想以及它们为什么会出现？
And how come when you stand at the edge of a bridge, even if you do not want to jump off, you think about jumping off?
为什么当你站在桥边时，即使你不想跳下去，你也会想到跳下去呢？
And this has to do with the fact that your nervous system, as a prediction machine, is oftentimes testing possibilities.
这与你的神经系统作为预测机器经常测试可能性有关。
And sometimes that testing goes way off into the Netherlands of the thought patterns and emotional patterns that we all have inside of us.
有时，这种测试会深入到我们内心的思维模式和情感模式。
The big difference between a thought and an action is that, of course, the nervous system is, in one case, not translating those patterns of thinking into motor sequences.
当然，思想和行动之间的巨大区别在于，在某种情况下，神经系统不会将这些思维模式转化为运动序列。
Andrew Huberman:
安德鲁·休伯曼：
That nerdy way of saying thoughts aren't actions, believe it or not, can be helpful for people if they really think about that and use it as an opportunity to realize that, first of all, they're not crazy.
不管你信不信，这种说思想不是行动的书呆子方式会对人们有所帮助，如果他们真的思考这一点，并利用它作为一个机会来认识到，首先，他们并不疯狂。
They're not thinking and feeling this stuff because they're bad or evil.
他们思考和感受这些东西并不是因为他们是坏的或邪恶的。
And, of course, sometimes this can cross over with other elements of life where we place moral judgment on people for certain behaviors.
当然，有时这可能会与生活中的其他因素交叉，我们会对人们的某些行为进行道德判断。
I think that's part of a healthy society.
我认为这是健康社会的一部分。
Of course, that's where we have laws and punishments, and rewards for that matter, for certain types of behaviors.
当然，这就是我们对某些类型的行为制定法律、惩罚和奖励的地方。
But this idea that thoughts are not as bad as actions, and that thoughts can be tolerated and the anxiety around thoughts can be tolerated and over time can diminish, that's a very powerful hallmark theme of the treatment of OCD.
但这种想法并不像行为那么糟糕，而且想法是可以容忍的，围绕想法的焦虑是可以容忍的，并且随着时间的推移可以减少，这是强迫症治疗的一个非常有力的标志主题。
So I'd be remiss if I didn't mention it.
所以如果我不提这件事那就是我的失职。
Andrew Huberman:
安德鲁·休伯曼：
Thoughts are not actions.
思想不是行动。
Actions can harm us, they can harm other people.
行为可能会伤害我们，也可能伤害他人。
They can soak up enormous amounts of time.
他们会花费大量的时间。
Thoughts can soak up enormous amounts of time.
思想会占用大量的时间。
They can be very troubling, they can be very detrimental.
它们可能非常麻烦，也可能非常有害。
We, of course, want to be sensitive to that.
当然，我们希望对此保持敏感。
But when it really comes down to it, the first step in treatment for OCD is this realization, or the approach to the realization, that thoughts are not as bad as actions.
但归根结底，治疗强迫症的第一步是认识到，或者认识到想法并不像行动那么糟糕。
Andrew Huberman:
安德鲁·休伯曼：
So what about hormones in OCD?
那么强迫症中的激素又如何呢？
Well, this has been explored, albeit not as extensively as I would've liked to find.
嗯，这已经被探索过，尽管没有我希望的那么广泛。
But when I went into the literature, I found one particularly interesting study entitled "Neurosteroid levels in patients with obsessive-compulsive disorder," first author Erbay, and as always, we'll provide a link to this study.
但当我查阅文献时，我发现了一项特别有趣的研究，题为“强迫症患者的神经类固醇水平”，第一作者 Erbay，一如既往，我们将提供该研究的链接。
Andrew Huberman:
安德鲁·休伯曼：
The objective of this study was to explore serum within blood, neurosteroid levels in people with OCD.
本研究的目的是探讨强迫症患者血液中的血清、神经类固醇水平。
Why?
为什么？
Well, because of the relationship between OCD and anxiety, and the fact that in stress-related disorders such as anxiety and depression, the hormones have been extensively explored, but not so much in OCD, at least until this study.
嗯，由于强迫症和焦虑之间的关系，以及在焦虑和抑郁等与压力相关的疾病中，荷尔蒙已被广泛探索，但在强迫症中的作用还没有那么多，至少在这项研究之前是这样。
So they compared serum levels of a number of different hormones: progesterone, pregnenolone, DHEA, cortisol, and testosterone.
因此，他们比较了多种不同激素的血清水平：黄体酮、孕烯醇酮、DHEA、皮质醇和睾酮。
This was done in 30 patients with OCD and 30 healthy controls.
这项研究是在 30 名强迫症患者和 30 名健康对照者身上进行的。
So it's not a huge study, but it's enough to draw some pretty nice conclusions.
所以这不是一项大规模的研究，但足以得出一些相当不错的结论。
These subjects were 18 to 49 years old, and the controls were age- and sex-matched healthy volunteers.
这些受试者年龄在 18 至 49 岁之间，对照组是年龄和性别匹配的健康志愿者。
Again, no OCD.
再说一次，没有强迫症。
Andrew Huberman:
安德鲁·休伯曼：
What was the basic takeaway from the study?
这项研究的基本结论是什么？
The basic takeaway from the study was that in females with OCD, there was evidence for significantly elevated cortisol and DHEA.
该研究的基本结论是，有证据表明患有强迫症的女性皮质醇和 DHEA 显着升高。
Now, that's interesting because cortisol is well known to be associated with the stress system, although every day, I should mention, we all, male or female, everybody experiences an increase in cortisol shortly after awakening.
现在，这很有趣，因为众所周知，皮质醇与压力系统有关，尽管每天，我应该提到，我们所有人，无论男性还是女性，每个人在醒来后不久都会经历皮质醇的增加。
That's a healthy increase in cortisol.
这是皮质醇的健康增加。
Late-shifted, meaning late in the day peaks in cortisol, where a shift in that cortisol peak to later in the day is a known correlate of depression and anxiety disorders.
晚移，意味着皮质醇在一天中的晚些时候达到峰值，其中皮质醇峰值转移到一天中的晚些时候是已知的抑郁症和焦虑症的相关性。
Andrew Huberman:
安德鲁·休伯曼：
So the fact that cortisol is elevated and DHEA are elevated in female patients with OCD suggests that the cortisol is either reflective of or causal for the increase in anxiety.
因此，女性强迫症患者皮质醇和 DHEA 升高的事实表明，皮质醇要么反映了焦虑的增加，要么是焦虑增加的原因。
We don't know the direction of that effect.
我们不知道这种影响的方向。
Now, in male patients with OCD, there was evidence for increased cortisol.
现在，有证据表明，患有强迫症的男性患者皮质醇有所增加。
Again, not surprising given the role of anxiety and cortisol, or I should say given the role of cortisol in anxiety and the increasing anxiety seen in OCD, but there are also significant reductions in testosterone, which should also not surprise us, because cortisol and testosterone more or less compete in some fashion for their own production.
考虑到焦虑和皮质醇的作用，这并不奇怪，或者我应该说，考虑到皮质醇在焦虑中的作用以及强迫症中所见的日益增加的焦虑，但睾酮也显着减少，这也不应该让我们感到惊讶，因为皮质醇和睾酮或多或少以某种方式竞争它们自己的产生。
Both are derived from the molecule cholesterol, and there are certain biochemical pathways that can either direct that cholesterol molecule toward cortisol synthesis or testosterone synthesis, but not both.
两者都源自胆固醇分子，并且某些生化途径可以引导胆固醇分子合成皮质醇或合成睾酮，但不能同时合成两者。
So they compete.
所以他们竞争。
Andrew Huberman:
安德鲁·休伯曼：
So when cortisol goes up, in general, not always, but in general, testosterone goes down and vice versa.
因此，当皮质醇升高时，通常（并非总是）但总体而言，睾丸激素会下降，反之亦然。
If you want to learn more about the relationship between cortisol and testosterone, and there are even some tools to try and optimize those ratios in both males and females, you can find that in our episode on optimizing testosterone and estrogen.
如果您想更多地了解皮质醇和睾酮之间的关系，甚至有一些工具可以尝试优化男性和女性的比例，您可以在我们关于优化睾酮和雌激素的剧集中找到相关内容。
That's at hubermanlab.com.
这是在 hubermanlab.com 上。
Andrew Huberman:
安德鲁·休伯曼：
Now, I would say the most interesting aspect of this study is not that DHEA and cortisol are elevated in females with OCD, or that cortisol and testosterone have this opposite effect, cortisol up and testosterone down in males with OCD, but rather the relationship between all of those DHEA, cortisol, and testosterone, in terms of GABA.
现在，我想说，这项研究最有趣的方面不是 DHEA 和皮质醇在患有强迫症的女性中升高，或者皮质醇和睾酮具有相反的作用，即在患有强迫症的男性中皮质醇升高而睾酮降低，而是所有这些 DHEA、皮质醇和睾酮之间的关系（就 GABA 而言）。
GABA, again being this inhibitory neurotransmitter that tends to quiet certain neuronal pathways, it does different things at different synapses, but in general, the more GABA that's present, the more inhibition that's present, and therefore the more suppression of neural activity.
GABA 又是一种抑制性神经递质，倾向于使某些神经元通路安静下来，它在不同的突触处发挥不同的作用，但一般来说，存在的 GABA 越多，存在的抑制就越多，因此对神经活动的抑制也就越多。
Andrew Huberman:
安德鲁·休伯曼：
And DHEA is known to be a potent antagonist of the GABA system.
众所周知，DHEA 是 GABA 系统的有效拮抗剂。
Okay, so here we have elevated DHEA in females.
好的，我们这里女性的 DHEA 升高了。
And I should also mention that testosterone is also known to tap into the GABA system.
我还应该提到，众所周知，睾酮也可以利用 GABA 系统。
Typically, when testosterone is elevated, GABA transmission at least is slightly elevated.
通常，当睾酮升高时，GABA 传输至少会略有升高。
So here we have a situation in which the pattern of hormones in females and males with OCD are different from those in people without OCD, such that GABA transmission is altered, and the net effect would be an overall reduction in GABA.
因此，我们面临的情况是，患有强迫症的女性和男性的激素模式与没有强迫症的人不同，因此 GABA 的传输发生了改变，净效应将是 GABA 的总体减少。
Now, GABA as an inhibitory neurotransmitter, and broadly speaking, is associated with lower levels of anxiety, and it tends to create balance within various neural circuits.
现在，GABA 作为一种抑制性神经递质，从广义上讲，与较低水平的焦虑有关，并且它倾向于在各种神经回路内创造平衡。
Andrew Huberman:
安德鲁·休伯曼：
Now, that's a very broad statement, but we know, for instance in epilepsy, that GABA levels are reduced, and therefore you get runaway excitation of certain circuits in the brain, and therefore seizures, either petit mal, mini seizures; or grand mal, massive seizures; or even drop seizures where people completely collapse to the floor in seizure.
现在，这是一个非常广泛的说法，但我们知道，例如在癫痫症中，GABA 水平降低，因此大脑中的某些回路会失控兴奋，从而导致癫痫发作，无论是小发作还是小发作；或大发作，大规模癫痫发作；甚至放弃癫痫发作，使人们在癫痫发作时完全倒在地板上。
You may have seen this before.
您可能以前见过这个。
I certainly have.
我当然有。
It's very dramatic, and it actually is quite debilitating for people, because obviously they don't know when these seizures are coming on, most often, and then they can fall into a stove or while driving, et cetera.
这是非常戏剧性的，实际上对人们来说是相当虚弱的，因为显然他们不知道这些癫痫发作什么时候会发生，最常见的是，然后他们可能会掉进火炉里或开车时等等。
Andrew Huberman:
安德鲁·休伯曼：
So the situation with OCD is one in which, for whatever reason — we don't know the direction of effect — certain hormones are elevated in females and certain hormones are elevated in males, and those hormones differ between males and females.
因此，强迫症的情况是这样的，无论出于何种原因——我们不知道影响的方向——某些激素在女性中升高，而某些激素在男性中升高，并且这些激素在男性和女性之间是不同的。
And yet they both funnel into a system where GABAergic or GABA transmission in the brain is reduced, because of this ability for those particular hormones to be antagonists to GABA.
然而，它们都进入了一个系统，在该系统中，大脑中的 GABA 能或 GABA 传输减少，因为这些特定激素具有 GABA 拮抗剂的能力。
And as a consequence, there's likely to be overall levels of increased excitation in certain networks in the brain.
因此，大脑中某些网络的整体兴奋水平可能会增加。
Andrew Huberman:
安德鲁·休伯曼：
And that brings us back to this cortico-striatal-thalamic loop.
这让我们回到了皮质-纹状体-丘脑环路。
This repetitive loop that seems to reinforce, we can say reinforces, obsession, leads to anxiety, leads to compulsion, leads to transient relief of anxiety, but then increase in anxiety, increased obsession, anxiety, compulsion anxiety, compulsion, anxiety, compulsion, and so on and so forth.
这种看似强化的重复循环，我们可以说是强化、痴迷、导致焦虑、导致强迫、导致焦虑短暂缓解，但随后焦虑增加、痴迷增加、焦虑、强迫性焦虑、强迫、焦虑、强迫，等等。
So I have not found studies that have explored adjusting testosterone levels through exogenous administration, cream or injection or otherwise, or that have focused on reducing DHEA in females.
因此，我还没有发现研究通过外源性给药、乳膏或注射或其他方式来调整睾酮水平，或者专注于减少女性的 DHEA。
If anyone is aware of such studies, please put them in the comment section on YouTube or send them to us.
如果有人知道此类研究，请将其放在 YouTube 上的评论部分或发送给我们。
We have a contact site on the website at hubermanlab.com, but the comment section on YouTube would be best.
我们的网站上有一个联系网站 hubermanlab.com，但 YouTube 上的评论部分最好。
Andrew Huberman:
安德鲁·休伯曼：
But because we know that hormones impact neuromodulators and neurotransmitters, as I just described, and that those neuromodulators and neurotransmitters play an intimate role in the generation and the treatment of things like OCD, it stands to reason that manipulations of those hormone systems, however subtle or dramatic, might, I want to highlight might, prove useful in adjusting the symptoms of OCD.
但是，正如我刚才所描述的，因为我们知道激素会影响神经调节剂和神经递质，并且这些神经调节剂和神经递质在强迫症等疾病的产生和治疗中发挥着密切的作用，所以我想强调的是，对这些激素系统的操纵，无论是微妙的还是戏剧性的，都可能对调整强迫症的症状有用。
And I hope that this is an area that researchers are going to pursue in the very near future, because many of the treatments for reducing DHEA or increasing testosterone or reducing cortisol have already made it through FDA approval.
我希望这是研究人员在不久的将来要研究的一个领域，因为许多减少 DHEA 或增加睾酮或减少皮质醇的治疗方法已经通过 FDA 批准。
They're out there.
他们就在那里。
They're readily prescribed.
They're readily prescribed.
Many of them are already in generic form, which means that the patents have already lapsed on the first versions of those drugs.
其中许多药物已经是仿制药，这意味着这些药物的第一个版本的专利已经失效。
Andrew Huberman:
安德鲁·休伯曼：
So when they're available as generic drugs, very often they're available at significantly lower cost.
因此，当它们作为仿制药提供时，通常可以以低得多的成本获得。
There's a whole discussion to be had there about patent laws and prescription drugs.
那里有关于专利法和处方药的全面讨论。
But because these drugs are largely available in prescription, yet generic form, I think there's a great opportunity to explore how hormones, not just cortisol, testosterone, and DHEA, but the huge category of hormones might impact the symptoms of OCD.
但由于这些药物大部分都是处方药，但都是非专利药，我认为这是一个很好的机会来探索激素（不仅仅是皮质醇、睾酮和 DHEA）如何影响强迫症的症状。
Especially since many of the symptoms of OCD show up right around the time of puberty.
特别是因为强迫症的许多症状都是在青春期左右出现的。
Andrew Huberman:
安德鲁·休伯曼：
We haven't talked a lot about childhood OCD, because we're going to do an entire series on childhood psychiatric disorders and challenges.
我们没有过多谈论儿童强迫症，因为我们将制作一个关于儿童精神疾病和挑战的完整系列。
But many children develop OCD early, as young as three or four, believe it or not, or even six or seven and 10.
但不管你信不信，许多孩子很早就患上了强迫症，小到三四岁，甚至六七岁、十岁。
And in adolescence and certainly around puberty and in young adulthood, it is rare, although it does happen that people will develop OCD very late in life, around 40 or older, just kind of spontaneously.
在青春期，当然是青春期前后和成年早期，这种情况很少见，尽管人们确实会在生命的很晚的时候，大约 40 岁或以上，自发地患上强迫症。
Most often when you look at their clinical history, you find that either they were hiding it or it was being suppressed in some way, or if it does spontaneously show up late in life like mid-30s or in one's 40s, typically, there's a traumatic brain injury, could be due to stroke or physical injury to the head or something of that sort.
大多数情况下，当你查看他们的临床病史时，你会发现要么他们隐藏了它，要么它以某种方式被抑制，或者如果它确实在晚年（如 30 多岁或 40 多岁）自发出现，通常是脑外伤，可能是由于中风或头部物理损伤或类似原因造成的。
Andrew Huberman:
安德鲁·休伯曼：
Nonetheless, there is an interesting correlation between the onset of puberty and certain forms of OCD.
尽管如此，青春期的开始与某些形式的强迫症之间存在着有趣的相关性。
There's certain forms of, or I should say, there's certain aspects of menopause that can relate to OCD.
更年期的某些形式，或者我应该说，更年期的某些方面可能与强迫症有关。
You can find all these things in the literature.
You can find all these things in the literature.
All this to say that hormones impact neurotransmitters and neuromodulators, which clearly impact the kinds of circuits that are involved in OCD.
所有这些都表明，激素会影响神经递质和神经调节剂，这显然会影响与强迫症相关的回路类型。
And it makes sense that, and I would hope that, there would be an exploration of how these hormones impact OCD in the not-too-distant future.
这是有道理的，我希望在不久的将来能够探索这些激素如何影响强迫症。
Andrew Huberman:
安德鲁·休伯曼：
Now, there is an extensive literature exploring how testosterone therapy, both in males and females, can be effective in some cases in the treatment of anxiety-related disorders, but not, at least to my knowledge, in OCD in particular.
现在，有大量文献探讨睾酮疗法（无论是男性还是女性）如何在某些情况下有效治疗焦虑相关疾病，但至少据我所知，尤其是在强迫症方面。
So this whole area of the use of testosterone and estrogen therapies, DHEA, cortisol suppression or maybe even enhancement for the treatment of OCD is essentially a big black box that very soon, I believe, will be lit.
因此，使用睾酮和雌激素疗法、DHEA、皮质醇抑制甚至增强治疗强迫症的整个领域本质上是一个大黑匣子，我相信很快就会被点燃。
Andrew Huberman:
安德鲁·休伯曼：
I realize that a number of listeners of this podcast are probably interested in the nontypical or holistic treatments for OCD.
我意识到这个播客的许多听众可能对强迫症的非典型或整体治疗感兴趣。
Dr. Blair Simpson's lab has at least one study exploring the role of mindfulness meditation for the treatment of OCD.
布莱尔·辛普森博士的实验室至少有一项研究探索正念冥想在治疗强迫症中的作用。
There, the data are a little bit complicated.
There, the data are a little bit complicated.
And I should mention that good things are happening, at least in the United States, probably elsewhere as well, but good things are happening in terms of the exploration of things like meditation and other, let's call them nontraditional or holistic forms of treatment for psychiatric disorders, because of the division of complementary health that's now been launched by the National Institutes of Health.
我应该提到，至少在美国，也许在其他地方，好事正在发生，但在探索冥想和其他精神疾病的非传统或整体形式的治疗方面，好事正在发生，因为美国国立卫生研究院现在推出了补充健康部门。
So whereas before people would think about meditation or yoga nidra or even CBD supplementation, for that matter, as kind of fringe maybe, or kind of woo or nontraditional, at the very least.
因此，尽管之前人们会考虑冥想或瑜伽休息术，甚至 CBD 补充剂，但就这一点而言，至少可能是一种边缘，或者是一种求爱或非传统。
Andrew Huberman:
安德鲁·休伯曼：
The National Institutes of Health in the United States has now devoted an entire division, an entire institute, purely for the exploration of things like breathing practices, meditation, et cetera.
美国国立卫生研究院现在投入了整个部门、整个研究所，纯粹用于探索呼吸练习、冥想等事物。
So there's a cancer institute, there's a hearing and deafness institute, there's a vision institute, and now there's this complementary health institute, which I think is a wonderful addition to the more traditional aspects of medicine.
所以有一个癌症研究所，有一个听力和耳聋研究所，有一个视觉研究所，现在有一个补充健康研究所，我认为这是对医学更传统方面的一个很好的补充。
I think no possible useful treatment should be overlooked or unresearched, in my opinion, provided that can be done safely.
我认为，只要可以安全地进行，任何可能有用的治疗方法都不应该被忽视或不加以研究。
Andrew Huberman:
安德鲁·休伯曼：
And as I mentioned, Dr. Blair Simpson's lab has looked at the role of mindfulness meditation and the treatment of OCD.
正如我提到的，布莱尔·辛普森博士的实验室研究了正念冥想的作用和强迫症的治疗。
Now, we should all keep in mind, no pun intended, that most of the data on mindfulness meditation shows that it increases the ability to focus.
现在，我们都应该记住，没有双关语的意思，大多数有关正念冥想的数据表明它可以提高专注能力。
Now, this brings us back to a kind of repeating theme today, which is that increased focus may not be the best thing for somebody with OCD, because it might increase focus on the obsession and/or compulsion.
现在，这让我们回到今天重复的主题，即对于强迫症患者来说，增加注意力可能不是最好的事情，因为它可能会增加对强迫症和/或强迫症的关注。
Andrew Huberman:
安德鲁·休伯曼：
Turns out that mindfulness meditation can be useful in the treatment of OCD, but mainly by way of how it impacts the focus on and the ability to engage in cognitive behavioral therapies.
事实证明，正念冥想对于治疗强迫症很有用，但主要是通过它如何影响认知行为疗法的注意力和能力。
So it's very unlikely, at least by my read of the data, to be a direct effect of meditation on relieving the symptoms.
因此，至少从我读到的数据来看，冥想不太可能对缓解症状产生直接影响。
Rather, it seems that meditation is increasing focus on things like cognitive behavioral therapy homework, and to not focus on other things, and therefore indirectly improving the symptoms of OCD.
相反，冥想似乎正在增加对认知行为治疗作业等事情的关注，而不是关注其他事情，从而间接改善强迫症的症状。
Andrew Huberman:
安德鲁·休伯曼：
Now, somewhat surprisingly, at least to me, there have also been a fairly large number of studies exploring how nutraceuticals, as they're sometimes called, supplements that are available over the counter can impact the treatment of obsessive-compulsive disorder.
现在，有些令人惊讶的是，至少对我来说，还有相当多的研究探索非处方药保健品（有时被称为补充剂）如何影响强迫症的治疗。
Now, there's such an extensive number of different compounds and supplements that fall under the category of nutraceuticals and that have been explored in the treatment of OCD that I'd like to point you to a review that is entitled "Nutraceuticals in the treatment of obsessive-compulsive disorder: A review of mechanistic and clinical evidence."
现在，有大量不同的化合物和补充剂属于营养保健品类别，并且已在强迫症的治疗中进行了探索，因此我想向您推荐一篇题为“治疗强迫症的营养保健品：机制和临床证据的回顾”的评论。
Andrew Huberman:
安德鲁·休伯曼：
So it's published in 2011, so it's over 10 years old.
它是 2011 年出版的，距今已有 10 多年的历史了。
And so by now, I have to imagine that there are an enormous number of additional substances that could be explored.
所以到现在为止，我必须想象还有大量的其他物质可以探索。
But there are just one or two here that I want to focus on.
但这里我只想重点关注一两个。
Here in this review, they describe effects of 5-HTP and tryptophan, so things that are in the serotonin pathway.
在这篇综述中，他们描述了 5-HTP 和色氨酸的作用，以及血清素途径中的物质。
Which would make sense, given what we know about the SSRIs.
鉴于我们对 SSRI 的了解，这是有道理的。
That people would explore, how different supplements that increase-
人们会探索不同的补充剂如何增加-
PART 3 OF 4 ENDS Andrew Huberman:
第 3 部分（共 4 部分）结束 Andrew Huberman：
...
...
SSRIs.
SSRIs。
That people would explore how different supplements that increase serotonergic transmission might impact OCD.
人们将探索增加血清素传递的不同补充剂如何影响强迫症。
What you find is that they do have significant effects in improving or reducing the symptoms of OCD in somewhat a similar way to some of the SSRIs, but you, of course, have to be careful.
您会发现，它们确实对改善或减轻强迫症症状有显着效果，与某些 SSRI 类似，但您当然必须小心。
Anything that's going to tap into a given neurochemical system to the same degree may very likely have the same sorts of side effects that a prescription drug would.
任何以相同程度利用特定神经化学系统的东西很可能会产生与处方药相同的副作用。
Andrew Huberman:
安德鲁·休伯曼：
One compound that I'd like to focus on in a little more depth, however, because it's exciting and interesting to me, is inositol.
然而，我想更深入地关注一种化合物，因为它对我来说令人兴奋和有趣，它是肌醇。
Inositol is a compound that we are going to talk about in several future podcasts.
肌醇是一种化合物，我们将在未来的几个播客中讨论它。
Because, well first of all, it seems that it can have impressive effects on reducing anxiety.
因为，首先，它似乎对减少焦虑有令人印象深刻的效果。
It also can have pretty impressive effects in improving fertility, in particular in women with polycystic ovarian syndrome.
它还可以在提高生育能力方面产生相当显着的效果，特别是对于患有多囊卵巢综合症的女性。
Andrew Huberman:
安德鲁·休伯曼：
And here I'm referring specifically to myoinositol because it comes in several forms.
在这里我特指肌醇，因为它有多种形式。
And it does appear that 900 milligrams of inositol can improve sleep, and can reduce anxiety, perhaps, when taken at that dosage or higher dosages.
而且，以该剂量或更高剂量服用 900 毫克肌醇确实可以改善睡眠，并可能减少焦虑。
Andrew Huberman:
安德鲁·休伯曼：
I will just confess first of all, I don't have OCD, although I will also confess that when I was a child, I had a transient tick.
首先我要承认，我没有强迫症，尽管我也会承认，当我还是个孩子的时候，我有过短暂的蜱虫。
I've talked about this on a podcast before.
I've talked about this on a podcast before.
It was a grunting tick.
那是一只咕噜咕噜的蜱虫。
So when I was about six or seven, I recall a trip to Washington, D.C., with my family, where I was feeling a strong desire or need even, as I recall, to grunt in order to clear something in my throat, but I didn't have anything in my throat.
因此，当我大约六七岁的时候，我记得有一次和家人一起去华盛顿特区，在那里我感到强烈的愿望或需要，甚至据我所知，需要咕噜咕噜地清除喉咙里的东西，但我喉咙里没有任何东西。
I didn't have a cold, or any postnasal drip.
I didn't have a cold, or any postnasal drip.
It was really just the feeling that I needed to do that to release some sort of tension.
这真的只是一种感觉，我需要这样做来释放某种紧张。
Andrew Huberman:
安德鲁·休伯曼：
And I remember my dad at the time telling me, "Don't do that.
我记得我父亲当时告诉我：“不要这样做。
Don't do that.
不要那样做。
It's not good to grunt," or something like that.
It's not good to grunt," or something like that.
I think he saw that it was kind of compulsive behavior, and so I would actually hide in the backseat of the rental car and do it, or I'd hide in my room.
我想他看出这是一种强迫行为，所以我实际上会躲在出租汽车的后座上这样做，或者我会躲在我的房间里。
Fortunately for me, it was transient.
Fortunately for me, it was transient.
I think about six months or a year later, it disappeared.
我想大约六个月或一年后，它就消失了。
Although I did notice, actually an ex-girlfriend of mine pointed out that when I get very tired and I've been working very long hours, sometimes that grunting tick will reappear.
虽然我确实注意到了，但实际上我的一位前女友指出，当我很累并且工作时间很长时，有时那种咕噜声会再次出现。
Andrew Huberman:
安德鲁·休伯曼：
What does that mean?
这意味着什么？
Do I have Tourette's?
我有妥瑞氏症吗？
I don't know.
我不知道。
Maybe.
或许。
I was never diagnosed with Tourette's.
I was never diagnosed with Tourette's.
Do I have OCD?
我有强迫症吗？
Maybe.
或许。
I certainly could be accused of having obsessive-compulsive personality disorder, which we'll talk about still in a few minutes.
我当然可能会被指责患有强迫性人格障碍，几分钟后我们还会讨论这个问题。
But the point here is that many children transiently express ticks or low-level Tourette's or OCD, and again transiently, and it disappears over time.
但这里的要点是，许多儿童会短暂地表现出蜱虫或低水平的抽动秽语症或强迫症，并且再次短暂地出现，并且随着时间的推移而消失。
Andrew Huberman:
安德鲁·休伯曼：
So inositol has been explored in a bunch of different contexts, including for ticks and OCD, et cetera.
因此，肌醇已在许多不同的环境中进行了探索，包括用于蜱虫和强迫症等。
Going back to inositol and its current use, or I should say my current use, I've been taking 900 milligrams of inositol as an addition to my existing toolkit for sleep, which I've talked about many times on this podcast and other podcasts.
回到肌醇及其目前的用途，或者我应该说我目前的用途，我一直在服用 900 毫克肌醇，作为我现有的睡眠工具包的补充，我在这个播客和其他播客上多次谈到过这一点。
It consists of magnesium threonate, apigenin and theanine.
它由苏糖酸镁、芹菜素和茶氨酸组成。
If you want to know more about that kit, you can go to our newsletter, Neural Network Newsletter, at hubermanlab.com.
如果您想了解有关该套件的更多信息，可以访问我们的时事通讯《神经网络时事通讯》，网址为 hubermanlab.com。
The "Toolkit for Sleep" is there.
The "Toolkit for Sleep" is there.
You don't even have to sign up for the newsletter, but it'll give you a flavor of the sorts of things that are in the newsletter.
您甚至不必订阅时事通讯，但它会让您大致了解时事通讯中的各种内容。
Andrew Huberman:
安德鲁·休伯曼：
In any case, I've been experimenting a bit with taking 900 milligrams of myoinositol, either alone or a combination with that sleep kit.
无论如何，我一直在尝试服用 900 毫克肌醇，无论是单独服用还是与睡眠套件结合使用。
And I must say the sleep I've been getting on inositol is extremely deep and does seem to lead to enhanced levels of focus and alertness during the day.
我必须说，服用肌醇后我的睡眠非常深，似乎确实可以提高白天的注意力和警觉性。
Andrew Huberman:
安德鲁·休伯曼：
And perhaps you're noticing that, because I'm talking more quickly on this podcast than in previous podcast.
也许您已经注意到了这一点，因为我在这个播客上的讲话速度比之前的播客更快。
No, I'm just kidding.
不，我只是开玩笑。
I don't think the two things relate in any kind of causal way.
我认为这两件事没有任何因果关系。
Andrew Huberman:
安德鲁·休伯曼：
The point here is that inositol is known to be pretty effective in reducing anxiety, but when taken at very high dosages.
这里的要点是，众所周知，肌醇在减轻焦虑方面非常有效，但服用剂量非常高时。
Can it do the same at low dosages?
Can it do the same at low dosages?
We don't know.
我们不知道。
I would consider 900 milligrams a low dose given the fact that most of the studies of inositol have explored very high dosages, like even 10 or 12 grams per day, which I must say seems exceedingly high.
我认为 900 毫克是低剂量，因为大多数肌醇研究都探索了非常高的剂量，比如每天 10 或 12 克，我必须说这似乎非常高。
And they do report that some of the subjects in those experiments actually stop taking the inositol because of gastric discomfort, or gastric distress, as it's called.
他们确实报告说，这些实验中的一些受试者实际上因为胃部不适或所谓的胃部不适而停止服用肌醇。
Andrew Huberman:
安德鲁·休伯曼：
So I've reported my results with sleep in a kind of anecdotal way.
所以我以一种轶事的方式报告了我的睡眠结果。
They certainly aren't peer-reviewed studies that I described about my own experience in an anecdotal way.
它们当然不是我以轶事方式描述的关于我自己经历的同行评审研究。
But nonetheless, it's been explored that things like glycine, which is an amino acid, which also acts as an inhibitory neurotransmitter in the brain taken at very high dosages, 60 grams per day.
但尽管如此，人们已经探索过像甘氨酸这样的物质，它是一种氨基酸，也可以作为大脑中的抑制性神经递质，以非常高的剂量（每天 60 克）服用。
That is an absolutely astonishingly high amount of glycine.
这绝对是含量高得惊人的甘氨酸。
I would not recommend taking that much glycine unless you're part of a study where they tell you to and you know it's safe.
我不建议服用那么多甘氨酸，除非您参加了他们告诉您的研究并且您知道它是安全的。
Eighteen grams of inositol, these are very, very high dosages used in these studies.
十八克肌醇，这些研究中使用的剂量非常非常高。
Andrew Huberman:
安德鲁·休伯曼：
Nonetheless, there's some interesting data about inositol leading to some alleviation of OCD symptoms, or partial alleviation of OCD symptoms, in as little as two weeks after initiating the supplement protocol.
尽管如此，有一些有趣的数据表明，在开始补充方案后短短两周内，肌醇就可以在一定程度上缓解或部分缓解强迫症症状。
Andrew Huberman:
安德鲁·休伯曼：
So I think there's a great future for these nutraceuticals, meaning I think more systematic exploration, in particular lower dosages in the context of OCD treatment.
因此，我认为这些营养保健品有一个美好的未来，这意味着我认为需要进行更系统的探索，特别是在强迫症治疗中降低剂量。
Andrew Huberman:
安德鲁·休伯曼：
And as we saw before, for the SSRIs and other prescription drug treatments, I think there really needs to be an exploration of these nutraceuticals in combination with behavioral therapies.
正如我们之前所看到的，对于 SSRI 和其他处方药治疗，我认为确实需要对这些营养保健品与行为疗法相结合进行探索。
And who knows, maybe with brain machine interface like transcranial magnetic stimulation as well.
谁知道呢，也许还有像经颅磁刺激这样的脑机接口。
Andrew Huberman:
安德鲁·休伯曼：
Now, way back at the beginning of the episode, I alluded to the fact that OCD is one thing, obsessive-compulsive disorder, and it's truly a disorder, and it's truly debilitating, and it's extremely common.
现在，回到本集的开头，我提到了这样一个事实：强迫症是一回事，强迫症，它确实是一种疾病，它确实使人衰弱，而且非常常见。
And then there's this other thing called obsessive-compulsive personality disorder, which is distinct from that, does not have the intrusive component, so people don't feel overwhelmed or overtaken by these thoughts.
还有一种叫做强迫性人格障碍，它与此不同，没有侵入性的成分，所以人们不会感到被这些想法淹没或淹没。
Rather, they find that the obsessions can sometimes serve them, or they even welcome them.
相反，他们发现这些痴迷有时可以为他们服务，或者甚至欢迎他们。
And I think many of us know people like this.
我想我们很多人都认识这样的人。
I perhaps even could be accused, or who knows, maybe have been accused of having an obsessive-compulsive personality at times.
我什至可能会被指责，或者谁知道呢，也许有时会被指责有强迫症人格。
Andrew Huberman:
安德鲁·休伯曼：
Why do I draw this distinction?
Why do I draw this distinction?
Well, first of all, we've come to a point in human history, I think in large part because of social media, but also in large part because there are a number of discussions being held about mental health that have brought terms like trauma, depression, OCD, et cetera into the common vernacular so that people will say, "Ah, you're so OCD." Or someone will say, "I was traumatized by that." Or, "I was traumatized by this."
嗯，首先，我们已经走到了人类历史上的一个阶段，我认为这在很大程度上是因为社交媒体，但也有很大一部分原因是因为有许多关于心理健康的讨论，这些讨论将创伤、抑郁、强迫症等术语带入了普通话中，这样人们就会说，“啊，你真是强迫症。”或者有人会说：“我因此受到了创伤。”或者，“我因此受到了创伤。”
Andrew Huberman:
安德鲁·休伯曼：
We should be very careful.
我们应该非常小心。
I'm certainly not the word police, but we should be very careful in the use of certain types of language, especially language that has real psychiatric and psychological definitions, because it can really draw us off course in providing relief for some of these syndromes.
我当然不是“警察”这个词，但我们在使用某些类型的语言时应该非常小心，尤其是具有真正的精神病学和心理学定义的语言，因为它确实会让我们在缓解某些综合症时偏离正轨。
Andrew Huberman:
安德鲁·休伯曼：
For instance, the word trauma is thrown around left and right nowadays.
例如，如今“创伤”这个词被左右使用。
"I was traumatized by this." Or, "That caused trauma." "You're giving me trauma." Listen, I realize that many people are traumatized by certain events, including things that are said to them.
“我因此受到了创伤。”或者，“这造成了创伤。” “你给我带来了创伤。”听着，我意识到很多人都因某些事件而受到创伤，包括对他们所说的话。
I absolutely acknowledge that.
我绝对承认这一点。
Hence, our episodes on trauma and trauma treatment.
因此，我们讲述了创伤和创伤治疗的故事。
Several of them, in fact.
事实上，其中有几个。
Dr. Conti, Dr. David Spiegel, and then dedicated solo episodes with just me blabbing about trauma and trauma treatment.
康蒂博士、大卫·斯皮格尔博士，然后是专门的个人剧集，只有我在谈论创伤和创伤治疗。
Andrew Huberman:
安德鲁·休伯曼：
But as Dr. Conti so appropriately pointed out, trauma is really something that changes our neural circuitry, and therefore our thoughts and our behaviors, in a very persistent way that is detrimental to us.
但正如康迪博士恰当地指出的那样，创伤确实会改变我们的神经回路，从而改变我们的思想和行为，以一种非常持久的方式对我们有害。
Not every bad event is traumatizing.
并非所有的坏事件都会造成创伤。
Not everything that we dislike or even that we hate, or that feels terrible to us, is traumatizing.
并非所有我们不喜欢、甚至讨厌的事情，或者让我们感觉很糟糕的事情，都会造成创伤。
Andrew Huberman:
安德鲁·休伯曼：
For something to reach the level of trauma, it really needs to change our neural circuitry, and therefore our thoughts and our behaviors, in a persistent way that is maladaptive for us.
为了达到创伤的程度，它确实需要改变我们的神经回路，从而改变我们的思想和行为，以一种对我们来说不适应的持续方式。
Andrew Huberman:
安德鲁·休伯曼：
Similarly, just calling someone obsessive is one thing, saying that someone has OCD or assuming one has OCD, simply because they have a personality or a phenotype, as we say, where they need things in perfect order.
同样，仅仅称某人有强迫症是一回事，说某人患有强迫症或假设某人患有强迫症，仅仅是因为他们有一种性格或一种表型，正如我们所说，他们需要完美的秩序。
Like I find myself correcting these pens, making sure that the caps are facing in the same direction, for instance, right now.
就像我发现自己正在纠正这些笔，确保笔帽面向同一方向，例如，现在。
That is not the same as OCD.
这与强迫症不同。
Andrew Huberman:
安德鲁·休伯曼：
If, for instance, I can tolerate these pens being at different orientation, or even throw the cap on the floor or something, it doesn't create a lot of anxiety for me.
例如，如果我可以容忍这些笔处于不同的方向，甚至可以将笔帽扔在地板上或其他什么东西，这不会给我带来很多焦虑。
I confess it creates a little bit in the moment, then I can forget about it and move on.
我承认它在当下创造了一点点，然后我就可以忘记它并继续前进。
That's one of the key distinctions between obsessive-compulsive personality disorder and obsessive-compulsive disorder in its strictest form.
这是强迫性人格障碍和最严格形式的强迫症之间的关键区别之一。
Andrew Huberman:
安德鲁·休伯曼：
Now, once one hears that OCD is different than obsessive-compulsive personality disorder, because of this difference in how intrusive the thoughts are or not, then that's useful.
现在，一旦人们听说强迫症与强迫性人格障碍不同，因为思想的侵入性与否存在差异，那么这是有用的。
But it really doesn't tell us anything about what is happening mechanistically in one situation or another.
但它确实没有告诉我们在某种情况下机械地发生的事情。
Andrew Huberman:
安德鲁·休伯曼：
Fortunately, there are beautiful data, again, from Dr. Blair Simpson's lab, and you can tell, based on the number of studies that I've referred to from her laboratory, that she's truly one of the luminaries in this field, that there really are some fundamental wiring differences, and behavioral differences, and psychological differences between people who have obsessive-compulsive disorder and those who have obsessive-compulsive personality disorder.
幸运的是，布莱尔·辛普森博士的实验室再次提供了漂亮的数据，根据我从她的实验室引用的大量研究，你可以看出她确实是这个领域的杰出人物之一，强迫症患者和强迫性人格障碍患者之间确实存在一些基本的接线差异、行为差异和心理差异。
Andrew Huberman:
安德鲁·休伯曼：
So this is a study, first author, Pinto, P-I-N-T-O, entitled "Capacity to delay reward differentiates obsessive-compulsive disorder and obsessive-compulsive personality disorder." And the methods in this study were to take 25 people with OCD and 25 people with obsessive-compulsive personality disorder and 25 people who have both, because it is possible to have both, and that's important to point out, and 25 so-called healthy controls, people that don't have obsessive-compulsive personality disorder or obsessive-compulsive disorder.
这是一项研究，第一作者，Pinto，P-I-N-T-O，题为“延迟奖励的能力区分强迫症和强迫性人格障碍”。这项研究的方法是选取 25 名患有强迫症的人、25 名患有强迫性人格障碍的人以及 25 名两者都患有的人，因为两者都有可能，这一点很重要，需要指出的是，还有 25 名所谓的健康对照者，即没有强迫性人格障碍或强迫性障碍的人。
They take clinical assessments, and then they took a number of tests that probed their ability to defer gratification.
他们进行临床评估，然后进行一系列测试，探讨他们延迟满足的能力。
In the laboratory, we call it delay discounting, so their ability to defer gratification through a task where they can either accept reward right away or accept reward later.
在实验室中，我们称之为延迟折扣，即他们通过任务延迟满足的能力，他们可以立即接受奖励或稍后接受奖励。
Andrew Huberman:
安德鲁·休伯曼：
Some of you may have heard of the two marshmallow task.
你们中有些人可能听说过两个棉花糖任务。
This is based on a study that was performed years ago on young children at Stanford and elsewhere where they take young children into a room, they offer them a marshmallow.
这是基于多年前对斯坦福大学和其他地方的幼儿进行的一项研究，他们将幼儿带入一个房间，并给他们提供棉花糖。
Kids like marshmallows, generally.
一般来说，孩子们喜欢棉花糖。
And you say, "You can eat the marshmallow right now, or you can wait some period of time, and if you are able to wait and not eat the marshmallow, you can have two marshmallows." And in general, children want two marshmallows more than they want one marshmallow.
你说：“你现在可以吃棉花糖，或者你可以等一段时间，如果你能等而不吃棉花糖，你可以吃两个棉花糖。”一般来说，孩子们想要两块棉花糖比想要一块棉花糖更多。
Andrew Huberman:
安德鲁·休伯曼：
So really what you're probing is their ability to access delayed gratification.
所以你真正要探索的是他们获得延迟满足的能力。
And there are very entertaining, even truly amusing videos of this on the internet.
互联网上有一些非常有趣、甚至非常有趣的视频。
So if you just do "two marshmallow task video" and you go into YouTube, what you'll find is that the children will use all sorts of strategies to delay gratification.
因此，如果你只做“两个棉花糖任务视频”，然后你进入YouTube，你会发现孩子们会使用各种策略来延迟满足。
Andrew Huberman:
安德鲁·休伯曼：
Some of the kids will cover the marshmallow, others will talk to the marshmallow and say, "I know you're not that delicious.
有些孩子会盖住棉花糖，另一些孩子会对着棉花糖说：“我知道你没那么好吃。
You look delicious, but no, you're not delicious." They'll engage with the marshmallow in all sorts of cute ways.
你看起来很美味，但不，你并不好吃。”他们会以各种可爱的方式与棉花糖互动。
They'll turn around and try avoidance, which actually speaks to a whole category of behaviors that people with OCD also use.
他们会转身尝试回避，这实际上涉及强迫症患者也使用的一整类行为。
I'm not saying these kids had OCD, but avoidance behaviors are very much a component of OCD.
我并不是说这些孩子患有强迫症，但回避行为在很大程度上是强迫症的一个组成部分。
People really trying to avoid the thing that evokes the obsession.
人们确实试图避免引起痴迷的事物。
Andrew Huberman:
安德鲁·休伯曼：
Well, some kids are able to delay gratification, some aren't.
嗯，有些孩子能够延迟满足，有些则不能。
And it's debatable as to whether or not the kids that are able to delay gratification go on to have more successful lives or not.
至于那些能够延迟满足的孩子是否会继续拥有更成功的生活，这是有争议的。
Initially, that was the conclusion of those studies.
最初，这是这些研究的结论。
There's still a lot of debate about it.
对此仍有很多争论。
We'll bring an expert on to give us the final conclusion on this, because there is one, and it's very interesting and not intuitive.
我们将邀请一位专家来给我们最终的结论，因为有一个专家，而且它非常有趣而且不直观。
Andrew Huberman:
安德鲁·休伯曼：
Nonetheless, adults are also faced with decisions every day, all day, as to whether or not they can delay gratification.
尽管如此，成年人每天、整天都面临着是否可以延迟满足的决定。
And this study used not a two marshmallow task, but a game that involved rewards, where people could delay in order to get greater rewards later.
这项研究使用的不是两个棉花糖任务，而是一个涉及奖励的游戏，人们可以推迟以便稍后获得更大的奖励。
Andrew Huberman:
安德鲁·休伯曼：
What is the conclusion?
What is the conclusion?
Well, first of all, obsessive-compulsive and obsessive-compulsive personality disorder subjects both showed impairments in their psycho-social functioning and quality of life.
嗯，首先，强迫症和强迫性人格障碍受试者都表现出心理社会功能和生活质量的损害。
They had compulsive behavior.
他们有强迫行为。
So these are people that are suffering in their life because their compulsions are really strong.
这些人在生活中遭受痛苦，因为他们的强迫行为非常强烈。
Andrew Huberman:
安德鲁·休伯曼：
So it's not just being really nitpicky or really orderly in one case and having full-blown OCD in the other.
因此，这不仅仅是在一种情况下非常挑剔或非常有秩序，而在另一种情况下则具有全面的强迫症。
Both sets of subjects are challenged in life, because they're having relationship issues or job-related issues, et cetera because they are that compulsive.
这两类人在生活中都面临着挑战，因为他们有人际关系问题或工作相关问题，等等，因为他们有强迫性。
Andrew Huberman:
安德鲁·休伯曼：
However, the individuals with obsessive-compulsive personality disorder, they discounted the value of delayed gratification significantly less than those with obsessive-compulsive disorder.
然而，患有强迫性人格障碍的人，他们对延迟满足的价值的重视程度明显低于患有强迫症的人。
What do I mean?
我是什么意思？
They are both impairing disorders that are marked by compulsive behaviors.
它们都是以强迫行为为特征的损害性疾病。
Here, I'm paraphrasing, but they can be differentiated by the presence of obsessions in OCD.
在这里，我是在解释，但它们可以通过强迫症中强迫症的存在来区分。
Andrew Huberman:
安德鲁·休伯曼：
So obsessions in OCD.
So obsessions in OCD.
People with OCD are absolutely fixated on certain ideas, and those ideas are intrusive.
强迫症患者绝对执着于某些想法，而这些想法是侵入性的。
Again, that's the hallmark theme.
这又是标志性主题。
And by an excessive capacity to delay reward in obsessive-compulsive personality disorder.
以及强迫性人格障碍中过度延迟奖励的能力。
That is people who have obsessive-compulsive personality disorder are really good at delaying gratification.
那就是患有强迫性人格障碍的人确实很擅长延迟满足。
So they are able to concentrate very intensely and perform very intensely in ways that allow them to instill order, such that they can delay reward.
因此，他们能够高度集中注意力并以非常强烈的方式执行，从而使他们能够灌输秩序，从而可以延迟奖励。
Andrew Huberman:
安德鲁·休伯曼：
Now, you can see why this contour of symptoms, meaning that the people with OCD are experiencing intrusive thoughts, whereas the people with obsessive-compulsive personality disorder show an enhanced ability to defer gratification.
现在，您可以明白为什么出现这种症状轮廓了，这意味着患有强迫症的人正在经历侵入性想法，而患有强迫性人格障碍的人表现出推迟满足的能力增强。
Andrew Huberman:
安德鲁·休伯曼：
You could see how that would lead to very different outcomes.
你可以看到这将如何导致截然不同的结果。
People with obsessive-compulsive personality disorder can actually leverage that personality disorder to perform better in certain domains of life.
患有强迫性人格障碍的人实际上可以利用这种人格障碍在生活的某些领域表现得更好。
Not all domains of life, because remember, again, these people are in this study, and they're showing up as experiencing challenges in life because of their obsessive-compulsive personality disorder.
并非生活的所有领域，因为再次记住，这些人都在这项研究中，他们因为强迫性人格障碍而在生活中遇到挑战。
Andrew Huberman:
安德鲁·休伯曼：
Nonetheless, people with obsessive-compulsive personality disorder, you can imagine, would be very good at, say, architecture or anything that involves instilling a ton of order.
尽管如此，你可以想象，患有强迫性人格障碍的人会非常擅长建筑或任何涉及灌输大量秩序的事物。
Maybe sushi chef, for instance.
Maybe sushi chef, for instance.
Maybe a chef in general.
Maybe a chef in general.
I know chefs that just throw things around like the chef on the Muppets, and throw things everywhere and still produce amazing food.
我认识一些厨师，他们只是把东西扔得到处都是，就像布偶上的厨师一样，把东西扔得到处都是，但仍然能做出美味的食物。
And then there are some people that are incredibly exacting.
还有一些人极其严格。
They're just incredibly precise.
They're just incredibly precise.
I think that movie, what is it?
I think that movie, what is it?
"Jiro Dreams of Sushi," that movie's incredible.
"Jiro Dreams of Sushi," that movie's incredible.
Certainly not saying he has obsessive-compulsive personality disorder, but I think it's fair to say that he is obsessive, or extremely meticulous and orderly about everything from start to finish.
当然不是说他有强迫性人格障碍，但我觉得可以公平地说，他是一个强迫症，或者说对一切事情从头到尾都极其细致、有条理。
Andrew Huberman:
安德鲁·休伯曼：
You can imagine a huge array of different occupations and life endeavors where this would be beneficial.
您可以想象许多不同的职业和生活事业，这将是有益的。
Science being one of them, where data collection and analysis is exceedingly important that one be precise.
科学就是其中之一，数据收集和分析的准确性非常重要。
Or mathematics, or physics, or engineering.
Or mathematics, or physics, or engineering.
Anything where precision has a payoff, and gaining precision takes time and delay of immediate gratification, you can imagine that obsessive-compulsive personality disorder would synergize well with those sorts of activities and professions.
任何事情只要精确就会有回报，而获得精确需要时间和延迟即时满足，你可以想象强迫性人格障碍会与这些类型的活动和职业很好地协同作用。
Whereas, obsessive-compulsive disorder is really intrusive.
然而，强迫症确实具有侵入性。
It's preventing functionality in many different domains of life.
它阻碍了生活中许多不同领域的功能。
Andrew Huberman:
安德鲁·休伯曼：
So the key takeaway here is that when we use the words obsessive-compulsive, or we call someone obsessive-compulsive, or we are trying to evaluate whether or not we are obsessive-compulsive, it's very important that we highlight that obsessive-compulsive disorder is very intrusive.
所以这里的关键要点是，当我们使用强迫症这个词，或者我们称某人为强迫症，或者我们试图评估我们是否有强迫症时，强调强迫症是非常侵入性的，这一点非常重要。
It involves intrusive thoughts, and it interrupts with normal functioning in life.
它涉及侵入性想法，并且会干扰生活的正常功能。
Andrew Huberman:
安德鲁·休伯曼：
Whereas, obsessive-compulsive personality disorder, while it can interrupt normal functioning in life, it also can be productive.
然而，强迫性人格障碍虽然会扰乱生活中的正常功能，但也可能会产生生产力。
It can enhance functioning in life, not just in work, but perhaps at home as well.
它可以增强生活功能，不仅是在工作中，也许在家里也是如此。
If you are somebody, and you have family members that really place enormous value on having a beautiful and highly organized home, well, then it could lend itself well to that.
如果您是某人，并且您的家庭成员确实非常重视拥有一个美丽且井井有条的家，那么它非常适合这一点。
Andrew Huberman:
安德鲁·休伯曼：
It's going to be a matter of degrees, of course.
It's going to be a matter of degrees, of course.
None of these things is an absolute.
None of these things is an absolute.
It's going to be on a continuum.
It's going to be on a continuum.
But I think it is fair to say that obsessive-compulsive disorder, whether or not in mild, moderate, or severe form, is impairing normal functioning.
但我认为可以公平地说，强迫症，无论是轻度、中度还是重度，都会损害正常功能。
Whereas, obsessive-compulsive personality disorder, there's a range of expressions of that, some of which can be adaptive, some of which can be maladaptive.
然而，强迫性人格障碍有多种表现形式，其中一些可能是适应性的，其中一些可能是适应不良的。
And again, it's all going to depend on context.
And again, it's all going to depend on context.
Andrew Huberman:
安德鲁·休伯曼：
Before we conclude, I do want to touch on something that I think a lot of people experience, and that's superstitions.
在我们结束之前，我确实想谈一谈我认为很多人都经历过的事情，那就是迷信。
Superstitions are fascinating, and there's some fascinating research on superstitions.
迷信是令人着迷的，并且有一些关于迷信的令人着迷的研究。
Andrew Huberman:
安德鲁·休伯曼：
One particular study that I'm a big fan of is the work of Bence Ölveczky at Harvard.
我非常喜欢的一项特别研究是哈佛大学 Bence Ölveczky 的研究。
He studies motor sequences and motor learning.
He studies motor sequences and motor learning.
And he has beautiful data on how people learn, for instance, a tennis swing, and the patterns that they engage in early on, and then the patterns of swinging that they, swinging the racket that is, that they engage in later as they acquire more skill.
他有关于人们如何学习的漂亮数据，例如，网球挥杆，以及他们早期所采用的模式，以及他们在掌握更多技能后所采用的挥杆模式，即挥动球拍。
And basically, the takeaway is that the amount of error or variation from swing to swing is dramatically reduced as they acquire skill.
基本上，结论是，随着他们掌握技能，挥杆之间的误差或变化量会大大减少。
Andrew Huberman:
安德鲁·休伯曼：
That's all fine and good.
这一切都很好。
And there's some beautiful mechanistic data that he and others have discovered to support how that comes to be.
他和其他人发现了一些漂亮的机械数据来支持这一点。
But they also explore animal models, in particular rats pressing sequences of buttons and levers to obtain a reward.
但他们也探索动物模型，特别是老鼠按下一系列按钮和杠杆以获得奖励。
Believe it or not, rats are pretty smart.
Believe it or not, rats are pretty smart.
I've seen this with my own eyes.
I've seen this with my own eyes.
You can teach a rat to press a lever for a pellet of food.
你可以教老鼠按下杠杆来获取食物颗粒。
Rats can also learn to press levers in a particular sequence in order to gain a piece of food.
老鼠还可以学习按特定顺序按下杠杆以获得一块食物。
And they can actually learn to press an enormous number of levers in very particular sequences in order to obtain pellets of food.
他们实际上可以学会以非常特定的顺序按下大量的杠杆以获得食物颗粒。
You can also give them little buttons to press, or even a pedal to stomp on with their foot, in order to obtain a pellet of food.
您还可以给它们按小按钮，甚至用脚踩踏板，以获得食物颗粒。
Basically, rats can learn exactly what they need to do in order to obtain a piece of food, especially if they're made a little bit hungry first.
基本上，老鼠可以准确地了解它们需要做什么才能获得食物，特别是如果它们首先感到有点饿的话。
Andrew Huberman:
安德鲁·休伯曼：
Bence's lab has published beautiful data showing that as animals and humans come to learn a particular motor sequence, very often they will introduce motor patterns in that sequence that are irrelevant to the outcome and yet that persist.
本斯的实验室发布了漂亮的数据，表明当动物和人类开始学习特定的运动序列时，他们通常会在该序列中引入与结果无关的运动模式，但这种模式会持续存在。
Andrew Huberman:
安德鲁·休伯曼：
If you've ever watched a game of baseball, you've seen this before.
如果您看过棒球比赛，您以前就看过这个。
Oftentimes, the pitcher up on the mound will bring the ball to their chin.
通常，投手丘上的投手会将球传到下巴上。
They'll look over their shoulder, they'll look back over the other shoulder, and then they will, of course, reel back and pitch the ball.
他们会回头看，他们会回头看另一个肩膀，然后他们当然会后退并投球。
But if you watch closely, oftentimes there are components in the motor sequence which are completely unrelated to the pitch.
但如果你仔细观察，通常电机序列中存在与音调完全无关的组件。
They're not looking necessarily to see if someone's stealing a base.
他们不一定要看看是否有人在偷基地。
They're not necessarily looking down at home plate where the batter is.
他们不一定会低头看着击球手所在的本垒板。
They're also doing things like touching the back of their ear before they bring the ball to their chin, or adjusting their hat.
他们还会做一些事情，例如在将球带到下巴之前触摸耳朵后部，或者调整帽子。
And if you watch individual pitchers, what you'll find is that they'll do the same sequence of completely irrelevant motor patterns before each and every single pitch.
如果你观察各个投手，你会发现他们在每次投球之前都会做同样的一系列完全不相关的运动模式。
Andrew Huberman:
安德鲁·休伯曼：
Similarly, rats that have been trained to, for instance, hit two levers and step on a pedal with their left hind foot and then tap a button up above that is the red button, will do that to gain a piece of food.
同样，经过训练的老鼠，例如，敲击两个杠杆，用左后脚踩踏板，然后点击红色按钮上方的按钮，也会这样做以获得一块食物。
But sometimes they'll also introduce a pattern into that motor sequence, where they will shake their tail a little bit, or they'll turn their head a little bit, or they'll move their ears a little bit, et cetera.
但有时它们也会在该运动序列中引入一种模式，它们会稍微摇动尾巴，或者稍微转动头部，或者稍微移动耳朵，等等。
Motor patterns that have nothing to do with obtaining the particular outcome in mind.
与获得特定结果无关的运动模式。
Andrew Huberman:
安德鲁·休伯曼：
In other words, you could eliminate certain components of the motor sequence, and it would not matter.
换句话说，您可以消除电机序列的某些组件，但这并不重要。
The rat would still get the pellet, the pitcher would still be able to pitch.
老鼠仍然会得到球，投手仍然能够投球。
And yet they get introduced because somehow, because they were performed again and again prior to successful trials, the rat or the human baseball pitcher comes to believe in some way that it was involved in generating the outcome.
然而，它们之所以被引入，是因为不知何故，因为在成功的试验之前一次又一次地进行了实验，老鼠或人类棒球投手开始以某种方式相信它参与了结果的产生。
Hence, superstition.
Hence, superstition.
Andrew Huberman:
安德鲁·休伯曼：
I confess I have a few superstitions.
我承认我有一些迷信。
I occasionally will knock on wood.
我偶尔会敲木头。
I'll say something that I want to happen, and then I'll say, "Oh, knock on wood." And I'll just do it.
我会说一些我想要发生的事情，然后我会说，“哦，敲木头。” And I'll just do it.
And occasionally I'll challenge myself and think, "Ah, I don't want to knock.
有时我会挑战自己并想：“啊，我不想敲门。
Don't knock on wood, Andrew, don't do that."
别敲木头，安德鲁，别那样做。”
Andrew Huberman:
安德鲁·休伯曼：
I don't think anyone wants to be superstitious.
I don't think anyone wants to be superstitious.
I certainly don't.
我当然不这么认为。
And so every once in a while, I'll just challenge it, and I won't actually knock on wood.
所以每隔一段时间，我就会挑战一下，而不会真正敲木头。
I'm admitting this to you to just normalize some of this.
我向你承认这一点只是为了让其中一些正常化。
Andrew Huberman:
安德鲁·休伯曼：
Some people have superstitions that border on or even become compulsions.
有些人的迷信近乎甚至成为强迫症。
They really come to believe that if they don't knock on wood that something terrible is going to happen.
他们真的开始相信，如果他们不敲木头，就会发生可怕的事情。
Maybe something in particular.
Maybe something in particular.
Or in the case of the baseball pitcher, they come to believe that if they don't touch their right ear before they reel back on the pitch, that the pitch won't be any good, or that they're going to lose the game.
或者以棒球投手为例，他们开始相信，如果他们在回到球场上之前不触摸自己的右耳，那么球场将不会有任何好处，或者他们将输掉比赛。
I don't know what their thought process is.
I don't know what their thought process is.
Andrew Huberman:
安德鲁·休伯曼：
Now, I also don't know what the rat is thinking, but the rat is clearly doing something, or thinking something is related to the final outcome.
现在，我也不知道老鼠在想什么，但老鼠显然在做某事，或者在思考某事与最终结果有关。
I don't know of any studies where they've intervened with the particular superstition-like behaviors of the rat to see whether or not the rat somehow doesn't continue to do the motor sequence to get the pellet.
我不知道有任何研究对老鼠的特定迷信行为进行干预，以观察老鼠是否以某种方式不继续执行运动序列来获取颗粒。
We don't know the rats.
We don't know the rats.
I don't speak rat.
I don't speak rat.
Most people don't.
大多数人都没有。
Or if you speak to a rat, if it speaks back, it's not in English.
或者，如果你和一只老鼠说话，如果它回嘴，那也不是英语。
Andrew Huberman:
安德鲁·休伯曼：
Anyway, the point is that superstitions are beliefs that we, on an individual scale, come to believe are linked to the probability of an outcome, when in fact we know, we actually know in our rational minds they have no real relationship to the outcome.
不管怎样，关键是迷信是我们在个人层面上相信与结果的概率有关的信念，而事实上我们知道，我们实际上在理性思维中知道它们与结果没有真正的关系。
Superstitions can become full-blown compulsions and obsessions when we repeat them often enough that they become automatic.
当我们经常重复迷信以至于它们变得自动时，迷信就会变成全面的强迫症和痴迷。
Andrew Huberman:
安德鲁·休伯曼：
And I think this is what we observe most of the time when we see a pitcher touching their ear.
我认为这就是我们在看到投手触摸他们的耳朵时大多数时候观察到的情况。
Or, for instance, in tennis, you see this a lot.
或者，例如，在网球比赛中，你经常看到这种情况。
You'll see someone, they'll slap their shoes.
你会看到有人，他们会拍鞋。
Often, I see this.
Often, I see this.
They'll slap their undersides of their souls.
They'll slap their undersides of their souls.
They may tell themselves that this is, I don't know, maybe moving out some of the dust or something in the bottoms of their soles that gives them more traction, and they want that to be ready for the serve, or something like that.
他们可能会告诉自己，我不知道，这可能是为了清除鞋底底部的一些灰尘或其他东西，从而给他们带来更大的牵引力，他们希望为发球做好准备，或者类似的事情。
And maybe there's some truth to that.
也许这有一定道理。
Andrew Huberman:
安德鲁·休伯曼：
But here, what we're referring to are behaviors that really have no rational relationship to the outcome, and yet we perform in a compulsive way.
但在这里，我们指的是那些与结果确实没有理性关系的行为，但我们却以一种强迫性的方式行事。
People with OCD, yes, tend to have more superstitions.
是的，患有强迫症的人往往有更多的迷信。
People with more superstitions, yes, tend to have a tendency towards OCD.
是的，迷信较多的人往往有强迫症的倾向。
And I should mention obsessive-compulsive personality disorder.
我应该提到强迫性人格障碍。
Andrew Huberman:
安德鲁·休伯曼：
If you think way back to the first part of this episode when I was just describing what the brain does: What does your brain do?
如果你回想一下本集的第一部分，当时我刚刚描述了大脑的作用：你的大脑是做什么的？
Housekeeping functions to keep you alive.
管家的作用是让你活下去。
And it's a prediction machine.
它是一个预测机器。
Your neural circuits, you have an enormous amount of biological investment of real estate, literally cells and chemicals that are there to try and make your world predictable, and to try and give you control, or at least the sense of control over that world.
你的神经回路，你有大量的生物投资，实际上是细胞和化学物质，它们试图让你的世界变得可预测，并试图给你控制权，或者至少是对那个世界的控制感。
And that's a normal process.
这是一个正常的过程。
Andrew Huberman:
安德鲁·休伯曼：
Low-level superstitions, moderate superstitions, represent a kind of a healthy range, I would say, of behaviors that are aimed at generating predictability that don't disrupt normal function.
我想说，低度迷信、中等迷信代表了一种健康的行为范围，旨在产生不破坏正常功能的可预测性。
Obsessive-compulsive personality disorder, provided it is not too severe, would, I think, represent the next level along that continuum.
我认为，强迫性人格障碍，只要不是太严重，就代表了这个连续体的下一个层次。
Andrew Huberman:
安德鲁·休伯曼：
And then obsessive-compulsive disorder, as I pointed out earlier, is really a case of highly debilitating, highly intrusive, really overtake of neural circuitry over our thoughts and behaviors that requires very dedicated, very persistent, and very effective treatments in order to stop those obsessions and compulsions and the anxiety that links them, somewhat counterintuitively, by teaching people to tolerate that level of increased anxiety and interrupt those patterns.
然后，正如我之前指出的，强迫症实际上是一种高度衰弱、高度侵入性、真正超越我们思想和行为的神经回路的情况，需要非常专注、非常持久和非常有效的治疗，以阻止这些强迫症和强迫症以及将它们联系在一起的焦虑，这有点违反直觉，通过教导人们容忍这种程度的焦虑增加并中断这些模式。
Andrew Huberman:
安德鲁·休伯曼：
And fortunately, as we described earlier, such treatments exist.
幸运的是，正如我们之前所描述的，这种治疗方法是存在的。
Cognitive behavioral therapy, drug treatments like SSRIs, although also drug treatments that tap into the glutamate system, and into perhaps also the dopamine system, the so-called neuroleptics.
认知行为疗法、SSRIs 等药物治疗，以及利用谷氨酸系统和多巴胺系统的药物治疗，即所谓的精神安定药。
And then, as we described, there's now an extensive exploration of things like ketamine, psilocybin, cannabis.
然后，正如我们所描述的，现在对氯胺酮、裸盖菇素、大麻等物质进行了广泛的探索。
The initial studies don't seem to hold much promise for cannabis and CBD in the treatment of OCD, but who knows, maybe more studies will come along that will change that story.
最初的研究似乎并没有对大麻和 CBD 治疗强迫症有太大希望，但谁知道呢，也许更多的研究将会改变这个故事。
Andrew Huberman:
安德鲁·休伯曼：
And then, of course, brain machine interface like transcranial magnetic stimulation.
当然，还有像经颅磁刺激这样的脑机接口。
And then just to remind you what I already told you before, combinations of behavioral and drug treatments and brain machine interface — I think is really where the future lies.
然后提醒您我之前已经告诉过您的内容，行为治疗和药物治疗以及脑机接口的结合 - 我认为这确实是未来所在。
Andrew Huberman:
安德鲁·休伯曼：
Fortunately, good treatments exist.
幸运的是，存在良好的治疗方法。
We cannot say that any one individual treatment works for everybody.
我们不能说任何一种个体治疗方法对每个人都有效。
There are fairly large percentages of people that won't respond to one set of treatments or another, and therefore one has to try different ones.
有相当大比例的人对一种或另一种治疗方法没有反应，因此必须尝试不同的治疗方法。
And then there are the so-called supplementation-based, or more holistic, therapies.
还有所谓的基于补充剂的或更全面的疗法。
Andrew Huberman:
安德鲁·休伯曼：
Today, I've tried to cover each and all of these in a fairly substantial amount of detail.
今天，我试图相当详细地介绍所有这些内容。
I realize this is a fairly long episode.
我意识到这是一个相当长的剧集。
That is intentional.
那是故意的。
Much like our episode on ADHD, on attention deficit hyperactivity disorder, I received an enormous number of requests to talk about OCD, and my decision to make this a very long and detailed episode about OCD really doesn't stem from any desire to subject you to too much information or to avoid the opportunity to just list things off.
就像我们关于注意力缺陷多动障碍的剧集一样，我收到了大量谈论强迫症的请求，而我决定将这一集制作成一个关于强迫症的非常长而详细的剧集，实际上并不是出于让您接受太多信息或避免列出事情的机会。
But what I've tried to provide is an opportunity to really drill deep into the neural circuitry, and an understanding of where OCD comes from.
但我试图提供的是一个真正深入研究神经回路的机会，并了解强迫症从何而来。
How OCD is different from things like the personality disorders that I described.
强迫症与我描述的人格障碍有何不同。
And also to give you a sense of how the individual behavioral and drug treatments work, and perhaps don't work, so that you can really make the best-informed choices.
还可以让您了解个人行为和药物治疗如何发挥作用，以及如何不起作用，以便您能够真正做出最明智的选择。
Andrew Huberman:
安德鲁·休伯曼：
Again, highlighting the fact that OCD is an extremely common, extremely common, and yet extremely debilitating condition.
再次强调这样一个事实：强迫症是一种极其常见、极其常见但又极其令人衰弱的疾病。
And one that I hope that if any of you have, or that you know people that have it, that you'll both gain sympathy and understanding for what they're dealing with, perhaps as a consequence of some of the information presented today, and maybe help them direct their treatment, find better treatment, and, of course, apply those treatments for some relief.
我希望，如果你们中有人患有这种病，或者您认识患有这种病的人，你们都会对他们正在处理的事情获得同情和理解，也许是今天提供的一些信息的结果，也许可以帮助他们指导治疗，找到更好的治疗方法，当然，应用这些治疗方法来缓解症状。
Andrew Huberman:
安德鲁·休伯曼：
If you're learning from and/or enjoying this podcast, please subscribe to our YouTube channel.
如果您正在学习和/或喜欢此播客，请订阅我们的 YouTube 频道。
That's a terrific zero-cost way to support us.
这是支持我们的绝佳零成本方式。
In addition, please subscribe to the podcast on Spotify and Apple.
此外，请订阅 Spotify 和 Apple 上的播客。
And on both Spotify and Apple, you can also leave us up to a five-star review and give us feedback.
在 Spotify 和 Apple 上，您还可以给我们留下五星级评价并向我们提供反馈。
Andrew Huberman:
安德鲁·休伯曼：
The best place to give us written feedback, however, is on the YouTube channel within the comment section.
不过，向我们提供书面反馈的最佳地点是 YouTube 频道的评论部分。
There, you can leave us feedback or suggestions about topics you'd like us to cover or guests you'd like us to interview here on the Huberman Lab podcast.
在那里，您可以向我们留下有关您希望我们在 Huberman Lab 播客上报道的主题或您希望我们采访的嘉宾的反馈或建议。
Andrew Huberman:
安德鲁·休伯曼：
In addition, please check out the sponsors mentioned at the beginning of today's podcast.
另外，请查看今天播客开头提到的赞助商。
That's the best way to support us.
这是支持我们的最好方式。
Andrew Huberman:
安德鲁·休伯曼：
During today's podcast, and on many previous episodes of the Huberman Lab podcast, we talk about supplements.
在今天的播客以及 Huberman Lab 播客的许多先前剧集中，我们讨论了补充剂。
While supplements aren't necessary for everybody, many people derive tremendous benefit from them for things like sleep and focus and anxiety, and so on.
虽然补充剂并不是每个人都需要的，但许多人从它们中获得了巨大的益处，例如睡眠、注意力和焦虑等。
The Huberman Lab podcast is now partnered with Momentous supplements, because Momentous supplements are of the very highest quality.
Huberman Lab 播客现在与 Momentous 补充剂合作，因为 Momentous 补充剂具有最高的质量。
They ship everywhere in the world, not just in the U.S. And we wanted to have one location where people could go in order to access the supplements that we describe and detail the various roles of here on the Huberman Lab podcast.
它们销往世界各地，而不仅仅是在美国。我们希望有一个地方，人们可以去那里获取我们在 Huberman Lab 播客上描述并详细介绍了这里的各种角色的补充剂。
Andrew Huberman:
安德鲁·休伯曼：
If you go to livemomentous.com/huberman, you can find those supplements.
如果您访问 livemomentous.com/huberman，您可以找到这些补充品。
The catalog of supplements available there is going to be expanding quite a bit in the weeks and months to come, but right now, already there are a number of different supplements for enhancing focus, enhancing sleep and so on that are available.
那里提供的补充剂目录将在未来几周和几个月内大幅扩大，但现在已经有许多不同的补充剂可供选择，用于增强注意力、改善睡眠等。
Again, that's livemomentous.com/huberman.
再说一遍，这是 livemomentous.com/huberman。
Andrew Huberman:
安德鲁·休伯曼：
If you're not already following Huberman Lab on Instagram and Twitter, please do so.
如果您还没有在 Instagram 和 Twitter 上关注 Huberman Lab，请立即关注。
There, I cover science and science-related tools, some of which overlap with the content on the Huberman Lab podcast, and some of which is distinct from the content on the Huberman Lab podcast.
在那里，我介绍了科学和科学相关的工具，其中一些与 Huberman Lab 播客上的内容重叠，其中一些与 Huberman Lab 播客上的内容不同。
So again, that's Huberman Lab on Instagram and Huberman Lab, also on Twitter.
再说一遍，这是 Instagram 上的 Huberman Lab 和 Twitter 上的 Huberman Lab。
Andrew Huberman:
安德鲁·休伯曼：
If you haven't already subscribed to our Neural Network Newsletter, this is a monthly newsletter.
如果您还没有订阅我们的神经网络通讯，这是每月通讯。
It's completely zero cost.
完全是零成本。
You go to hubermanlab.com, you go into the menu, you click on "newsletter." You can see some example newsletters.
您访问 hubermanlab.com，进入菜单，单击“新闻通讯”。您可以查看一些新闻通讯示例。
For instance, a toolkit for sleep.
例如，睡眠工具包。
You can download that right away.
您可以立即下载。
You don't even have to sign up for the newsletter.
您甚至不必订阅时事通讯。
You can get the toolkit for neuroplasticity, for the use of cold, for the use of heat in health, et cetera.
您可以获得用于神经可塑性、冷的使用、健康中的热的使用等的工具包。
All of that's there, and if you sign up for the newsletter, you'll get the monthly newsletter sent to you.
所有这些都在那里，如果您订阅时事通讯，您将收到发送给您的每月时事通讯。
We don't share your email information with anybody, and we have a very clear privacy policy there.
我们不会与任何人分享您的电子邮件信息，并且我们有非常明确的隐私政策。
So again, it's the Neural Network Newsletter, available within the newsletter tab under the menu at hubermanlab.com.
再说一次，它是神经网络新闻通讯，可在 hubermanlab.com 菜单下的新闻通讯选项卡中找到。
Andrew Huberman:
安德鲁·休伯曼：
In closing, I'd like to thank you for this in-depth discussion about the mechanisms and various treatments for obsessive-compulsive disorder and some of the related disorders.
最后，我要感谢您对强迫症和一些相关疾病的机制和各种治疗方法的深入讨论。
And as always, thank you for your interest in science.
一如既往，感谢您对科学的兴趣。
PART 4 OF 4 ENDS
第 4 部分（共 4 部分）结束